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SECTION 00622 - Contractor's Application for Payment.doc <br />Application for Payment No. <br />For Work Accomplished through the period of through <br />To: Indian River Countv (OWNER) <br />From: (CONTRACTOR) <br />Contract: 2008080 <br />Project: 12rStreet Sidewalk from 43`d Ave to 27th Ave. <br />OWNER's Contract No.2008080 <br />ENGINEER Indian River County <br />ENGINEER's Contract No.N/A <br />1. Original Contract Price: $ <br />2. Net change by Change Orders and Written Amendments (+ or -): $ <br />3. Current Contract Price (1 plus 2): $ <br />4. Total Work to date: <br />4.a Percentage of Work completed to date: % <br />4.b Total Work completed to date: $ <br />4.c Total equipment and material stored to date: <br />$ (1) <br />4.d Total Work completed and stored to date: (4.b plus 4.c) $ <br />5. Retainage (per Agreement): <br />5.a 10% of completed Work (0.10 x 4.b): <br />5.b 20% of stored equipment and material (0.20 x 4.4 <br />5.c Total Retainage (5.a plus 5.b): $ <br />6. Total Work completed and stored to date less retainage <br />(4.d minus 5.c): $ <br />7. Previous Payments: $ <br />Be AMOUNT DUE THIS APPLICATION 6 MINUS 7): $ <br />(1) Attach detailed schedule and copies of all paid invoices. <br />1. Original Contract Price: $ <br />2. Net change by Change Orders and Written Amendments (+ or -): $ <br />3. Current Contract Price (1 plus 2): $ <br />4. Total completed and stored to date: $ <br />5. Retainage (per Agreement): <br />of completed Work: $_ <br />of stored material: $ <br />Total Retainage: $ <br />6. Total completed and stored to date less retainage (4 minus 5): $ <br />7. Less previous Application for Payments: $ <br />Be DUE THIS APPLICATION (6 MINUS 7): L— <br />00622 - Contractor's Application for Payment <br />00622-1 <br />F:\Engineering\Capital <br />Projects\0604.12th St Sidewalk <br />Improve between 43rd Ave 8 27th Ave\Bid Documents\00622 - Contractor's <br />Application <br />for Payment.doc Rev. 05/01 <br />