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J'APPLICATION AND cERTIFICATE FOR PAYMENT A~,~ DOCUMENT G702 PAG[ ONE OF 3 ~.^~, <br /> <br /> PROJECT:Cabarru~ County Public.Health Center ARCHITECT:Grler-Pripp A~oclate", Inc. <br /> .(name, address) Concord, l~or~h Carolina <br /> &RCHITECT'S PROJECT NO: N.C. J486 <br /> <br /> TO {Owner) Ca'barru.- County CONTRACTOR: Harkey Con~tructi0n Cot, Inc. <br /> Concord, North carbllea <br /> CONTRACT EOR: General Con. truction <br /> APPLICATION DATE: Sept, 22,' '76 APPLICATION NO:l~J -..~.. <br /> A~N: PERIOD FROM~ep~, 1, 1976 TO Final <br /> Appli~tion is made for Payment, as shown below, in conn~tion with the Contract. <br /> CHANGE ORDER SUMMARY ' Confin~ ~h~t, AIA D~ment GT02A, is attached. <br /> ~nge O~der{ approv~ ADDITIONS $ DEDU~IONS $ <br /> in previous ~nth~ by . The print status of the account for this Contract is as follows: <br /> ~ner~ ~2~ [7~,00 <br /> TOTAL ORIGINAL CO~ SU~ ..................... S 318,200, O0 <br /> Jsub~uent C~geOrders <br /> Numar Approved N~t ch~ng~ ~ Ch~ng~ Ord~ .................. $- ~ s ~ [. 00 <br /> (daleJ <br /> CO~ SUM TO DA~ ....................... S 330,371.00 <br /> TOTAL CO~D · STOR~ TO DA~ .......... $ 33o, 37 L. co <br /> . (Column G on G702A) <br /> TOTA~ ~AINAG~ ' % ......................... <br /> Net c~n~e byChange Orde~ $ ~2 ~ [?[ ' 00 or as noted in Column I on GT0~ <br /> TOTAL ~RNED L~S R~AINAGE . ..S. 33o,371.oo <br /> s,,~, of: Co~n~ o,: 3 ~3,852.45 <br /> The undersigned Contractor certifies that the Work covered by this AppJi- LESS PR~OUS C~FICA~ ~R PAYME~ ........ <br /> calion Jot Paymen~ has been comp[et~ in accordance with Ihe Conu~cl <br /> D ...... I~, thai all ..... ts have bce~ paid by him Jor Work for which <br /> previous Certificates for Payment were issued and paymenll received from CURRENT PAYMENT DUE ......................... <br /> ~ebor and nrov~ion~ ,o~.~aLd con,trac~.. 27~h~ , Ceph ~76 <br /> WO have complied with all . = - '~mcdo~noswomlooem,ememls uaym. . .. <br /> y~ ' My Commission expl~d: gl ' <br /> ~ ,~ __Pres. Oa,e:oept 22~ 1976 April 21, 1979 ' <br /> <br /> <br />