EFTA00609239.pdf

LSJ CONSTRUCTION Subcontractor Payout Project: Mechanical Desal #1010 18-Jan-11 Trade: Electrical Requisition #1 Subcontractor Michael J. Glidden Electrical Services, Inc. Insurance ex•iration: May 14. 2011 Invoice # Requisition #1 Partial Final Phase # 16-000 X Original Contract Sum: $75,550.00 Change Orders Submitted & Approved: $0.00 New Change Orders: $0.00 Total Work Contracted to Date: $75,550.00 Total Work Completed to Date: 42% $31,550.00 Less Retainage: $0.00 Total Payments Made to Date: $0.00 / Total Current Payment Due: $31,550.00 Balance to Finish including Retainage: $44,000.00 Sales Tax Liability: a. Subcontractor/Supplier is liable, explaii Labor and materials b. Non-resident Subcontractor/Supplier Bond Applicable: c. Use Tax to be paid by our company: d. Shipping incl. Total Outlays for this contract incl. Sales or Use Tax: $31,550.00 JEE approval attached Invoice Attached YES NO YES NO X Submitted Bill Approved by: Gary Signed: Signed: Date: January 18,,2011 Date: January 18, 2011 Approved by: Em crTh Approved by: Signed: Signed: Date: EFTA00609239  LSJ CONSTRUCTION Project Mechanical Desal #1010 Jbcontractor - full legal name: Michael J Glidden Electrical Services. In Date Revised: January 18. 2011 Phase # 16.000 Trade: Electrical Invoice N Requisition n1 Insurance expiration. 5/14/11 Payment Partial Final X Invoice/Re:1# Date C/O Amount Retainage Due Paid Dale Paid Chedu7 Balance Contract 03/12/10 75.550 00 CO#1 CO#2 CO#3 CO#4 .CO45 Requisition #1 01/18/11 31.550.00 0.00 31.550.00 31,550.00 Requisition #2 0.00 • 0.00 Requisition #3 0.00 - 0.00 Requisition #4 0.00 0.00 0.00 Requisition #5 0.00 0.00 0.00 Requisition 06 0.00 0.00 0.00 Total 31.550.00 1 0.00 31.550 00 0.00 31,550.00 1 Contract Amount - Phase contract 76.550.00 COO Description CO#2 CO#3 CO#4 CO#5 Contracted To Date 75,550 00 Balance of Contract inflintainnge 44.000.00 EFTA00609240  APPLICATION AND CERTIFICATION FOR PAYMENT AM DOCUMENT G702 TO OWNER L .3 I La PROJECT: r(eic\ n e."‘ c.c14/,‘ 1:3e'Se..A 13% APPLICATION NO Distribution to. F tot 40 Application Date. =OWNER I 1811 FROM CONTRACTOR: Period From. new* inspect« Archiled: e_kwoe 6tt--tn PERIOD TO [CONTRACTOR -aeakc-,c,,l Sex v:c es PROJECTS mPM CONTRACTOR'S APPLICATION FOR PAYMENT The uvidersened Contractor canines Mat to the beS1 of the Contractors knowledge. Apptcation is made for payment. as shown below. in connection with the Contract information and beat the Wort mated by Vas Araskaton for Payment nos boon Continuation Sheet, MA Document G703, o attached completed in accordance vita me Contract Documents. that as amens have been pad by me Contractor for Wort for whO promos Certificates for Payment Iwo issued and Ointments received from Me Omits. and that current payment shown harm a :Km clue 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3 CONTRACT SUM TO DATE (Line i 75, 55o - By. 4 TOTAL COMPLETED et STORED TO DATE (Column G on 6703) - 5 RETAINAGE. State of County of a 0.00% % of Completed Work less Mob/dawn Subscribed and swom to before me this (Column 0 • E 011 6703) day of Notary Public: b. 0.00% % of Stored Material My Commission expires. (Column F on G703) Total Retainage (Unite 5.9 • 5b