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.payrn�e�r�t <br />SECTION 00622 - Contractor's Application for Partial Payment <br />MAY 10 2017 Application for Payment No. 10 <br />For Work Accomplished through the period of 04/01/17 through 04/30/17 <br />F <br />To: Indian River County (OWNER) <br />From: Timothy Rose Contracting, Incorporated <br />Contract: 1138 <br />Project: Old Dixie Resurfacing from 7161 St to CR510 Protect <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: $2,134,988.10 <br />5. Retainage (per Agreement): <br />0 % of completed Work/Materials: LO <br />0% of "retainage: N0 <br />Total Retainage: $0 <br />6. Total completed and stored to date less retainage (4 minus 5): $2,134,988.10 <br />7. Less previous Application for Payments: $2,031,572.34 <br />8. DUE THIS APPLICATION (6 MINUS 7): 103 415.76 <br />CONTRACTOR'S CERTIFICATION: <br />I hereby certify that the labor and materials fisted 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 <br />State of Florida <br />County of Indian River <br />Subscribed and sworn to before me this 2255 Day of ADrfl 2, 017 <br />Notary Public <br />My Commissiones: 10/03/19 <br />Timothy Rose Contracting, Incorporated <br />(CONTRACTOR) <br />/6 <br />n•� <br />i�E3QRA�EF ' MY COMMISSI5 <br />MH ES: Oc019 <br />t1nfUNfVVVVVVqV%P <br />SII a 3.5 3 LV — b L4, q- Uo Ll &I — I'S a <br />00622-1 <br />C:1Users\Debb1e%Documents%O1d Dixie Resurfacing from 71st St to OR 51 Mover PA#10.doc <br />P73 <br />