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Home My WebLink AboutPrime Construction Group Contractor's Application for Payment -1997 12 16 ---'~--''''''''-- '''-~'~;,;, " To: City of Winter Springs 1126 E. SR 434 Winter Springs, Florida 32708 Page 1 of 2 CONTRACTOR'S APPLICATION FOR PAYMENT No.2 Job #970290 Engineer's File No. W04!5?02 Lift Station #7W Improvements Bid No. 97-023 Contractor: Prime Construction Group, Inc. 5528 Force Four Parkway Orlando, Florida 32839 Finance Ace!. No. Contract date: September 29th, 1997 Completion date: November 19th, 1997 Application Date: December 16th, 1997 For Period Ending: December 16th, 1997 STATEMENT OF WORK Original Contract Price $64,300.00 Net Change Orders $16,175.71 Current Contract Price $80,475.71 Work to be Done $0.00 Work Completed to Date $80,475.71 Amount Retained 5.00% $4,023.79 Sub-total $76,451.92 ~ ?o*4''lt.fg' "32..( $'", I::) 0 ~tf512.1 121S'"/.<12.. <(J I SI 3(.,~, q '2... Previous Payments Approved $61,085.00 Amount Due This Payment $15,366.92 The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress payments received from the Owner on account of work performed under the contract referred to above have been applied by the undersigned to discharge in full all obligations of the undersigned incurred in connection with work covered by prior Application for Payment uner said contract, being Applications for Payment numbered 1 through 2 inclusive: (2) all materials and equipment incorporated in siad Project or otherwise listed in or covered by this Application for Payment are free and clear of all liens, claims, s~urity interests and encumbrances. . I County of Seminole State if Florida \ \ By: ,\ \\ \ ~J:;J\ .'.\....~..' \~.-... .' . ..-~--~ ! ~~.- ::::::;.;--- .j ~ -,> --.~--....- Dated: December 16th, 1997 Before me on this 16th day of December 16th ,1997, personally appeared Roy W. Smith, Jr., known to me, (or has produced) , as identification and who did (did not) take an oath) who, being duly sworn did depose and say that he is the President of the Contractor above-mentioned; that he excuted the above Application for Payment and statement on behalf of said Contractor; and that all of the statements contained therin are true, correct and complete. Q)'''1ih FRANCES A. TAMAYO to: ~T.\ \ MY COMMISSION' CC 611286 " . 1 EXPIRES: Nowmber 21, 1899 '/if.,.' BondId 11Iu NoIIIy PublIc ~ My commission expries: 11/21/99 Payment of the amount requested above is approved: :: ~I{:!t L# By: Date: Date: Date: Date: /.2~fI17 I 111 'f 1- '] '1 ~ tt Q' ., 0 PAYMENT REQUEST NO.2 Page 2 of 2 General Contractor: Prime Construction Group, Inc. P.O. Box 590507 Orlando, Florida 32809-0507 Project No. 970290 Date: December 16th, 1997 LIFT STATION #7W IMPROVEMENTS City of Winter Springs, Florida City's Project No. 97-023 CPH Project #W0455.02 WORK PERFORMED WORK PERFORMED WORK PERFORMED CONTRACT QUANTITIES PREVIOUS PERIOD THIS PERIOD TO DATE UNIT -- ITEM NO. DESCRIPTION QTY. UNIT PRICE AMOUNT QUANTITY AMOUNT QUANTITY AMOUNT QUANTITY AMOUNT % COMPo BONDS & INSURANCE 1 LS $1,000.00 $1,000.00 100.00% $1,000.00 0.00% $0.00 100.00% $1,000.00 100.00% SUBMITTALS 1 LS $1,000.00 $1,000.00 100.00% $1,000.00 0.00% $0.00 100.00% $1,000.00 100.00% MOBILIZATION 1 LS $5,000.00 $5,000.00 100.00% $5,000.00 0.00% $0.00 100.00% $5,000.00 100.00% INSTALL 6" BYPASS CONNECTION 1 LS $3,000.00 $3,000.00 100.00% $3,000.00 0.00% $0.00 100.00% $3,000.00 100.00% SET UP BYPASS PUMPING 1 LS $6,500.00 $6,500.00 100.00% $6,500.00 0.00% $0.00 100.00% $6,500.00 100.00% PLUG INLET TO WETWELL 1 LS $2,500.00 $2,500.00 100.00% $2,500.00 0.00% $0.00 100.00% $2,500.00 100.00% PREP & COAT WETWELL 1 LS $10,500.00 $10,500.00 100.00% $10,500.00 0.00% $0.00 