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Application and Certificate for Payment <br /> APPLICATION NO.: 4 (FINAL) <br /> TO OWNER: Indian River County PRO.IEcT: Vero Lake Estates Master Planned 12% Water Transmission Main <br /> Board of County Commissioners PERIOD TO: 11 /30/2008 <br /> 1800 27th Street <br /> Vero Beach , FL 32960 <br /> CONTRACT DATE: 11 !20/2007 <br /> CONTRACTOR: SHELTRA & SON CONSTRUCTION CO., INC. PROJECT NO: UCP #2958 <br /> P.O. BOX 336, INDIANTOWN, FL 34956 <br /> Mos <br /> CONTRACTOR' S APPLICATION FOR PAYMENT <br /> ORIGINAL CONTRACT SUM: $968.328.00 The undersigned Contractor certifies that to the best of the contractors knowledge, information and belief the <br /> work covered by this application for Payment <br /> has been completed in accordance with the contract documents, that all amounts have been paid by the contractor for work which previous <br />catifiates for <br /> CHANGE ORDERS M 1&2 $ 114. 197.60 payment were issued and payments received from the owner, and that current payment shown herein is now due. <br /> CONTRACTOR <br /> CONTRACT SUM TO DATE: $ 1 .082.525 .60 <br /> BY: DATE: Z S <br /> TOTAL WORK COMPLETED: $ 1 .078.535 .00 oltn L. Pluswick <br /> STATE OF: FLORIDA <br /> RETAINAGE (ONu): $0,00 COUNTY OF: MARTIN <br /> SUBSCRIBED AND SWORN TO BEFORE ME TIES DAY OF ib «M E Z o0 <br /> EARNED LESS RETAINAGE: $ 1 .078.535.00 1 SILVER <br /> on DID NOTARYNOTARY PUBLIC: g►: Cmmiss"- <br /> EJ#reS p pri127, 2012 <br /> LESS PREVIOUS CERT. $884.587 .50 11 � gmibdTMuLgrtiiaYruarwaWa5-7ats <br /> CURRENT PAYMENT DUES $ 193.947 .50 , MY COMMISSION EXPIRES: <br /> ENGINEER' S CERTIFICATE FOR PAYMENT <br /> FINAL CHANGE ORDER #3 -$34990.60 to accordance with the contract documents, based on on-site observations and the data comprising this application, the <br />engineer certifies to the owner that to <br /> the best of the engineers knowledge, information and belief the work has progressed as indicated, the quality of the work is in <br /> accordance with contract <br /> BALANCE TO FINISH $0.00 documents, and the contractor is entitled to payment of the AMOUNT CERTIFIED. <br /> - CHANGE ORDER SUMMARY ADDITIONS / DEDUCTIONS AMOUNT CERTIFIED„„„,„„„„„+,„„,„m„++,++++++++,++++,»+++++«.++»++++++++»+»++++++++++++++*++»++m++,«+.+,++++s <br /> Total changes previous mos. <br /> Total approved this Month ENGINEER: <br />