Laserfiche WebLink
APPLICATION FOR PAYMENT NO. <br />6F <br />To: Indian River County Utilities OWNER <br />From: TLC Diversified, Inc._ (CONTRACTOR) <br />Contract:` <br />PROJECT: Roseland Elevated Storage Tank Water Transmission Main <br />OWNER's Contract No. 2019-067 <br />For Work accomplished through the date of: 1213112021 <br />1. Original Contract Price: <br />2. Net change by Change Orders and Written Ame-idments (+ or <br />3. Current Contract Price (1 plus 2): <br />4. Total completed and stored to date: <br />5. Retainage (per Agreement): <br />_0.00% % of Completed Work: $0.00 <br />0.00% % of Stored Materials $0.00 <br />Total Retainage: $0.00 <br />6. Total completed and stored to date less retainage (4 minus 5): <br />7. Less previous Apllications for Payments: <br />8. DUE THIS APPLICATION (6 MINUS 7): $19,401.30 <br />Accompanying Documentation: See attached Sheets. <br />$298,000.00 <br />$298,000.00 <br />$294,925.92 <br />$2941925.92 <br />$275,524.62 <br />CONTRACTOR'S Certification <br />The undersigned CONTRACTOR certifies that (1) title m all Work, materials and equipment incorporated in said Work or <br />otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment free and clear of all Liens, <br />security interests and encumbrances; (2) all Work covered by this Application for Payment is accordance with the Contract <br />Documents and not defective; and (3) the labor and materials listed on this Application for Payment have been used in the <br />construction of this Work and payment received from the last progress payment has been used to make payments to all <br />subcontractors, laborers, materialmen and suppliers except as listed below: NONE <br />Dated 01/05/22 TLC Diversified, Inc. <br />JT_ C TRACTOR <br />By: /G <br />Mark Selph, Operations A1. ager <br />State of Florida <br />County of Manatee <br />Subcribed to before 5 <br />LAUREN MOOOVERN <br />and sworn me this <br />Notary Public <br />da of � <br />Y U Q 2022 °� o <br />State of Florida <br />�0-u�ti f' C OhL�r1 s�Nct t9 <br />Commt# HH2O2764 <br />Expires 11/29/2025 <br />Notary Public <br />My Commision expires: <br />Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br />Dated <br />ENGINEER <br />By: U 1/3 1 /2o2Z <br />EJCDC No. C -700-E (2002 Edition) <br />Prepared by the Engineers Joint Contract Documents Committee and endorsed by The Associated General Contractors of America and the Construction <br />Specification Institute. <br />00800-26 <br />Printed : 1/5/2022 Page 1 of 5 TLC Job 19-13-01 <br />45 <br />