RFQ 26-14 WTP #1 Market St Renovations

APPLICATION AND CERTIFICATION FOR PAYMENT
TO OWNER: PROJECT: APPLICATION NO: DISTRIBUTION TO:
x OWNER
x ENGINEER
City of Lake Wales PERIOD TO: 10/1/2024 - 10/31/24 CONTRACTOR
FROM CONTRACTOR: INSPECTOR
CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by this Application for Payment has been cmpleted in accordance with the
Application is made for payment, as shown below, in connection
Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
the Contract Continuation Sheet, AIA Document G703, is attached.
Certificates for Payment were issued and payments recieved from the Owner, and that current
1 ORGINAL CONTRACT SUM..................$ $0.00 payments shown herein is now due
2 Net change by Change Order.....................$ CONTRACTOR: Innovative Pipeline Systems LLC
3 CONTRACT SUM TO DATE (Line 1 + 2)...$ $0.00
4 Total Completed & Stored to Date $ $0.00 BY: DATE:
5 RETAINAGE State of: County of:
a. 5% of Completed Work $ $0.00
b. 5% of Stored Materials $ 0 Subscribed and sworn before me this ______ day of _____2021
Total Retainage $0.00
(Lines 5a + 5b) Notary Public:
6 TOTAL EARNED LESS RETAINAGE.........$ $0.00 My Commission expires:
(Line 4 less Line 5 Total)
7 LESS PREVIOUS CERTIFICATES FOR PAYMENT...$ $0.00
(Line 6 from prior Certificate) CONTRACTOR CERTIFICATE FOR PAYMENT
8 CURRENT PAYMENT DUE.....................$ $0.00 In accordance with the Contract Documents, based on on-site observations and the data comprising this
application, the Contractor certifies to the Owner that to the best of the Contractors knowledge,
9 BALANCE TO FINISH, INCLUDING RETAINAGE...$
informatin and belief the Work has progressed as indicated, the quality of the Work is in accordance with
the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
CHANGE ORDER ADDITIONS DEDUCTIONS
SUMMARY AMOUNT CERTIFIED ................$ $0.00
The changes approved in (Attached explanation if amount certified differes from the amount applied for. Intial all figures
$ $
previous month by owner on this Application and on the Continuation Sheet that are changed to conform to the amount
Total approved this Month $ $ certified.)
Totals $0.00 $0.00 ENGINEER
Net Changes by Change By: Date:
$0.00
Order
This Certificate is not negotiable. The Amount Certified is payable only to the Public Works Director
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract. By: Date:

Direct Purchases By Owner - 000006
DIRECT PURCHASES BY OWNER
The Owner is tax exempt and upon agreement with the Construction Manager may wish
to exercise its right to purchase directly various construction materials, supplies and
equipment that may be part of this Contract. The Owner will, via its purchase orders,
purchase the materials and the Construction Manager shall assist the Owner in the
preparation of purchase orders. The Owner may direct the Construction Manager to
prepare the purchase order on the Owner's form and make ready for verification and
execution by the Owner. The materials may be purchased from the vendors/suppliers
selected by the Construction Manager, for the price originally negotiated by the
Construction Manager. The Construction Manager will prepare a list of materials,
supplies and equipment and the Owner will advise the Construction Manager which items
from the list it wishes to purchase directly, with enough lead time to allow this request to
be incorporated into the overall construction schedule.
The Guaranteed Maximum Price amount shall be reduced by the net, undiscounted
amount of the purchase order, plus all sales taxes that would have applied. ISSUANCE
OF THE PURCHASE ORDERS BY THE OWNER DOES NOT CHANGE ANY OF THE
CONSTRUCTION MANAGER'S RESPONSIBILITIES REGARDING MATERIAL
PURCHASES, OR INSTALLATIONS, WITH THE SOLE EXCEPTION OF THE
PAYMENTS FOR THE MATERIALS SO PURCHASED. The Construction Manager
remains fully responsible for all other obligations it has under the terms of this contract
regarding materials purchased, including but not limited to, coordination of the work
including ordering of materials, correct quantities ordered, submittals, protection, storage,
scheduling, shipping, security, expediting, receiving, checking shipping tickets, and
invoices, installation, cleaning, all applicable warranties. Regardless of any direct
purchase, the Construction Manager remains responsible for ensuring that all materials
purchased meet the requirements of the Contract Documents.
In the event that materials, supplies, or equipment purchased under this option, are
defective or rejected for any reason whatsoever, and it becomes necessary in the opinion
of the Construction Manager to initiate legal action against the responsible party, the
Owner agrees to assign and subordinate to the Construction Manager any claims the
Owner has against the responsible party resulting from the purchase order and to execute
any legal documents necessary to accomplish the assignment, subordination or
subrogation of such claims and to cooperate with the Construction Manager in such legal
action.
DIRECT PURCHASES BY OWNER 000006 - 1

