Casino reinvestment development authority bid for general construction
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- John F. Palmieri
- Attachment “A” Application for Payment (Or Equivalent Owner Approved AIA G702) NO. ________
- 8. DUE THIS APPLICATION (6 MINUS 7)
- Attachment “A” - Continued (Or Equivalent Owner Approved AIA G703) Invoice Summary
ACKNOWLEDGMENT AS TO CRDA STATE OF NEW JERSEY: COUNTY OF ATLANTIC: On this ___day of _______, 2013, in the County and State aforesaid, before me, the subscriber, a Notary Public authorized to take acknowledgments and proofs in said County and State, personally appeared John F. Palmieri, the Executive Director of the CASINO REINVESTMENT DEVELOPMENT AUTHORITY, a public body established in, but not of, the Department of the Treasury of the State of New Jersey, who I am satisfied, in the person who, a such officer of said public body, signed, sealed and delivered the within instrument made by said public body, and he did acknowledge that he, as such officer, signed and delivered the same on behalf of said public body for the uses and purposes therein set forth, and that said instrument is the voluntary act and deed of said public body duly authorized by a proper resolution of its Members. ________________________ Name:
Notary Public My Commission Expires: (NOTARY SEAL) 
Attachment “A” Application for Payment (Or Equivalent Owner Approved AIA G702) NO. ________ To: (OWNER) From: (CONTRACTOR) Contract: Project: Contract No. .
1. Original Contract Price: $_____________________ 2. Net change by Change Orders and Written Amendments (+ or -): $_____________________ 3. Current Contract Price (1 plus 2): $_____________________ 4. Total completed and stored to date (See Invoice Summary): $_____________________ 5. Retainage (per Contract): _____% of completed Work: $____________________ _____% of stored material: $____________________ Total Retainage: $_____________________ 6. Total completed and stored to date less retainage (4 minus 5): $_____________________ 7. Less previous Application for Payments: $_____________________ 8. DUE THIS APPLICATION (6 MINUS 7): $_____________________ CONTRACTOR'S CERTIFICATION: THE UNDERSIGNED CONTRACTOR CERTIFIES THAT (1) ALL PREVIOUS PROGRESS PAYMENTS RECEIVED FROM OWNER ON ACCOUNT OF WORK DONE UNDER THE CONTRACT REFERRED TO ABOVE HAVE BEEN APPLIED ON ACCOUNT TO DISCHARGE CONTRACTOR’S LEGITIMATE OBLIGATIONS INCURRED IN CONNECTION WITH WORK COVERED BY PRIOR APPLICATIONS FOR PAYMENT NUMBERED 1 THROUGH _____ INCLUSIVE; AND (2) ALL WORK COVERED BY THIS APPLICATION FOR PAYMENT IS IN ACCORDANCE WITH THE CONTRACT DOCUMENTS AND NOT DEFECTIVE. Accompanying this Application for Payment is the duly executed Contractor’s Partial Release and Waiver of Liens, the duly executed Partial Release and Waiver of Liens of each of the Contractor’s subcontractors and/or suppliers, and all documentation of measurement of unit price Pay Items as required by the Contract Documents and the Engineer. Dated ____________________________ By: __________________________ Contractor State of ______________________________ County of ____________________________ Subscribed and sworn to before me this _____ day of __________________, 2013 ____________________________________ Notary Public My Commission expires: _____________________ Attachment “A” - Continued (Or Equivalent Owner Approved AIA G703) Invoice Summary
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