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SECTION 00622 - Contractor's Application for Final Payment <br /> I <br /> Application for Payment No. 1. j <br /> For Work Accomplished through the period of 9/01/2015 through 9/15/2015 <br /> To: Indian River Countv— Dept of Utilities (OWNER) <br /> From: Blue Goose_ Construction. LLC (CONTRACTOR) <br /> Contract: 2015001 <br /> Project: 3" Galvanized Water Main Replacement — Vista Royal <br /> OWNER's Contract No. ENGINEER's Contract No. <br /> ENGINEER Mr. Gordon Sparks. <br /> (1s) <br /> pt <br /> tact,detailed;schedule::andi'coes of all ai 'invoices <br /> _ -- <br /> 1. Original Contract Price: $71,442.93 <br /> 2. Net change by Change Orders and Written Amendments (+ or $0.00 <br /> 3. Current Contract Price (1 plus 2): $71,442.93 <br /> 4. Total completed and stored to date: $71,442.93 <br /> 5. Retainage (per Agreement): <br /> % of completed Work: $ <br /> % of retainage: $ <br /> Total Retainage: $0.00 <br /> 6. Total completed and stored to date less retainage (4 minus 5): $71,442.93 <br /> 7. Less previous Application for Payments: $0.00 <br /> 8. DUE THIS APPLICATION 6 MINUS 7): $71.442.93 <br /> CONTRACTOR'S CERTIFICATION: <br /> I hereby certify that the labor and materials listed on this request for payment have been used in the <br /> construction of this work and payment received from the last request for payment has been used to <br /> make payments to all subcontractors, laborers, material men and suppliers, except as noted below. <br /> The acceptance of final payment shall be and shall operate as a release of the OWNER from all <br /> claims and all liability to the CONTRACTOR other than claims in stated amounts as may be <br /> specifically excepted by the CONTRACTOR for all things done or furnished in connection with this <br /> Work and for every act and neglect of the OWNER and others relating to or arising out of this Work. <br /> Any payment, however, final or otherwise, shall not release the CONTRACTOR or his sureties from <br /> any obligations under the Contract Documents or the Payment and Performance Bonds. <br /> Dated 9/24/2015 � <br /> (CONTRACTOR) <br /> By: Robert S. Holmes <br /> State of OC i do- <br /> County of -CL Ci <br /> Subscribed and sworn to before me this :'' DENISE SMITH <br /> day of <br /> MY COMMISSION ii FF910496 <br /> EXPIRES November 07,2019 <br /> Notary Public Fl&WeNm yssftire Can, <br /> My Commission expires: I t 1 <br /> 00622-Contractor's Application for Final Payment-Per Marian <br /> 00622-1 1�1 1 <br /> C:1UserslghamptonlAppDatalLoca[Microsoft\Windows\Temporary Internet FleslContent.OutlooklLRHJTTRF100622-Contractor's Application for Final Payment-Per Marian.doc Rev. 1/4 <br /> 05M t <br />