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APPLICATION FOR PAYMENT NO.2 - FINAL <br />To: <br />Indian River County Utilities <br />From: <br />Blue Goose Growers, LLC (CONTRACTOR) <br />Contract: <br />1290 <br />PO #: <br />Project: <br />Forest Park 6" WM Extension <br />For Work completed through the date of 04/17/18 <br />1 Original Contract Price: <br />2 Net change by Change Orders and Written Amendments (+ or <br />3 Current Contract Price (1 plus 2) <br />Contractor Purchased Material <br />4 Total completed and stored to date: <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) <br />7 Less previous Application for Payments <br />8 DUE THIS APPLICATION (6 MINUS 7) <br />Accompanying Documentation: <br />$ 74,920.78 <br />(14,532.38)= <br />60,388.40 <br />3,827.06 <br />64,215.46 <br />64,215.46 <br />59,046.05 <br />$ 5,169.41 <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: 5 1 oil <br />State of Florida <br />County of St Lucie <br />Blue Goose Growers, LLC <br />CONTRACTOR <br />By: <br />-A�4,o,,�— <br />Greg Hampto Control r <br />Subscrib d and sworn to before me this 0 day of l 2018 <br />Notary Public TERESAGORMAN <br />aR1�Y'y'�� = MY COMMISSION t: FF 945828 <br />My Commission expires: :+= ber 22, 2019 <br />��ms <br />BondedftuNotaryPublio UnderwritersPayment of the above AMOUNT DUE THIS recommended. <br />Dated: <br />Min/11. <br />L <br />