Laserfiche WebLink
J <br />40 <br />• <br />NOV-29-1999 14:06 561 267 4660 561 287 4660 P.02i02 <br />INDIAN RIVER COUNTY, FLORIDA <br />APPLICATION FOR PAYMENT NO.19 - Revised <br />PROJECT N0 8823 ACCOUNT NO: <br />PROJECT: Kings Highway 58th Ave. 2§th St. to 26th St. <br />CONTRACT HAMF/ADDRESS: <br />APPLICATION DATE:11%8%91 FOR PERIOD ENDING 9/25/99 <br />[' ntrartors Certification <br />The undersigned CONTRACTOR hereby certifies that all items and amounts on the <br />face of this appliction for payment are correct; that all work has been <br />performed and/or materials supplied in full accordance with the terms and <br />conditions of the contract. <br />The undersigned CONTRACTOR hereby swears under penalty of perjury that (1) all <br />previous progress payments received from the OWNER 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 undcrsigned incurred in aomneotion with <br />work covered by prior Applications for Payment under said contract, being <br />Applications for Payment numbered 1 through inclusive; and (2) all <br />materials and equipment incorporation in said project 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 November 8 , 1999 <br />COUNTY OF MARTIN <br />STATE OF FLORIDA <br />DI RIDA, iC. <br />(Contr <br />BY: <br />(Rage/Title) <br />Ted H. Tyson, President <br />Before me this 8th day of November 1999, personally appeared <br />Ted H. Tyson , known to me, who being duly sworn, <br />deposes and says that he is the P-2idP11- of the CONTRACTOR above <br />mentioned: that he executed the above Application for Payment and statement <br />on behalf of said CONTRACTOR: and that all of the statements contained herein are <br />true, correct and complete. 1'2 <br />Board ofCountyCommission Not6zy Public <br />Approved for Payment i crystalMonocandke <br />`K MYC0MMISS"iCCg24V2 em <br />12-7- Date; Apr➢Q 2003 <br />'.Ziw' eorpEonaumorreaeuwa+c;Nc <br />,h�wmanW <br />STATEMENT OF VORK <br />Original Contract Price <br />$ <br />5,977,966.93_ <br />Materials Stored S 18,819.12 <br />detailed schedule and paid invoices) <br />Net Change Orders <br />$ <br />212,857.60 <br />(Attach <br />Total Vork/Materials to date 55,678,673.55 <br />6,190,824.53 <br />Current Contract Price <br />$ <br />Less 5% Retainage 8 203 33-68 <br />>Jork to Date: <br />Under Original Contract <br />S <br />5 306,425.40 <br />Sub Total $5.394, 39.67 <br />Under Change Order <br />s <br />353,425.03 <br />Less Prior Applications $5,123,560.96 <br />% Vork Completed to date <br />91% <br />BALANCE DUE THIS APPLICATION a 271,178.91 <br />[' ntrartors Certification <br />The undersigned CONTRACTOR hereby certifies that all items and amounts on the <br />face of this appliction for payment are correct; that all work has been <br />performed and/or materials supplied in full accordance with the terms and <br />conditions of the contract. <br />The undersigned CONTRACTOR hereby swears under penalty of perjury that (1) all <br />previous progress payments received from the OWNER 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 undcrsigned incurred in aomneotion with <br />work covered by prior Applications for Payment under said contract, being <br />Applications for Payment numbered 1 through inclusive; and (2) all <br />materials and equipment incorporation in said project 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 November 8 , 1999 <br />COUNTY OF MARTIN <br />STATE OF FLORIDA <br />DI RIDA, iC. <br />(Contr <br />BY: <br />(Rage/Title) <br />Ted H. Tyson, President <br />Before me this 8th day of November 1999, personally appeared <br />Ted H. Tyson , known to me, who being duly sworn, <br />deposes and says that he is the P-2idP11- of the CONTRACTOR above <br />mentioned: that he executed the above Application for Payment and statement <br />on behalf of said CONTRACTOR: and that all of the statements contained herein are <br />true, correct and complete. 1'2 <br />Board ofCountyCommission Not6zy Public <br />Approved for Payment i crystalMonocandke <br />`K MYC0MMISS"iCCg24V2 em <br />12-7- Date; Apr➢Q 2003 <br />'.Ziw' eorpEonaumorreaeuwa+c;Nc <br />,h�wmanW <br />