or CERTIFICATE FOR PAYMENT Total in Column I of 6703) 8. TOTAL EARNED LESS EtETAINAGE (line 4 Less Line 5 Total) 3 ir 5-5-0 - In accordance ttith the Contract Documents. based on on-sne observations and the data 7 LESS PREVIOUS CERTIFICATES FOR comprising this application The knifed certifies to the Owner that to the best of the PAYMENT (Line 8 from prior Cereleatin AreNted's knowledge. Information and belief the Work has progressed as indicated. the 0 quality of the Work Is in accordance mei the Contract Documents. and Ihe Contractor is 8. CURRENT PAYMENT DUE -9 I f 550 entitled to payment (tithe AMOUNT CERTIFIED. 9. BALANCE TO FINISH. INCLUDING RETAINAGE (Une 3 ins Une 0) q i CX:O - AMOUNT CERTIFIED .5/ 57E' (Ann explanation a amount cerned diffeh from the amount applied lot. Initial all ?cures CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS this Application and on the Connualion Sheet that are changed to conform to Me amour Total cAanges approved • caddied) in previous months by Owner Cowman Total approved this Month By: k Dm: / 1/ This kale s not negotiable. The MOUNT CERTIFIED is payable only o the Calm TOTALS named hen. Issuance, payment and acceptance of payment are without Pendia to ar nghts of the Owner or Contractor under this Contract. NET CHANGES by Change Order AlA DOCUMENT G702. APPLICATION AND CERTIFICATION FOR PAYMENT' 1992 EDITION' AIA 01992 n€ 1,31W004•48111Vit 0, ',ROCCO'S. MS NEW YORK AIM bbanyarcoi, a lebanati Users may obtain validation of this document by requesting a completed AlA Document D401 • Certification of Document's Authenticity from the Licensee. Summary Sheet I of I EFTA00609241  CONTINUATION SHEET .MA DOCUMENT G703 IADJGt'mentG?N APPI ICA •ION ANn rr PT lc le A TioN rtDP DAVME .; APPI CATION NO OM' aCtOf s signel cert•ficabe" .s atta:meo APPI CATION DATE labolaltons below amounts re state', to etl•neagesi nena, PERIOD TO Mtn I nn ,» *. IC% whe'e ie le gebeee9e ICY k !C“. • ,"ay JD:• e f: .. E t n t5• tesestitttn tra S.:III out I 0 ‘VOlet CI MP' I II (1 ',eh, MAT( MA( S BALANCE WI lAr4Ar.! Y. co eh. *Ai iji e .4a 0,8 PRI VIt KIS t IS elo ,.f N Ii v C , 0 .. 4 9 1 '1 : 1 1.11INISII ,g vdmiAls. ! •-,t iji (2 Ai.- • • ' ''•) 1 ELI ben •Nti4A I * .1.g k I) “ 14 I I 000' 1 i (--C. .n‘C - I4-yZ° el/375 — ga 3 4 -4, GI 375 - 7$7, 3 000? Me...4....rteal f O- itagiiiEta_e50° ~ sii fa.500 - At: 5% 1 OT1 - 9001 0004 1. ...) al"C ---- . it-• 13,500- o d I 3500 - ',005 V'' 't /St. 4". Vkereket•Stelt k 2),I DO Good Br Ito - . -t',10.1.t.t.e4 14 Soo- 0 "" 7so- b o- o71.9 0009 5750 - __ble.74kanajetaC___ /5A8Ser 0 V' j• e • 1 11Z.5. q ZOO d O o o - COO C126 70 09'4 03IS 0016 001" COI a 00, - 307( 'MI 1072 2023 7174 1)25 GRAND TOTALS 11 875- I 3AO1.5.-1 ..- I 75: 525 -1 0 j ~- ~ - 1 3 1r550 L I 9 f 000 - EFTA00609242 Emad Hanna From: Eve Febe Sent: Thursday, January 20, 2011 1:23 PM To: Emad Hanna Cc: Bill Rowles; Monique Harry Subject: Michael J. Glidden Electrical Services, Inc Req. #01 1010 Attachments: Michael J. Glidden Electrical Services, Inc. Req. #01 1010.pdf Good Afternoon Emad, Attachment for payment Michael J. Glidden Electrical Services, Inc Req. #01. In the amount of $31,550.00. Project #1010. Code 16.000 Eve EFTA00609243