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Page 5 of 6 <br />ATTACHMENT A <br />1 List of all subcontractors, laborers, materialmen and suppliers who have not been <br />paid from the payment received from the last Pay Request and the reason why <br />they were not paid (attach additional pages as necessary): <br />2 List of all subcontractors, laborers, materialmen and suppliers for which a signed <br />release of lien form (partial or final as applicable) is not included with this Pay <br />Request, together with an explanation as to why the release of lien form is not <br />included (attach additional pages as necessary): <br />00622 - Contractor's Application for Payment - 03-10 rev.doc <br />00622 - 5 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1302-IR Blvd Resurfacing (SCOP) US1 to 17th St Admim\bid documents\00622 - Contractors Application for Payment - 03-10 <br />rev.doc Rev. 05/01 <br />