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INVOICE #: <br />SOUTHLAND PAINTING CORP. <br />2635 NW 4th Street <br />Fort Lauderdale, FL 33311 <br />Phone #: 954-748-2770 <br />Fax # . 954-748-2901 <br />8007 <br />REQUISITION # 16-07 <br />Date 085/25/2016 <br />Attachment 1 <br />To: Indian River Purchasing Dept. Job: Bid # 2016038 Sec. Containment <br />1800 27th Street <br />Vero Beach, FL 32960 Owner lnidan River County <br />This Invoice is for work performed on the above named job for the pay period ending 085/25/2016 <br />j �Do Not Write in <br />this space <br />AMOUNT OF ORIGINAL CONTRACT <br />APPROVED CHANGE ORDERS <br />TOTAL CONTRACT and <br />APPROVED CHANGE ORDERS <br />VALUE OF WORK PERFORMED <br />VALUE OF MATERIALS STORED ON SITE <br />TOTAL <br />LESS PREVIOUS REQUISITIONS <br />AMOUNT OF THIS REQUISITION <br />LE55 10 % RETAINAGE <br />LESS PREVIOUS PAYMENTS <br />PAYMENT REQUESTED <br />$ 81.334.00 <br />$ 81,334.00 <br />$ 81,334.00 <br />$ 81,334.00 <br />$ 81,334.00 <br />$ 81,334.00 <br />RELEASE <br />The Contractor certifies that all materials, labor, and services furnished by him through the above mentioned <br />pay period have been fully paid for (except as listed hereon below) and the premises of the above named <br />job cannot be made subject to any valid lien or claim by anyone who furnished material, labor or services to <br />the Contractor for use in said job; and the Contractor releases Indian River Purchasing Dept. <br />and the Owner from any further liability in connection with all materials, labor, and services furnished by <br />the Contractor through this pay period. <br />This release is given in order to induce payment in the amount of $ 81,334.00 <br />and on receipt of said payment by the Contractor this release becomes in full force and effect. <br />Exceptions are as follows: <br />Notary Affidavit: <br />Sworn to and subscribed before me this <br />day of <br />(Notary Public) <br />(SEAL) <br />SOUTHLAND PAINTING,CORP. <br />By: Carlos Rocha <br />Title: QCS <br />Date: 085/25/2016 <br />(SEAL) <br />58 <br />