Unimark EC3000 Series Especificaciones descargar pdf (Pagina 253)

To Owner: Date:

Period To/From:

RLI No.:

Project Name:

Work Authorization No.:

Project Manager:

Request for Payment No.:

NTP Date:

Vendor Code:

Contract For: P.O. NO.:

1) By: Date:

4) day of

5) Project Manager Certificate for Payment

( Columns D + E )

( Columns F ) AMOUNT CERTIFIED

6) -$

PROJECT MANAGER for BCAD

7) Less Previous Applications for Payment By:

(Line 6 from prior Certificate) Print Name: Date:

8) -$

DIRECTOR, AIRPORT DEVELOPMENT

9) -$ By:

(Line 3 less Line 6) Print Name: Date:

Deductions

OWNER: BROWARD COUNTY AVIATION DEPARTMENT, CONTRACT ADMINISTRATOR

By:

-$ Name: Date:

EXHIBIT K

APPLICATION AND CERTIFICATE FOR PAYMENT

Broward County Aviation Department

c/o Airport Development

100 Aviation Blvd.

Fort Lauderdale, Florida 33315

From Contractor:

CONTRACTOR'S APPLICATION FOR PAYMENT

Application is made for payment, as shown below, in

connection with the contract. Continuation Sheet -

Schedule of Values Form is attached.

The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief, the Work covered by this

Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the

Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current

payment shown herein is now due.

CONTRACTOR:

Original Contract Sum

Net change by Change Orders, Amendments

State of:

County of:

Contract Sum To Date (Line 1+2)

Subscribed and sworn to before

Notary Public:

Total Completed and Stored to Date

me this

My Commission Expires:

(Column G on Schedule of Values Form)

Retainage:

a) _____% of Completed Work

In accordance with the Contract Documents, based on on-site observations and the data comprising this Application, the Project

Manager certifies to the Owner that to the best of his knowledge, information and belief, the Work has progressed as indicated,

including all quantities, materials, work percentages completed, and the quality of the Work is in accordance with the Contract

Documents and the Contractor is entitled to payment of the AMOUNT CERTIFIED.

b) _____% of Stored Material

Total Retainage:

(Line 5a + 5b or Total in Column M)

(Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet (Schedule of

Values) that are changed to conform to the amount certified.)

Total Earned Less Retainage

(Lines 4 less Line 5 Total)

Current Payment Due

Balance to Finish, Including Retainage

The undersigned, after examination of the attached payment request, notes that: (1) The Project Manager's review has conformed to

established BCAD procedural standards, (2) that the Project Manager has received sufficient information and backup documentation

from the Contractor for analysis and his subsequent recommendation for payment, and (3) that such recommended payment amount

appears to be fair and reasonable.

Change Order, Amendments Summary

Additions

Total changes approved in previous months

by Owner.

Total approved this month

TOTALS

NET CHANGES by Change Order,

Amendments

This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and

acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.

Exhibit 3

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Unimark EC3000 Series Especificaciones Pagina 253

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