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SECTION 00622 - Contractor's Application for Payment <br /> 27�h Avenue Milling and Resurfacing (Oslo Road to S.R. 60) <br /> Application for Payment No. 7 <br /> For Work Accomplished through the period of 03/01/13 through 04/25/13 <br /> To: Indian River County(OWNER) <br /> From: (CONTRACTOR) Ranger Construction Industries,Inc. <br /> Bid: 2012029 <br /> Project: 0391 <br /> 1) Attach detailed schedule and copies of all paid invoices. <br /> 1. Original Contract Price: $ 1,293,157.53 <br /> 2. Net change by Change Orders and Written Amendments(+or-): $ 55.771.78 <br /> 3. Current Contract Price(1 plus 2): <br /> $ 1,348,929.31 <br /> 4. Total completed and stored to date: $1,309,203.54 <br /> 5. Retainage(per Agreement): <br /> 100 %of completed Work: $ 1,309,203.54 <br /> 0 - %of retainage: $ <br /> Total Retainage: $ <br /> 6. Total completed and stored to date less retainage(4 minus 5): $ 1.309,203.54 <br /> 7. Less previous Application for Payments: $ 1.177.968.19 <br /> 8. DUE THIS APPLICATION 6 MINUS 7): $131.235.35 <br /> CONTRACTOR'S CERTIFICATION: <br /> UNDER PENALTY OF PERJURY, the undersigned CONTRACTOR certifies that (1) the labor <br /> and materials listed on this request for payment have been used in the construction of this Work; (2) <br /> payment received from the last pay request has been used to make payments to all subcontractors, <br /> laborers, materialmen and suppliers except as listed on Attachment A, below; (3)title of all Work, <br /> materials and equipment incorporated in said Work or otherwise listed in or covered by this <br /> Application for Payment will pass to OWNER at time of payment free and clear of all Liens,security <br /> interests and encumbrances (except such as are covered by a Bond acceptable to OWNER <br /> indemnifying OWNER against any such Lien, security interest or encumbrance); (4) all Work <br /> covered by this Application for Payment is in accordance with the Contract Documents and not <br /> defective; and(5) If this Periodic Estimate is for a Final Payment to project or improvement, I further <br /> certify that all persons doing work upon or furnishing materials or supplies for this project' or <br /> improvement under this foregoing contract have been paid in full, and that all taxes imposed by <br /> Chapter 212 Florida Statutes, (Sales and Use Tax Act, as Amended) have been paid and <br /> discharged,and that I have no claims against the OWNER. <br /> Attached to or submitted with this form are: <br /> 1. Signed release of lien forms (partial or final as applicable) from all subcontractors, laborers, <br /> materiaimen and suppliers except as listed on Attachment A,together with an explanation as <br /> to why any release of lien form is not included; <br /> 00622-Contractor's Application for Payment-03-10 rev.doc <br /> 00822-1 <br /> F.1Pubrx V4*1MENG1NEERtNG DIVISION PROJECTSM91-27th Ave at SM St SWAdmlmlCw*vd Domme Ms10 W-CuftdWs Appbwflm for PaymerM-W-10 tsv.doo Rev. <br /> 05101 <br /> 66 <br />