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e SECTION 00622 - Contractor's Application for Payment . doc Application for Payment No . For Work Accomplished through the period of through To : Indian River County ( OWNER) From : ( CONTRACTOR) Contract : 2008081 Project: TT�Street Sidewalk from 16th Ave to 11th Pl . OWNER's Contract No . 2008081 ENGINEER's Contract No . N/A ENGINEER Indian River County 1 . Original Contract Price : $ 2 . Net change by Change Orders and Written Amendments (+ or -) : $ 3 . Current Contract Price ( 1 plus 2 ) : $ 4 . Total Work to date : 4 . a Percentage of Work completed to date : % 4 . b Total Work completed to date : $ 4 . c Total equipment and material stored to date : $ ( 1 ) 4 . d Total Work completed and stored to date : (4 . b plus 4 . c) $ 5 . Retainage (per Agreement) : 5 . a 10% of completed Work (0 . 10 x 4 . b) : 5 . b 20 % of stored equipment and material (0 . 20 x 4 . c) : 5 . c Total Retainage (5 . a plus 5 . b) : $ 6 . Total Work completed and stored to date less retainage (4 . d minus 5 . c) : $ 7 . Previous Payments : $ 8 . AMOUNT DUE THIS APPLICATION ( 6 MINUS 7) : $ ( 1 ) Attach detailed schedule and copies of all paid invoices . 1 . Original Contract Price : $ 2 . Net change by Change Orders and Written Amendments (+ or -) : $ 3 . Current Contract Price ( 1 plus 2 ) : $ 4 . Total completed and stored to date : $ 5 . Retainage ( per Agreement) : of completed Work : $ of stored material : $ Total Retainage : $ 6 . Total completed and stored to date less retainage (4 minus 5) : $ 7 . Less previous Application for Payments : $ Be DUE THIS APPLICATION 6 MINUS 7) : i - 00622 - Contractor's Application for Payment 00622 - 1 F.\Engineering\Capital Projects\0216-12th Street Between 16th Avenue and 11th Place\0216 Bid Documents\00622 - Contractor's Application for Payment.doc Rev. 05/01