Request for Punch List Inspection - 000007
REQUEST FOR PUNCH LIST INSPECTION
CITY OF LAKE WALES
(MUST BE SUBMITTED PRIOR TO SUBSTANTIAL COMPLETION)
TO: , City of Lake Wales
, Architect
FROM: , Contractor
Project Number and Description:
Date Submitted:
Inspection date requested:
This project is ready for a punch list inspection by the Owner, Architect and Engineers. The
entire project has been inspected personally by the undersigned and, to the best of our ability to
determine, all work is complete and properly done with the exception of items listed in detail on
the exception sheet with reasons stated for lack of completion. All items previously submitted in
writing by the Owner, Architect or Engineers, including change orders, have been complied with,
otherwise resolved or are listed as exceptions.
All painting, touch up painting, trim, finish work, roofing flashings, sheet metal work, window
cleaning, floor treatment and site clean up are complete. All motors and controls are operating
and have been tested and adjusted as appropriate. The HVAC system is complete and all
components are properly operating. Test and balance of the HVAC system has been done and
any reported defects are corrected.
All door closers and locksets are properly adjusted and operating. All permanent master keys
and change keys have been supplied directly to the Owner's representative. Window screens
and blinds are installed. All electrical panels have been properly labeled.
Intercom and fire alarm systems are complete, tested and properly operating.
All potable water lines are acceptably tested and sanitized if required by the contract. All
sitework is complete including fencing, stormwater management, sanitary sewer, lift stations
and/or wastewater treatment plant, paving and athletic fields.
The as built plans are fully updated by all parties and are available at the jobsite for inspection.
Operating and maintenance manuals are complete as required, are assembled and have been
reviewed for completeness by the general contractor and are available at the jobsite for
inspection.
REQUEST FOR PUNCH LIST INSPECTION 000007 - 1

Request for Punch List Inspection - 000007
Signature Date
General Contractor
(Project Superintendent)
General Contractor
(Owner or Project Manager)
Electrical Sub-contractor
(Owner or Project Manager)
Plumbing Sub-contractor
(Owner or Project Manager)
HVAC Sub-contractor
(Owner or Project Manager)
Roofing Sub-contractor
(Owner or Project Manager)
Painting Sub-contractor
(Owner or Project Manager)
Sitework Sub-contractor
(Owner or Project Manager)
Confirmation by Owner
Confirmation by Architect
Confirmation by Mechanical
Engineer
Confirmation by Electrical
Engineer
Confirmation by Civil
Engineer
Status of Test and Balance: Part A Completed
Report Issued
REQUEST FOR PUNCH LIST INSPECTION 000007 - 2

Request for Punch List Inspection - 000007
EXCEPTION LIST
Work Not Complete Responsible Party Reason for Not Being Complete
REQUEST FOR PUNCH LIST INSPECTION 000007 - 3

Request for Punch List Inspection - 000007
Notes:
1. A punch list inspection will not be scheduled until this request is completed, signed and
submitted to the Owner and the Architect and the project is found to be substantially
complete.
2. A punch list inspection will not be scheduled if the exception list includes work which could
be complete but is not complete because of lack of sub-contractor response or for
convenience.
3. The punch list inspection will normally be scheduled to take place within one week of
receipt of a properly executed and signed request.
4. Every effort will be made to conduct the punch list inspection with all parties (Owner,
Architect and Engineers) present at the same time. Completion and issue of the
inspection list will be expedited.
5. Every effort will be made to include all inputs into the inspection list initially issued. If this
is not possible, the Architect will issue an addendum to cover added items, there will only
be one inspection list which will be attached to and become a part of the Certificate of
Substantial Completion. Time allowed for completion of work on the punch list will be
stated on the Certificate of Substantial Completion.
REQUEST FOR PUNCH LIST INSPECTION 000007 - 4

Punch List Inspection Format - 000008
PUNCH LIST INSPECTION FORMAT
FOR THE PUNCH LIST INSPECTION OF ALL
CITY OF LAKE WALES MAJOR CONSTRUCTION
TO: , Architect
FOR: Project #
CONSTRUCTION MANAGER:
DATE OF PUNCH LIST INSPECTION:
1. Publish a written list of defects to the City and the Prime Contractor in five working days
indicating numbered defects or inequalities. Both Architectural and Engineering punch
lists shall be delivered, performed and incorporated as one. It is the Architect's
responsibility to notify all parties of the date and time of the punch list inspection.
2. ARCHITECTURAL - Numbered punch list items shall be carried out in a logical manner
including but not limited to:
A. Civil
1. Paving
2. Storm Water
3. Retention Areas
4. Irrigation System
5. Sod
6. Fencing
B. Electrical
1. Site
2. Switch gear/panels (Reference FISH)
3. Lighting (Reference FISH)
4. Equipment (Reference FISH)
C. Plumbing
1. Site
2. Fixtures (Reference FISH)
3. Fire Sprinkler (Reference FISH)
4. Equipment (Reference FISH)
D. HVAC
1. Site
2. Equipment (Reference FISH)
3. Reference Test and Balance Report
PUNCH LIST INSPECTION FORMAT 000008 - 1

Punch List Inspection Format - 000008
NOTE: All equipment shall be run through its full range of operation and/or cycle.
4. Verification that punch list items are complete shall be done at the Construction
Manager's request. One re-inspection shall be performed as a part of the Architect's
contract. If additional inspections are required, the Construction Manager will reimburse
the Owner for the cost of such inspections including charges by the Architect.
At the second re-inspection if any items remain the Architect shall, at the Owner's
request, assign a cost to complete the remaining work and forward to the City. At each
re-inspection the first punch list shall be used. Line out each item number and date.
The original punch list shall be re-published for re-inspections. Any item noted as
complete shall be lined through the item number, so any item number not lined out will
indicate that the item remains to be done. Indicate date that all items are lined out.
PUNCH LIST INSPECTION FORMAT 000008 - 2