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SECTION 00622 - Contractor's Application for Final Payment <br />Application for Payment No. 1. <br />For Work Accomplished through the period of 9/20/2015 through 9/23/2015 <br />To: Indian River County – Dept of Utilities (OWNER) <br />From: Blue Goose Construction. LLC (CONTRACTOR) <br />Contract: 2015001 <br />Project: The Highlands & Falcon Trace Water Main Loop Completions <br />OWNER's Contract No. ENGINEER's Contract No. <br />ENGINEER Mr. Gordon Sparks. <br />(f);Attach detail" i:s- f, aciule and copies"gf`all paid :invoices! <br />1. Original Contract Price: $88,613.69 <br />2. Net change by Change Orders and Written Amendments (+ or $0.00 <br />3. Current Contract Price (1 plus 2): $88,613.69 <br />4. Total completed and stored to date: $88,613.69 <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): $88.613.69 <br />7. Less previous Application for Payments: $0.00 <br />8. DUE THIS APPLICATION (6 MINUS 7): $88,613.69 <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 r L--- — ' <br />(CONTRACTOR) <br />By: R.S. Holmes <br />State of <br />County of SA LlxX-k- — <br />Subscribed and sworn to before me this <br />day of Q—g \ <br />Notary Public to` t Ia <br />My Commission expires: l <br />Cecile Rose Help <br />NOTARY RUt3 X <br />STATE OF FUINDA <br />Corm FF244M <br />E>Pires g/29/2019 <br />1092 - 1094 Highland & Falcon Trace WM Loop Q <br />00622-1 <br />F:\USERS\COMMON\Blue Goose Construction\t-Projects\1- Projects Awarded\INDIAN RIVER UTILITIES LABOR CONTRACT\Bllling\1092 -1094 Highland 8 Falcon Trace WM Loop <br />v2.doc Rev 05101 <br />114 <br />