Laserfiche WebLink
ATTACHMENT 4 <br /> CONSULTANT'S APPLICATION FOR PAYMENT NO. <br /> for <br /> WORK ORDER NO. 1 -RR - PROFESSIONAL� ENGINEERINGY SERVICES <br /> for the ROCKRIDGE SUBDIVISION SURGE PROTECTION PROJECT <br /> To: INDIAN RIVER COUNTY PUBLIC WORKS DEPARTMENT <br /> For Work accomplished through the date of <br /> Percent Total Gross <br /> Contract Complete Percent Contract <br /> Task Amount From Complete Amount Due <br /> (2) Previous This Pay This Pay <br /> Pay Request Request <br /> Requests 3) (2)x(3 <br /> Land Surveying Services 18 , 000 <br /> TOTAL GROSS CONTRACT AMOUNT DUE THIS PAY REQUEST <br /> AMOUNT OF RETAINAGE <br /> ( 10% of Total Gross Contract Amount Due This Pay Request) <br /> CONTRACT AMOUNT EARNED TO DATE <br /> (Total Gross Contract Amount Due This Pay Request minus Amount of <br /> Retainage) <br /> TOTAL AMOUNT PAID TO CONSULTANT PRIOR TO THIS PAY ( ) <br /> REQUEST <br /> AMOUNT DUE THIS PAY REQUEST <br /> (Contract Amount Earned To-Date minus Total Amount Paid To Consultant <br /> Prior To This Pay Request) <br /> ( 1 ) Attach copies of all invoices for Reimbursable Expenses <br /> CONSULTANT' S CERTIFICATION : <br /> THE UNDERSIGNED CONSULTANT' S REPRESENTATIVE CERTIFIES that I have <br /> checked and verified this Application for Payment No . _ and that to the best of my <br /> knowledge and belief, it is a true and correct statement of work performed and/or material <br /> supplied by the CONSULTANT ; that all work and/or materials included in the Application <br /> for Payment have been inspected by me and/or by my duly authorized representative or <br /> assistants; that it has been performed and/or supplied in full accordance with the <br /> requirements of the referenced Contract and with sound engineering practice and <br /> judgment; and that the payment amount claimed and requested by the CONSULTANT is <br /> correctly computed on the basis of work performed and/or materials supplied to date . <br /> THE UNDERSIGNED CONSULTANT' S REPRESENTATIVE ALSO CERTIFIES that all <br /> previous progress payments received from the COUNTY on account of Work done under <br /> the Contract referred to above have been applied on account to discharge <br /> 7 <br /> FAPublic Works\KeithM\Stormwater Projects\Rockridge Subdivision\Work Orders\Work Order #1 - Malcolm Pirnie\FINAL VERSION - <br /> Malcolm Pirnie Work Order #1 -RR (for initial surveying services).doc <br />