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Na 1 _ • m 1001 W . Cypress Creek Rd , Suite 300 .. . : ;.. , . Ft . Lauderdale , Florida 33309 Application for Payment No . 1 _ For Work Accomplished through the period of September 1 st through September 15th , 2005 . To : Indian River County ( OWNER) From : The Danella Companies , Inc . , Utilities Labor Contractor Project Name : Best Car Wash FM Relocation COUNTY WIP NO . : UCP # 2665 ENGINEER OF RECORD : Gordon E . Sparks , P . E . . 1 . Original Contract Price : $21 , 999 . 52 2 . Net change by Change Orders and Written Amendments ( + or - ) : - 31664 . 65 3 . Current Contract Price ( 1 plus 2 ) : $ 18 , 334 . 87 4 . Total completed and stored to date (*) : $ 18 , 334 . 87 5 . Retainage ( per Agreement) : 0 % of completed Work : $0 . 00 0 % of stored material : $ 0 . 00 Total Retainage : $0 . 00 6 . Total completed and stored to date less retainage (4 minus 5 ) : $ 18 , 334 . 87 7 . Less previous Application for Payments : $0 . 00 8 . DUE THIS APPLICATION ( 6 MINUS 7 ) : $$ 181334 . 87 (*) If applicable, an Itemized list of labor and/or materials furnished and installed I s attached. CONTRACTOR' S CERTIFICATION : The undersigned CONTRACTOR certifies that ( 1 ) all previous progress payments received from OWNER on account of Work done under the Contract referred to above have been applied on account to discharge CONTRACTOR ' s legitimate obligations incurred in connection with Work covered by prior Applications for Payment numbered 1 through 2 inclusive ; ( 2 ) title of all Work , materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment free and clear of all Liens , security interests and encumbrances ( except such as are covered by a Bond acceptable to OWNER indemnifying OWNER against any such Lien , security interest or encumbrance ) ; ( 3 ) all Work covered by this Application for Payment is in accordance with the Contract Documents and not defective and (4) If this Periodic Estimate is for a Final payment to project or improvement , I further certify that all persons doing work upon or furnishing materials or supplies for this project or improvement under this foregoing contract have been paid in full , and that all taxes imposed by No . 212 Florida Statutes , ( Sales and Use Tax Act , as Amended ) have been paid and discharged , and that I have no claims against the OWNER . —� Dated J ( CONTRACTOR ) By : ,, State of L"A — n County of �> �t� J� NICHOLAS J. FIDUCCIA Subscribed and sworn to b forewwe this P40TA <YPUeuc - STATE Or : _ .: •tnA day of I � , . ° �aes""nDD01"_ : Notary Public DOM= TURU 141WP Page 1 of 2 Y:\Job Folders\Indian River County nnual Contract\Best Car Wash\IRC - 00622Application for Payment Best Car Wash. doc Rev. 07/01 Attachment 1