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APPLICATION FOR PAYMENT NO:2 FINAL -Jeri CO!/�' <br /> cgsTo: Indian River County Utilities cmc �, <br /> From: Blue Goose Growers, LLC(CONTRACTOR) c <br /> Contract: NOV 21 2017 y <br /> PO#: <br /> Project: Heron Cay MHP-Longpointe Ct-WM&Service Replacement Received <br /> For Work completed through the date of November 15,2017 FMarICe . - <br /> 1 Original Contract Price: $ 59,334.17 <br /> 2 Net change by Change Orders and Written Amendments(+or-): - <br /> 3 Current Contract Price(1 plus 2) 59,334.17 <br /> 4 Total completed and stored to date: 53,940.15 <br /> 5 Retainage(per Agreement) <br /> of completed work <br /> of stored material $ - <br /> Total Retainage: - <br /> 6 Total complete and stored to date less retainage(4 minus 5) 53,940.15 <br /> 7 Less previous Application for Payments 20 669.33 <br /> 8 DUE THIS APPLICATION(6 MINUS 7) 33,270. <br /> / <br /> /A-Re)--/7 k�-1—' I\oe1000--\-451� <br /> Acco m panyinDocumentation: <br /> 4.0 0 011. <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that(1)all previous progress payments received from OWNER on <br /> account of Work done under the Contract referred to above have been applied on account to discharge <br /> CONTRACTOR's legitimate obligations incurred in connection with Work covered by prior Applications for <br /> Payment numbered 1 through 1 inclusive;(2)title of all Work, materials and equipment incorporated in <br /> said Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of <br /> payment free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond <br /> acceptable to OWNER indemnifying OWNER against any such Lien,security interest or encumbrance);and(3) <br /> all Work covered by this Application for Payment is in accordance with the Contract Documents and not <br /> defective. <br /> Dated: 1 1. 20.1 I- Blue Goose Growers, LLC OCE/k. <br /> CONTRACTOR O <br /> • �pv2.. an <br /> By: . �� 0� <br /> 1 Greg Hampton, ontroll NA <br /> State of lDkrkA4. <br /> County of S}.LL.) c i e <br /> • <br /> Subscribed i d sworn to befor me this Z-(� day of W D✓e-rh Th tv' , 2017 <br /> Notary Public TFAESAGORMAN <br /> SeNs My COM.14SSION I FF945828 <br /> My Commission expires: Pi <br /> �J,,, .l S <br /> EXPIRES:December 22.2019 <br /> ' aYi 8ocdedThu NotaryPutAcUnder�tes <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated: 0//2Of , <br /> • ENGIJ.: Wit <br /> By:,„, . 6z------ kti3 <br /> Oft\I'l <br /> ( <br /> P50 <br />