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SECTION 00622 -Contractor's Application for Final Payment <br /> Application for Payment No. 2 FINAL <br /> For Work Accomplished through the period of 10/28/2013 through 11/28/2013 <br /> To: INDIAN RIVER COUNTY UTILITIES (OWNER) <br /> From: MELVIN BUSH CONSTRUCTION INC. (CONTRACTOR) <br /> Contract: WATER, SEWER, AND RECLAIM WATERLINE REPLACEMENT/EXTENSIONS AND <br /> MISCELLANEOUS LABOR CONTRACT BID NO. 2010052 AWARDED <br /> Project: CONSTRUCT TWO WM LOOPS ONE AT 9 MANOR SW & ONE ON 13th ST SW. <br /> OWNER's Contract No. ENGINEER's Contract No. <br /> ENGINEER INDIAN RIVER COUNTY UTILITIES. <br /> (1) Attach detailed schedule and copies of all paid invoices. <br /> 1. Original Contract Price: $37000.00 <br /> 2. Net change by Change Orders and Written Amendments (+ or-): $ <br /> 3. Current Contract Price (1 plus 2): $37000.00 <br /> 4. Total completed and stored to date: $30,311.16 <br /> 5. Retainage (per Agreement): <br /> % of completed Work: $ <br /> % of retainage: $ <br /> Total Retainage: $ <br /> 6. Total completed and stored to date less retainage (4 minus 5): $30,311.16 <br /> 7. Less previous Application for Payments: $15,250.55 <br /> 8. DUE THIS APPLICATION (6 MINUS 7): $15,060.61 <br /> CONTRACTOR'S CERTIFICATION: � 7 f.-2-0(P �3�Z�j — I(d��l s►) <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 12/03/2013 MELVIN BUSH CONSTRUCTION, INC <br /> (C�Rc.eA <br /> By: <br /> State of FLORIDABAR±3RRp1�� <br /> County of SAINT LUCIE r'•: �, PAWc C <br /> E1SSIPV a Fr 42.''1914 � �` i .,z HOa to PKV,E-EC <br /> Subscribed and sworn to before me this 0 `y ,� r XP)RES:it ne is2Q ,; AYCO'-'e MMS510N r FF 027974 of Deceroger . . <br /> EXPIRES:June 16,2017 <br /> Bonded Thor ko PACUM <br /> Notary Public BARBARA PAWELEC <br /> My Commi�si n expires: <br /> 00622-Contractor's Application for Final Payment <br /> 00622-1 <br /> FAusersVnary=TIVE PROJECTS and CONTRACTS 2012-201311RC 201005202011 ANNUAL REQUIREMENTS LABOR CONTRACTl00622-Conlrector's Application for Final <br /> Payment.doc Rev.05101 <br /> 41 <br />