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SECTION 00622 - Contractor's Application for Partial Payment <br />REVISED 2 <br />Application for Payment No, 10 <br />For Work Accomplished through the period of 04/01/17 through 04/30/17 <br />To: Indian River County (OWNER) <br />From: Timothy Rose Contracting, Incorporated <br />Contract: 1138 <br />Project: Old Dixie Resurfacing from 71St St to CR510 Project <br />OWNER's Bid No. 2016001 <br />ENGINEER I.R.C. Public Works. <br />(1) Attach detailed schedule and copies of all paid invoices. <br />1. Original Contract Price: $2,467,160.62 <br />2. Net change by Change Orders and Written Amendments (+ or <br />3. Current Contract Price (1 plus 2): $2,467,160.62 <br />4. Total completed and stored to date: $2,139,741.70 <br />5. Retainage (per Agreement): <br />0 % of completed Work/Materials: $00 <br />0% of retainage: $0 <br />Total Retainage: <br />6. Total completed and stored to date less retainage (4 minus 5): $2.139,741.70 <br />7. Less previous Application for Payments: $2,031,572.34 <br />8. DUE THIS APPLICATION (6 MINUS 7): $108,169.36 <br />CONTRACTOR'S CERTIFICATION: <br />1 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 05/09/17 Timothy Rose Contracting, Incorporated <br />(CONTRACTOR) <br />By `� <br />State of Florida <br />County of Indian River <br />Subscribed and sworn to before me this 25 Day of Aari1,2017 <br />Notary Public <br />DE?30RAH WEST <br />My COMMISSION it FF904578 <br />'� ExPliira:Octoba 03, 2019 <br />osFl <br />My Commissionexpi : 10/03/19`'''°^��°"`�"°}AD <br />00622-1 <br />CAUsers\Debbie\Documents101d Dixie Resurfacing from 71st St to CR 5101Cover PA#10 - revised.doc <br />P72 <br />