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9/30/2015 9:20:07 PM
Official Document Type
Agenda Item Number
Danella Companies, Inc.
Utilities Contractor - Best Car Wash FM Relocation
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Na 1 _ <br /> • m <br /> 1001 W . Cypress Creek Rd , Suite 300 <br /> .. . : ;.. , . Ft . Lauderdale , Florida 33309 <br /> Application for Payment No . 1 _ <br /> For Work Accomplished through the period of September 1 st through September 15th , 2005 . <br /> To : Indian River County ( OWNER) <br /> From : The Danella Companies , Inc . , Utilities Labor Contractor <br /> Project Name : Best Car Wash FM Relocation <br /> COUNTY WIP NO . : UCP # 2665 <br /> ENGINEER OF RECORD : Gordon E . Sparks , P . E . . <br /> 1 . Original Contract Price : $21 , 999 . 52 <br /> 2 . Net change by Change Orders and Written Amendments ( + or - ) : - 31664 . 65 <br /> 3 . Current Contract Price ( 1 plus 2 ) : $ 18 , 334 . 87 <br /> 4 . Total completed and stored to date (*) : $ 18 , 334 . 87 <br /> 5 . Retainage ( per Agreement) : <br /> 0 % of completed Work : $0 . 00 <br /> 0 % of stored material : $ 0 . 00 <br /> Total Retainage : $0 . 00 <br /> 6 . Total completed and stored to date less retainage (4 minus 5 ) : $ 18 , 334 . 87 <br /> 7 . Less previous Application for Payments : $0 . 00 <br /> 8 . DUE THIS APPLICATION ( 6 MINUS 7 ) : $$ 181334 . 87 <br /> (*) If applicable, an Itemized list of labor and/or materials furnished and installed I s attached. <br /> CONTRACTOR' S CERTIFICATION : <br /> The undersigned CONTRACTOR certifies that ( 1 ) all previous progress payments received from <br /> OWNER on account of Work done under the Contract referred to above have been applied on <br /> account to discharge CONTRACTOR ' s legitimate obligations incurred in connection with Work <br /> covered by prior Applications for Payment numbered 1 through 2 inclusive ; ( 2 ) title of all Work <br />, <br /> materials and equipment incorporated in said Work or otherwise listed in or covered by this <br /> Application for Payment will pass to OWNER at time of payment free and clear of all Liens , security <br /> interests and encumbrances ( except such as are covered by a Bond acceptable to OWNER <br /> indemnifying OWNER against any such Lien , security interest or encumbrance ) ; ( 3 ) all Work <br /> covered by this Application for Payment is in accordance with the Contract Documents and not <br /> defective and (4) If this Periodic Estimate is for a Final payment to project or improvement , I further <br /> certify that all persons doing work upon or furnishing materials or supplies for this project <br /> or <br /> improvement under this foregoing contract have been paid in full , and that all taxes imposed by No . <br /> 212 Florida Statutes , ( Sales and Use Tax Act , as Amended ) have been paid and discharged , and <br /> that I have no claims against the OWNER . —� <br /> Dated J <br /> ( CONTRACTOR ) <br /> By : ,, <br /> State of L"A — n <br /> County of �> �t� J� NICHOLAS J. FIDUCCIA <br /> Subscribed and sworn to b forewwe this P40TA <YPUeuc - STATE Or : _ .: •tnA <br /> day of I � , . ° �aes""nDD01"_ : <br /> Notary Public DOM= TURU 141WP <br /> Page 1 of 2 <br /> Y:\Job Folders\Indian River County nnual Contract\Best Car Wash\IRC - 00622Application for Payment Best Car Wash. doc Rev. 07/01 <br /> Attachment 1 <br />
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