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4b r-. INDIAN RIVER COURi'i'Y, i+1,ORIDA APPLICATION FOR PAYMENT NO_ .Final PROJECT NO. 8 23 _ ACCOUNT NO: PRDJECT: K no Hwy (SStti Ave) 25thjt to -26th St~ CONTRACTOR NAISEIADDRSSS:- 1]IU0=H F Q C. P.O, Pravpr 719, Stuart, 9 lurid& 34995 APPLICATION DATE: g1 4jb4 -_-- -- _ FOR PERIOD ENDING 5235100 --- Contractors Certification The underoignod CONTRACTOR hereby certifies that all items and amounts on the faces of thin applicaLian for payment are correct; that all work has been performed and/or materials supplied in bull accordanen with the terms and conditions of the contract. The undersigned CONTRACTOR hereby swears under penalty of perjury that (1) all previous progress payments received from the OWNER on account of work performed under the contract referred to above have been applied by the undersigned to discharge in full all obligatlons of the undersigned incurred in connection with work covered by prior Applications for Payment under said contract, being Applications for Payment numbered l through inclusive; and (2) all materials and equipment incorporated in said project or otherwriae listed in or covered by this Application for Payment are free and clear of all ling claisv�s. security interests and encumbrances. Board of County Comrnissia Dated 4� �� 9' aCJao ��.1�5-�. oYLORIDA Approved for Payment___ _L BY: June 20, 2000 COUNTY OF I[IQIAN RIVER STATEMENT OF WORK STATE OF FLORIDA Original Contract Price $5977266.93 Materials Stored $!0,00 — Net change Orders $- 35' (Attach detailod schedule and paid invoicss) Current Contract Price $6145232.- Z9 Total NorY./Materiale to Dates $6145232.30 Work to Date: ..,� > n GyaSION of ndilm IA142 ,rr ;i I.fYCOMM$3NQPZfCiJZ;Zi2 fyFIFFS Lens % Retainage ti r Under Original Contract $ 527 93 sub Total $6145232.3022- Under change order $ 167265,37 burn Prior Payments $5594938.75 Percent of Work Completed to date 100 a SAIMCS DUE THIS PAYMENT $AS�Y,r�3 dt'( Contractors Certification The underoignod CONTRACTOR hereby certifies that all items and amounts on the faces of thin applicaLian for payment are correct; that all work has been performed and/or materials supplied in bull accordanen with the terms and conditions of the contract. The undersigned CONTRACTOR hereby swears under penalty of perjury that (1) all previous progress payments received from the OWNER on account of work performed under the contract referred to above have been applied by the undersigned to discharge in full all obligatlons of the undersigned incurred in connection with work covered by prior Applications for Payment under said contract, being Applications for Payment numbered l through inclusive; and (2) all materials and equipment incorporated in said project or otherwriae listed in or covered by this Application for Payment are free and clear of all ling claisv�s. security interests and encumbrances. Board of County Comrnissia Dated 4� �� 9' aCJao ��.1�5-�. oYLORIDA Approved for Payment___ _L BY: June 20, 2000 COUNTY OF I[IQIAN RIVER r (Name Title) _ STATE OF FLORIDA Cari>lisae._p_ G.1�8 Defoe 1me tkvLa Ly'P,. day o1 ,.Chairman to d� ; personally appeared to being duly sworn, 0bew-l" RZ noun me, who dapases and sayu that kAkhe in t e O the CONTRACTOR above mentioned; that (s)he executed the above Application for Payvarnt and etatement on behalf of said CONTRACTOR; and that all of ths statemento contained herein arR true, icorruct and L'Lmpletwa. ..,� > n GyaSION of ndilm IA142 ,rr ;i I.fYCOMM$3NQPZfCiJZ;Zi2 fyFIFFS _ ti r pl1 Wtd40 NN ROY 1AI (W94KI W- Ot y £t3/'ZM'd 0999, Lie 19S 099V Me 199 E43::41 t Pt hlif