EFTA00609239.pdf

Approved by: Em crTh LSJ CONSTRUCTION Subcontractor Payout Project: Mechanical Desal #1010 Trade: Electrical Subcontractor Michael J. Glidden Electrical Services, Inc. Insurance ex•iration: May 14. 2011 Invoice # Phase # Requisition #1 16-000 Original Contract Sum: Change Orders Submitted & Approved: New Change Orders: Total Work Contracted to Date: Partial X 18-Jan-11 Requisition #1 Final $75,550.00 $0.00 $0.00 $75,550.00 Total Work Completed to Date: 42% $31,550.00 Less Retainage: $0.00 Total Payments Made to Date: Total Current Payment Due: Balance to Finish including Retainage: 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 Total Outlays for this contract incl. Sales or Use Tax: JEE approval attached YES NO Submitted Bill Signed: Date: January 18,,2011 Signed: $0.00 / $31,550.00 $44,000.00 incl. $31,550.00 Invoice Attached YES NO X Approved by: Gary Signed: Date: January 18, 2011 Approved by: 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 Requisition #2 Requisition #3 Requisition #4 Requisition #5 Requisition 06 01/18/11 31.550.00 0.00 31.550.00 31,550.00 0.00 • 0.00 0.00 - 0.00 0.00 0.00 0.00 0.00 0.00 0.00 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 COO CO#2 CO#3 CO#4 CO#5 76.550.00 Description Contracted To Date Balance of Contract inflintainnge 75,550 00 44.000.00 EFTA00609240 APPLICATION AND CERTIFICATION FOR PAYMENT AM DOCUMENT G702 TO OWNER L .3 I L a FROM CONTRACTOR: e_kwoe 6tt--tn -aeakc-,c,,l Sex v:c es PROJECT: r(eic\ ne."‘ c.c1/4,‘ 1:3e'Se..A 13% F tot 40 Archiled: APPLICATION NO Application Date. Period From. PERIOD TO PROJECTS I 1811 Distribution to. =OWNER new* inspect« [CONTRACTOR mPM CONTRACTOR'S APPLICATION FOR PAYMENT Apptcation is made for payment. as shown below. in connection with the Contract Continuation Sheet, MA Document G703, o attached 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3 CONTRACT SUM TO DATE (Line i 4 TOTAL COMPLETED et STORED TO DATE (Column G on 6703) 5 RETAINAGE. a 0.00% % of Completed Work less Mob/dawn (Column 0 • E 011 6703) b. 0.00% % of Stored Material (Column F on G703) Total Retainage (Unite 5.9 • 5b or Total in Column I of 6703) 8. TOTAL EARNED LESS Et ETAINAGE (line 4 Less Line 5 Total) 7 LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 8 from prior Cereleatin 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH. INCLUDING RETAINAGE (Une 3 ins Une 0) 75, 55o - - 3 ir5-5-0 - 0 -9 If 550 q i CX:O - CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total cAanges approved • in previous months by Owner Total approved this Month TOTALS NET CHANGES by Change Order The uvidersened Contractor canines Mat to the beS1 of the Contractors knowledge. information and beat the Wort mated by Vas Araskaton for Payment nos boon 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 By. State of Subscribed and swom to before me this Notary Public: My Commission expires. County of day of CERTIFICATE FOR PAYMENT In accordance ttith the Contract Documents. based on on-sne observations and the data comprising this application The knifed certifies to the Owner that to the best of the AreNted's knowledge. Information and belief the Work has progressed as indicated. the quality of the Work Is in accordance mei the Contract Documents. and Ihe Contractor is entitled to payment (tithe AMOUNT CERTIFIED. AMOUNT CERTIFIED .5/ 57E' (Ann explanation a amount cerned diffeh from the amount applied lot. Initial all ?cures this Application and on the Connualion Sheet that are changed to conform to Me amour caddied) Cowman By: k Dm: / This kale s not negotiable. The MOUNT CERTIFIED is payable only o the Calm named hen. Issuance, payment and acceptance of payment are without Pendia to ar nghts of the Owner or Contractor under this Contract. 1/ 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 IADJGt'mentG?N APPI ICA • ION ANn rr PT lc le A TioN rtDP DAVME .; OM' aCtOf s signel cert•ficabe" .s atta:meo labolaltons below amounts re state', to etl•neagesi nena, Mtn I nn ,» *. IC% whe'e ie le gebeee9e ICY k !C“. • ,"ay JD:• .MA DOCUMENT G703 APPI CATION NO APPI CATION DATE PERIOD TO e f: .. E t n t5• tesestitttn tra S.:III out I 0 ‘VOlet CI MP' I II (1 MAT( MA( S ',eh, BALANCE WI lAr4Ar.! Y. co eh. *Ai iji e .4a 0,8 PRI VIt KIS t IS elo ,.f N Ii v •-,t iji (2 ben •Nti4A I I) “ 14 I I C , 0 .. 4 9 1 '1 : 1 Ai.- • • ' ''•) 1 * .1.g k 1.11INISII ,g vdmiAls. ! ELI 000' 1 i (--C. .n‘C I4-yZ° el/375 — ga 3 4 -4, GI 375 - 7$7, 3 - 000? Me...4....rteal O - itagiiiEta_e50° ~ sii fa.500 - At: 5% 1 OT1 - 9001 ----. it-• f 0004 1. ...) al "C 13,500- o d I 3500 - ',005 V'''t /St. 4". Vkereket•Stelt k 2),I DO Br Ito - Good . -t',10.1.t.t.e4 14 Soo- 0 "" 7so- b o - o71.9 5750 - 0009 __ble.74kanajetaC___ j• e • 1 /5A8Ser 0 V' 11Z.5. q ZOO d O o o C126 70 - COO 09'4 03IS 0016 001" COI a 00,- 307( 'MI 1072 2023 7174 1)25 11 875- GRAND TOTALS I 3AO1.5.-1 I 75: 525 -1 0 j ~- ..- ~ - 1 3 1 r550 L I 9 f000 - 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