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SECTION 00622 - Contractor's Application for ��l Payment <br />REVISION # 2 <br />Application for Payment No 6 <br />For Work Accomplished through the period of 04/12/14 through 09/23/14 <br />To: Indian River Countv (OWNER) <br />From: Timothv Rose Contractinq, Incorporated <br />Contract: 9334 <br />Project: T27 -Street and 27th Avenue Intersection Improvements <br />OWNER's Bid No. 2013021 <br />ENGINEER I.R.C. Public Works. <br />(1) Attach detailed schedule and copies of all paid invoices. <br />1. Original Contract Price: <br />2. Net change by Change Orders and Written Amendments (+ or <br />3. Current Contract Price (1 plus 2): <br />4. Total completed and stored to date: <br />5. Retainage (per Agreement): <br />5 % of completed Work/Materials: $0 <br />% of retainage: $ <br />Total Retainage: <br />6. Total completed and stored to date less retainage (4 minus 5): <br />7. Less previous Application for Payments: <br />8. DUE THIS APPLICATION (6 MINUS 7): <br />$1,525,216.32 <br />0.00 <br />$1,525,216.32 <br />$1,424,417.27 <br />$1,424,417.27 <br />$1,353,196.41 <br />$71,220.86 <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 10/03/14 <br />State of Florida <br />County of Indian River <br />Subscribed and sworn to before me this 03 <br />day of October 2014 <br />Notary Public <br />My Commission expires: 10/03/15 <br />Timothv Rose Contractina, Incorporated <br />(CONT <br />o. �MAAnn.�r� <br />DEBORAH DE'EST <br />MY COMM[SSION J r??1368gy <br />E)UTM: fn -fAXY C3, _u i 3 <br />v �. h :ter `� wr. hmae to <br />Page 1 of 2 <br />00622-1 152 <br />C:\Users\0wner\Documents\12th St. 27th Ave. Intersection Imps\Cover PA #6.doc <br />