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SECTION 00622 - Contractor's Application for Partial Payment <br />FINAL <br />Application for Payment No 5 <br />For Work Accomplished through the period of 01/01/16 through 01/15/16 <br />To: Indian River County (OWNER) <br />From: Timothy Rose Contracting, Incorporated <br />Contract: 1413 <br />Project: Martin Luther King Jr. Walking Trail <br />OWNER's Bid No. 2015034 <br />ENGINEER I.R.C. Public Works. <br />(1) Attach detailed schedule and copies of all paid invoices. <br />1. Original Contract Price: $128,723.60 <br />2. Net change by Change Orders and Written Amendments (+ or -): $189,586.57 <br />3. Current Contract Price (1 plus 2): $318,310.17 <br />4. Total completed and stored to date: $312,447.12 <br />5. Retainage (per Agreement): <br />2_% of completed Work/Materials: <br />5% of retainage: <br />Total Retainage: $00 <br />6. Total completed and stored to date less retainage (4 minus 5): $312.447.12 <br />7. Less previous Application for Payments: $294,074.51 <br />8. DUE THIS APPLICATION (6 MINUS 7): $18,372.61 <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 />Dated 01/15/16 <br />State of Florida <br />County of Indian River <br />Subscribed and sworn to before me this 15 Day of January <br />Notary Public 1� <br />My Commission expires: 10/03/19�,�.. �� <br />Timothy Rose Contracting. Incorporated <br />(CONTRACTOR) <br />BY: <br />DEBORAH WEST <br />MY COMM1ssION i FF904578 <br />EXPIRES: October 03, 2019 <br />00622-1 i <br />C:\Users\Owner\DocumentsNIJC Walking Trail\Cover PA #5.doc 84 <br />