100.00% $10,500.00 100.00% REMOVE EXISTING PUMPS/SET NEW PUMPS 1 LS $24,400.00 $24,400.00 100.00% $24,400.00 0.00% $0.00 100.00% $24,400.00 100.00% INSTALL VALVES & PIPING 1 LS $6,500.00 $6,500.00 100.00% $6,500.00 0.00% $0.00 100.00% $6,500.00 100.00% DEMO ABOVE GROUND ACCESS 1 LS $500.00 $500.00 100.00% $500.00 0.00% $0.00 100.00% $500.00 100.00% RESET HOIST RAILS 1 LS $1,000.00 $1,000.00 100.00% $1,000.00 0.00% $0.00 100.00% $1,000.00 100.00% INSTALL CONTROLS 1 LS $2,000.00 $2,000.00 100.00% $2,000.00 0.00% $0.00 100.00% $2,000.00 100.00% START-UP 1 LS $400.00 $400.00 100.00% $400.00 0.00% $0.00 100.00% $400.00 100.00% CONTRACT TOTALS $64,300.00 $64,300.00 $0.00 $64,300.00 100.00% CHANGE ORDERS: ChanQe Orders No 1: 1 Furnish/Install Two 60 AMP Disconnects 1 LS $1,955.71 $1,955.71 0.00% $0.00 100.00% $1,955.71 100.00% $1,955.71 100.00% 2 Furnish/Install 20" Line Stop on Force Main 1 LS $14,220.00 $14,220.00 0.00% $0.00 100.00% $14,220.00 100.00% $14,220.00 100.00% . REVISED CONTRACT TOTALS $80,475.71 $64,300.00 $16,175.71 $80,475.71 ~. WAIVER AND RELEASE OF LIEN RIGHTS (FULL AND FINAL) WHEREAS, the undersigned has furnished certain labor and services or materials, or both, used in the construction of improvements constructed on the following described real property in SEMINOLE County, Florida: LIFT STATION NO 7 IMPROVEMENTS CITY OF WINTER SPRINGS PRIME PROJECT # 970290 Pursuant to an agreement by and between PRIME CONSTRUCTION GROUP, INC. (Prime Contractor) and SANDERS COMPANY, INC. (Subcontractor/Supplier) NOW, THEREFORE, in consideration of the sum of $14,042.00 receipt of which is hereby acknowledged, the undersigned does hereby waive, release, quit claim, and forever discharge said real property and improvements thereon and the owner thereof, from any and all claims, claims of liens, rights to liens, or liens for services or materials or any other lien whatsoever, which the undersigned has or may hereafter have against said property. The undersigned warrants that he has the right and authority to execute this instrument, for himself or for and on behalf of the partnership, firm or corporation, indicated, and that (he) (she) (it) has not and will not assign or transfer any claim of payment or of any right to perfect a lien upon said realty as improved. The undersigned warrants that all suppliers, material men and laborers furnishing material to or performing labor for (him) (her) (them) (it) have been fully paid and that no conditional bill of sale, retain title contract, or chattel mortgage has been given by anyone for or in connection with any materials, fixtures, furnishings, labor, appliances or machinery placed upon or installed or incorporated in the said premises by (him) (her) (them) (it), except as follows (if none, so state): NONE The following is a brief description of the work, services or materials of the undersigned: FAIRBANKS MORSE PUMPS/CONTROL PANEL WITNESS, the following signature and seal this /7 z.::L day of ~-t!/AV ..-L~ .1997. Witness Sworn and s~bscribed before me this / J .~ day of ~/f(/~ ,1997. SANDERS COMPANY, INC. se~cA ~o~AUO C. 12675/l,Jerre ~Q Printed Name and Title ~A A!4<:A'!../-4 V 0,. b/h d' Jil NOTARY PUBLIC My commission expires: //1--; . ,,~ ~ ~~ FRANCES A. TAMAYO MV COMMISSION' co 511266 EXPIRES: NovImber 21,19119 IIandlId TIuu ~ PubIc IJncIeIwIIlin .~"-;-:,.-:-_.~.,,,~.--_._., ~---- -~.'-'-'~ '-~'<- "":"-:."'''';~.----- -.,.--~~ -;:"711i"'~'7"----~?,,'TV- . 3610 3610 R56340 56340 41948 43121 .JCtJ3970Z90 .JOB970Z90 RENOVA.LS#7W/BID-97-023 RENOVATION TO LIFT ST#7~ 2:6879 PRIME CONSTRUCTION GROUP If.o..qa. 3 7118 1:01; 3 ~O 3 Irq ~I: J. 287002.. 3 3" ~:~~Sf~-(,f2i""~';.i~f~1i~:~t~~1:~~~m{t~i!t~~S~~~~~~~~~~~~~~f!;'~.~~; :!r.... "t:~ :~ "