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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 County (OWNER) <br />From: (CONTRACTOR) <br />Project No. 2009024 <br />Project: Oslo Road Boat Ramp Repairs <br />Bid No. 2009024 <br />ENGINEER Indian River County <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.c): <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 />8. 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 Tess retainage (4 minus 5): $ <br />7. Less previous Application for Payments: $ <br />8. DUE THIS APPLICATION (6 MINUS 7): $ <br />00622 - Contractor's Application for Payment <br />00622 - 1 <br />F:\Engineering\Capital Projects\0381 Oslo Road Boat Ramp\0381 Contract Documents and Specifications\00622 - Contractors Application for Payment.doc Rev. 05/01 <br />