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2019-212A
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2019-212A
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Last modified
12/31/2019 11:06:44 AM
Creation date
12/31/2019 11:04:48 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Change Order
Approved Date
12/17/2019
Control Number
2019-212A
Agenda Item Number
12.G.1.
Entity Name
CK Contractors & Development
Subject
West Wabasso Sewer Phase 2 Project
Project Number
UCP #4117
Bid Number
2019-020
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APPLICATION FOR PAYMENT NO. 10 Cr►jolfl <br />To: Indian River County Department of Utilities Services (OWNER) <br />From: CK Contractors and Development (CONTRACTOR) <br />Contract: Bid Number 2019020 CK Job # 5014 <br />PROJECT: West Wabasso Community Gravity Sewer System Phase 2 <br />OWNER's Contract No. 2019-020 ENGINEER's Project No. <br />For Work accomplished through the date of: 11/30/2019 <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 />4. Total completed and stored to date <br />5. Retainage (per Agreement): <br />0 % of completed Work: $ 0.00' <br />% of retainage: <br />Total Retainage: <br />6. Total completed and stored to date less retainage (4 minus 5): <br />7. Less previous Application for Payments: <br />8. DUE THIS APPLICATION (6 MINUS 7): $ 81,619.19 V"" <br />Accompanying Documentation: <br />CONTRACTOR'S Certification: <br />$ 1,657,419.24 <br />$ 0.00 <br />$ 1,657,419.24 <br />$ 1,632,383.86 <br />$ 0.00', <br />$ 1,632,383.86 <br />$ 1,550,764.67 <br />The undersigned CONTRACTOR certifies that (1) title to all Work, materials and equipment incorporated in said <br />Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment free <br />and clear of all Liens, security interests and encumbrances; (2) all Work covered bythis Application for Payment is <br />in accordance with the Contract Documents and not defective; and (3) the labor and materials listed on this <br />Application for Payment have been used in the construction of this Work and payment received from the last <br />progress payment has been used to make payments to all subcontractors, laborers, materialmen and suppliers <br />except as listed below: None " <br />Dated December 2nd, 2019 CK Co ractors and Development <br />CONTRACTOR <br />C� By: <br />State of T ��w riis0r11111 <br />County Of C ,��`1—?1\P4A C, <br />Subscribed and sworn to before me this <br />day of Zme N ��aa .i o T4 <br />Nota Public'"'G2228� # <br />My ommis -ion ex ' es:/ <br />Payment of the above AMOUNT DUE THIS! !('�tt`Q°�eco ded. <br />Dated3_l� <br />`ENGINEER <br />EJCDC No. C -700-E (2002 Edition) <br />Prepared by the Enpineere Joint Contract Documents Committee and endorsed by The Associated General Contractors of America and the Construction <br />Specification Institute. <br />00800-26 <br />
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