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L SECTION 00622 - Contractor' s Application for Payment Application for Payment No . For Work Accomplished through the period of through To : Indian River County (OWNER ) From : (CONTRACTOR) Contract : Project: OWNER's Contract No . ENGINEER' s Contract No , ENGINEER 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 : 8 . DUE THIS APPLICATION 6 MINUS 7) : - - 00622 : 00622 - Contractor's Application for Payment REV 04-07.doc 00622 - 1 F:\Engineering\Special Projects\Eagle Trace Phase 2\Contract Documerds\Eagle Trace Subdivision Phase II\00622 - Contractor's Application for Payment REV 04-07.doc Rev. 05/01