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CONTRACTOR APPLICATION FOR PAYMENT <br />Project Name: South County Brine Disposal Pipeline <br />Application No.: 5Final <br />Date Prepared : 5/6/2014 <br />Period Beginning: 12/25/2013 <br />Owner: Indian River County <br />Period Ending : 1/28/2014 <br />Engineer's Project No.: <br />Contractor : Felix Associates of Florida, Inc. <br />Felix's Project No.: 1620-001 <br />Dollar % Completion : 93.42% <br />Engineer : Kimley-Horn Associates <br />Last Change Order No.: <br />Work Started: 8/25/2013 <br />Contract Time : 156 <br />Contract Completion Date : 1/2812014 <br />Analysis of Adjusted Contract Amount to Date : <br />$ 1,164,853.40 <br />(A) Original Contract Amount <br />(B) Plus/Less: Adds/Deducts per Contract Change Orders <br />(C) Current Contract Amount to Date Based on Estimated Quantities <br />Analysis of Work Performed : <br />$ - <br />$ 1,164,853.40 <br />$ 1,088,201.47 <br />(A) Total Value of Work Performed to Date <br />(B) Less 0 % Retained <br />(D) Net Value Earned on Contract to Date <br />(E) Less : Amount of Previous Applications <br />$ - <br />$ 1,088,201.47 <br />$ 1,033,791.40 <br />(F) Balance Due this Pay Application $ 54,410.07 <br />LI -1I- —IZ 7 <br />Contractor's Certification : The undersigned Contractor certifies <br />that : <br />(1) All prevbus progress payments received from Owner on Account of Work done under the Contract referred to above have been applied to <br />discharge In full all obligations of Contractor Incurred in connection with Work covered by prior Applications for Payment numbered 1 through 3 <br />inclusive; (1) Title to all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for <br />Payment will pass to Owner at time of payment free and dear of all liens, claims, security interest and encumbrances (except such as are <br />covered by Bond acceptable to Owner indemnifying Owner against such Iten, claim, security interest or encumbrance); (3) All Work covered by <br />this Application for Payment is in accordance with the Contract Documents and not defective as that term Is defined In the Contract Documents. <br />Dated Mav 6 , 20 14 Felix Asso - • f a. •rId: nc <br />Fe <br />By ,; <br />Thomas Pas ore, Pro ect Manager <br />Acknowlegement: <br />STATE OF FLORIDA, COUNTY OF MARTIN, BEFORE ME PERSONALLY APPEARED Thomas Pastore TO ME WELL KNOWN TO BE <br />THE PERSON DESCRIBED IN AND WHO EXECUTED THE FOREGOING INSTRUMENT, AND ACKNOWLEDGED TO AND BEFORE ME <br />THAT HE EXECUTED SAID INSTRUMENT FOR THE PUROSED THEREIN EXPRESSED. <br />WITHNESS MY HAND AND OFFICIAL THIS 6thDAY OF May 20 14_ <br />C,V <br />NOTARY <br />MY COMMISISON EXPIRES S / s /11 <br />PUBLIC, STATE OF FLORIDA AT LARGE <br />Contractor's Recommendation :Payment of the above amount due this application <br />is recommended <br />7,41A4 <br />1A4 Y�� 5-71 y <br />Dated , 20 <br />Approved by OWNER for Payment : <br />By By <br />Date : /ttil, <br />Felix Associates, LLC. <br />Pay Request #5Final <br />AO 5 4y- <br />5/6/2014 <br />38 <br />