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r <br />BooK 9� Peer 6 t6 <br />IEC1EadI <br />XXDXM D � <br />»vim PA <br />a <br />APP'sial J U L 1 0 1996 <br />Z.=cAs=os1< pm 110. <br />PRO== NO ACCOUNT NO It <br />PROJECTt ROADWAY & .DRAINAGE IMPROVEMENTS - 261H S L' DEPT. <br />CONTRACTOR NMW/ADDRS86t Carter Associates, Inc. <br />1708 21st Street, Vero Beach, FL 32960 <br />APPLZCATZON DATES FOR PERIOD YNDINa <br />STATZMZHT OF WORK <br />original Contract Price $ 36,465.00 as <br />Net Change orders f. 1.870.00 <br />Current Contract Price $ 38,335.00 <br />Work to Dates <br />Under original Contract $36,465.00 <br />Under Change order S 1,870.00 <br />Percent of Work Completed to date i <br />contractors Certification <br />Zbtal <br />to Date <br />Less 10% Rtatainags <br />Sub Total <br />Loss Prior Payments <br />BALANCE DUE TRIG PAYMENT <br />$ 1,418.77 <br />39,753.77 <br />= 0.00 <br />39,753.77 <br />= 35,600.80 <br />4,152.97 <br />The undersigned CCNTRhCTOR hereby certifies that all items and amounts on the <br />lace of this application for payment are aorreatl that all work has' been <br />Performed and/or materials aupplied in full accordance with the teras and <br />conditions of the contract. <br />The undersigned CONTRACTOR hereby swears tender penalty of perjury that (1) all <br />previoua progrena payments received from the OMOR on account of Work performed <br />under the contract referred to above have been applied by the undersigned to <br />discharge in full all obligations of the undersigned incurred in connection with <br />work covered by prior Applications for Payment. under said contract, being <br />Applications for Payment numbered 1 through 8 inclusive: and (2) all <br />materials and equipment Incorporated in said pro ect or otherwise listed in or <br />covered by this Application for Payment are free and clear of all liens, claims, <br />security interests and encumbrances. <br />Dated July 10, __, 1996,E CARTER ASSOCIATES INC. <br />Coso� <br />{ <br />BY .Py <br />N Blum, Project Manager <br />OOUNT7t of INDIAN RIVaA <br />STATE OF FLORSDA <br />Before me this 1 <br />h0th d y of July , 19:96, personally appeared <br />38—pones-Inand says (n)he n the Pro otvn me,—who <br />w <br />Mar. of the CONTRACTOR above <br />mentioned) that (s)he executed the above ApplLoatLon for Payment and statement <br />on behalf of said CONTRACTORr and that all of the statements contained herein are <br />true, correct and complete. <br />Notary c <br />my commiasion Expires <br />lCW1 FiYER MUNTY PUBLIC NCiMS <br />APPROVfP GATE <br />01Y. FEAD v <br />�PO� • <br />ACCT. • <br />92 <br />JULY 239 1996 <br />VY Plj OFFICIAL NOTARY S]E)tP- <br />0.4,P' ^ �, 9e, <br />ff * <br />.fs Q <br />KAREN L KUENN <br />COMMISSION NUM <br />CC354615 <br />MY COMMISSION <br />10 <br />20 <br />MAR. 199 <br />