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SECTION 00622 - Contractor's Application for Partial Payment <br /> REVISION # 3 <br /> Application for Payment No. 18 <br /> For Work Accomplished through the period of 09/01/14 through 10/06/14 <br /> To: Indian River County (OWNER) <br /> From: Timothy Rose Contracting, Incorporated <br /> Contract: 0517 <br /> Project: Oso Road Phase III Roadway Improvements (Between 58th Ave & 43`d Ave) <br /> OWNER's Bid No. 2012036 <br /> ENGINEER I.R.C. Public Works. <br /> (1) Attach detailed schedule and copies of all paid invoices. <br /> 1. Original Contract Price: $3,812,202.37 <br /> 2. Net change by Change Orders and Written Amendments (+ or $0.00 <br /> 3. Current Contract Price (1 plus 2): $3,812,202.37 <br /> 4. Total completed and stored to date: $3,731,200.19 <br /> 5. Retainage (per Agreement): <br /> 5 % of completed Work/Materials: $00 <br /> % of retainage: $ <br /> Total Retainage: $00 <br /> 6. Total completed and stored to date less retainage (4 minus 5): $3,731,200.19 <br /> 7. Less previous Application for Payments: $3,544,640.18 <br /> 8. DUE THIS APPLICATION (6 MINUS 7): $186,560.01 <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 October 16, 2014 Timothy Rose Contracting, Incorporated <br /> (CONTRAC R) <br /> By: <br /> State of Florida <br /> County of Indian River <br /> Subscribed and sworn to before me this 16''day of October 2014 <br /> Notary Public: <br /> E <br /> EI30S�jM Commission res: 10/03/15 N:w" ' xo:wYAx4w <br /> Page 1 of 2 <br /> 44 <br /> 00622-1 <br /> C:\Users\Owner\Documents\Oslo Roadway Improvements\Cover PA#18.doc <br />