APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 Page 1 of 1 TO OWNER: City of Fontana - Controls APPLICATION NO.: 12-RET City of Fontana PERIOD TO: 9/30/2022
PROJECT NOS.:
FROM CONTRACTOR: CONTRACT DATE: 3/15/2021
Alliance Building Solutions, Inc. RETENTION INVOICE
12520 High Bluff Drive Ste. 345
San Diego, CA 92130 PO# 22200260
CONTRACT FOR: Energy Project
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information Application is made for payment, as shown below, in connection with the Contract. andrein eithe Confed by ocuments, ahar al moumes ave been paid by the Contractor Continuation Sheet, AIA Document G703, is attached.
for Work for which previous Certificates for Payment were issued and payments received
1. ORIGINAL CONTRACT SUM $1,226,479.00 from the Owner, and that current payment shown herein is now due.
2. Net Change by Change Orders $0.00
3. CONTRACT SUM TO DATE (Line 1 + 2) $1,226,479.00 CONTRACTOR: ALLIANCE BUILDING SOLUTIONS, INC.
4. TOTAL COMPLETED & STORED TO DATE $1,226,479.00 Tim gray 9/26/2022 By: Date:
(Column G on G703) Tim Gray, CFO
5. RETAINAGE:
% of Completed Work
(Columns D+E on G703)
% of Stored Material
(Column F on G703)
Total Retainage (Line 5a + 5b or
Total in Column I of G703) $0.00
6. TOTAL EARNED LESS RETAINAGE $1,226,479.00
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $1,165,155.05 (Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE $61,323.95
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) $0.00
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous
months by Owner $0.00 $0.00
Total approved this Month $0.00 $0.00
TOTALS $0.00T $0.00
NET CHANGES by Change Order $0.00
Project: City of Fontana - Controls
] ALLIANCE Application No.: 12-RET
Application Date: 9/30/2022
Period To: 9/30/2022
PO# 22200260
WORK COMPLETED
MATERIALS TOTAL BALANCE TO RETAINAGE
SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED AND
ITEM DESCRIPTION OF WORK APPLICATION THIS PERIOD FINISH (IF VARIABLE NO. VALUE STORED STORED TO DATE (G/C) (C-G) RATE)
(D + E) (NOT IN D OR E) (D + E + F)
1 Project Bond, Engineering, Mobilization
2 Bond and Insurance 12,265.00 11,651.75 613.25 es 12,265.00 100% $ 3 Engineering 61,324.00 58,257.80 3,066.20 61,324.00 100% $ 4 Mobilization en 244,069.00 231,865.55 12,203.45 244,069.00 100% $ 6 City of Fontana - Citywide EMS
7 Aquatics Center 21,507.00 is 20.431.65 1,075.35 21,507.00 100% 8 Art Depot enares 20,007.00 19,006.65 1,000.35 20,007.00 100% 9 Center Stage Theater 56,022.00 53,220.90 2,801.10 56,022.00 100% 11 Ceres Center 78,028.00 74,126.60 3,901.40 78,028.00 100% 12 Community Services Building 37,514.00 35,638.30 1,875.70 37.514.00 100% 13 Cypress Community Center 24,509.00 23,283.55 1,225.45 24,509.00 100% 14 Don Day Center 23,508.00 22,332.60 1,175.40 23,508.00 100% 15 DSO Building 25,509.00 24,233.55 1,275.45 25,509.00 100% 16 East Annex Building 27,513.00 26,137.35 1,375.65 27,513.00 100% 17 City Hall 38,514.00 en 36,588.30 1,925.70 38,514.00 100% 18 Police Department 25,509.00 24,233.55 1,275.45 tesis es esenes un es es es es 25,509.00 100% asesinas en es un un es es en es en es es ese 19 Heritage Community Center 33,512.00 31,836.40 es 1,675.60 33,512.00 100% 20 Human Recources / Chamber of Commerce 22,509.00 21,383.55 1,125.45 22,509.00 100% 21 Jack Bulik Center • 22,508.00 21,382.60 1,125.40 22,508.00 100% 22 Jesse Turner Center 65,523.00 62,246.85 3,276.15 65,523.00 100% 23 Knopf Center 21,006.00 19,955.70 1,050.30 21.006.00 100% 24 Lewis Library 212,574.00 201,945.30 10,628.70 212,574.00 100% 25 Miller Center 27,508.00 26,132.60 1,375.40 27,508.00 100% 26 Mary Vagle Nature Center 22,006.00 20,905.70 1,100.30 22,006.00 100% 27 Public Works, Admin Building 26,510.00 25,184.50 1,325.50 26,510.00 100% 28 Public Works, West Annex 26,009.00 24,708.55 1,300.45 26,009.00 100%
