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40 <br />4W <br />INDIAN DIVER COUNTY, FLORIDA <br />r♦ APPLICATION FOR PAYMENT NO. EIGHT <br />PROJECT NO,2M <br />b PROJECT. Round Island Oceanfront Park Project <br />CONTRACTOR NAMEIADDRESS. Summit tCanstrnction Manapettlent. Inc, 1940 58rtrite <br />Ye€o ilcach, E112xida 32966 <br />APPLICATION DATE;-�' 34.2000 FOR PERIOD ENDING: A1MU 7' 14.2000 <br />The undersigned CONTRACTOR hereby certifies that all Rents and amounts on the face of this application for payment are Correct; <br />that all work has been performed and/or materials supplied in full accordance with. d.c terms and conditions of the contract. <br />The undersigned CONTRACTOR hereby swears under penalty that (1) all previous progress payments received from OWNER on <br />account of work performed under the conbael referenced to above have been applied by the undersigned to discharge in full all <br />obligations of the undersigned incurred in connection with work covered by prior Applic, i fo,Gl ynxnt under said contract, being <br />Applications for Payment numbered 1 through 5 inclusive; and (2) all materials and egtr me in ?peed in said project or <br />otherwise listed in or covered by this Application for Payment arc frog and clear of all li ns, aims, t' 'ly interests and <br />etreumbrances. / } <br />Dated it <br />1 cl <br />Summit Man_ aRS iqg. <br />(Contractor) Division App I <br />By: U-LSLt.:— <br />(NameF{'isle) �` Public (Yorks Director <br />COUNTY OF INDIAN RIVER <br />STATE OF PLpRI A <br />[3efore day of i.L , 20 A3 r7 , personally appeared <br />known to arc, who being duty swum, deposes and says <br />that (s) be is the t Lim % of the CONTRACTOR above mentioned; that (s)he executed the <br />abnvc A plication ar Payment and Statement on behalf Of said CONTRACTOR; and that a the statements contained here in arc <br />ttir tmlt�d`cuirflet. <br />Board Car vnunly OM I stoat <br />App"J"'d for Paymorit. <br />5epteinber 12, 2000 Date <br />p a ha rman <br />. Erall, V�- — 1q, -A I � - <br />iN1DIA1J91V[11QtMfYPt1RLICWOHKS <br />nPf�f;OVfO DAIS <br />itlFt[CFOPb <br />OtV ll[dII <br />ACCT,► I' !1 C' <br />Nolary Public <br />MyCm <br />unrissi A®NESA HEWOSM <br />,' MYcomdlssloirrr'C�I <br />EY.PIPLES: J* 20, W. <br />yw aen3tdrVuwwyrdh4� <br />P'*kUna <br />STATEMENT OF WORK <br />Original Contract Price <br />$831,084.41 <br />Materials Stored <br />$ <br />(Altachcd detailed schedule) <br />Net Change Orders <br />$3,893.32 <br />Taal WorklMaterial to Date <br />$834,977.73 <br />Current Contract Price <br />5834,977.73 <br />Less 10% Retainage <br />$83,491.77 <br />Work to Date: <br />5834,977.73 <br />Sub Total <br />$751,479.96 <br />Under Orig. Contract <br />$831,084.41 <br />Less Prior Payments <br />$727,819.64 <br />Under Change order <br />$3,893.32 <br />Percent of Work comp. to date: <br />100% <br />BALANCE DUIi "I'I-11S PAYMENT <br />$23,660.32 <br />q'�t�•'�jj(�(:TORS --C_ C-.RTfp1CA7ItlN <br />The undersigned CONTRACTOR hereby certifies that all Rents and amounts on the face of this application for payment are Correct; <br />that all work has been performed and/or materials supplied in full accordance with. d.c terms and conditions of the contract. <br />The undersigned CONTRACTOR hereby swears under penalty that (1) all previous progress payments received from OWNER on <br />account of work performed under the conbael referenced to above have been applied by the undersigned to discharge in full all <br />obligations of the undersigned incurred in connection with work covered by prior Applic, i fo,Gl ynxnt under said contract, being <br />Applications for Payment numbered 1 through 5 inclusive; and (2) all materials and egtr me in ?peed in said project or <br />otherwise listed in or covered by this Application for Payment arc frog and clear of all li ns, aims, t' 'ly interests and <br />etreumbrances. / } <br />Dated it <br />1 cl <br />Summit Man_ aRS iqg. <br />(Contractor) Division App I <br />By: U-LSLt.:— <br />(NameF{'isle) �` Public (Yorks Director <br />COUNTY OF INDIAN RIVER <br />STATE OF PLpRI A <br />[3efore day of i.L , 20 A3 r7 , personally appeared <br />known to arc, who being duty swum, deposes and says <br />that (s) be is the t Lim % of the CONTRACTOR above mentioned; that (s)he executed the <br />abnvc A plication ar Payment and Statement on behalf Of said CONTRACTOR; and that a the statements contained here in arc <br />ttir tmlt�d`cuirflet. <br />Board Car vnunly OM I stoat <br />App"J"'d for Paymorit. <br />5epteinber 12, 2000 Date <br />p a ha rman <br />. Erall, V�- — 1q, -A I � - <br />iN1DIA1J91V[11QtMfYPt1RLICWOHKS <br />nPf�f;OVfO DAIS <br />itlFt[CFOPb <br />OtV ll[dII <br />ACCT,► I' !1 C' <br />Nolary Public <br />MyCm <br />unrissi A®NESA HEWOSM <br />,' MYcomdlssloirrr'C�I <br />EY.PIPLES: J* 20, W. <br />yw aen3tdrVuwwyrdh4� <br />P'*kUna <br />