Project: City of Fontana - Controls
ALLIANCE Application No.: 12-RET
Application Date: 9/30/2022
Period To: 9/30/2022
PO# 22200260
WORK COMPLETED
FROM PREVIOUS MATERIALS TOTAL BALANCE TO RETAINAGE
ITEM SCHEDULED PRESENTLY COMPLETED AND
DESCRIPTION OF WORK APPLICATION THIS PERIOD FINISH (IF VARIABLE NO. VALUE (D+ E) STORED STORED TO DATE (G/C) (C -G)
(NOT IN D OR E) RATE)
(D+ E+ F)
29 Supervisor Station 51,016.00 48,465.20 2,550.80 51,016.00 100%$ 30|
37 SUB-TOTAL $ 1,226,479.00 $ 1,165,155.05 61,323.95 $ TS 1,226,479.00 100% $ 38 39 Change Order Work
40 Change Order No. 1 0%
41 Change Order No. 2 nune es eses 0%
42 Change Order No. 3 inereees
43 Change Order No. 4 us u
44 Change Order No. 5
45 TOTAL$1,226,479.00 1,165,155.05 61,323.95 1,226.479.00 100% 61,323.95
CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT
NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT.
A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT.
Identifying Information
Name of Claimant: Alliance Building Solutions, Inc.
Name of Customer: City of Fontana
Job Location: City of Fontana Controls
Owner: City of West Covina
Conditional Waiver and Release
This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this job. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this document is signed by the claimant, are waived and released by this document, unless listed as an Exception below. This document is effective only on the claimant's receipt of payment from the financial institution on which the following Maker of Check: City of Fontana
Amount of Check: $61,323.95
Check Payable to: Alliance Building Solutions, Inc.
Exceptions
This document does not affect any of the following: 8/31/2021 Disputed claims for extras in the amount of: $ 1,284.27 Signature
Claimant's Signature: Tim gray
Claimant's Title: Tim Gray CFO/COO
Date of Signature: 09/26/2022
7/1/12
ALLIANCE INVOICE
BUILDING SOLUTIONS, INC
Alliance Building Solutions, Inc.
12520 High Bluff Drive #345 INVOICE NO. 12-RET
San Diego, CA 92130
858-333-4771. DATE 9/30/2022
[email protected]
TO
City of Fontana
16489 Orange Way
Fontana, CA 92335
JOB PO#:22200260
City of Fontana - Controls
DESCRIPTION TOTAL
2. Bond and Insurance $613.25
3. Engineering $3,066.20
4. Mobilization $12,203.45
7. Aquatics Center $1,075.35
8. Art Depot $1,000.35
9. Center Stage Theater $2,801.10
11. Ceres Center $3,901.40
12. Community Services Building $1,875.70
13. Cypress Community Center $1,225.45
14. Don Day Center $1,175.40
15. DSO Building $1,275.45
16. East Annex Building $1,375.65
17. City Hall $1,925.70
18. Police Department $1,275.45
19. Heritage Community Center $1,675.60
20. Human Recources / Chamber of Commerce $1,125.45
21. Jack Bulik Center $1,125.40
22. Jesse Turner Center $3,276.15
DESCRIPTION TOTAL
23. Knopf Center $1,050.30
24. Lewis Library $10,628.70
25. Miller Center $1,375.40
26. Mary Vagle Nature Center $1,100.30
27. Public Works, Admin Building $1,325.50
28. Public Works, West Annex $1,300.45
29. Supervisor Station $2,550.80
SUBTOTAL $61,323.95
Less 5% retention
Thank you for your business! TOTAL DUE $61,323.95
City of Fontana - Approval Signature Date