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• <br />l <br />® APPLICATION FOR PAYMENT NO. 2-r ' ina <br />To Indian River County --- DOWNER) <br />Contnctfor Rackrid e Area County•Sewer Project <br />OWNER'S Project No. Us (JR (M.",, ENGINEER'S Project No. <br />For work accomplished through the date of <br />MEM <br />COK RACrOR's Schedule oFYaluct <br />work Completed <br />Unit P*a Quantity <br />//mount <br />Quantity Amount <br />$ r. <br />S <br />SEE ATTACHED SCHED <br />LE OF VALUES <br />Tool <br />S <br />S 80,912.00 <br />(Orig. Contract) <br />C.O. No. t <br />C.O. No. 2 <br />Accompanying Documentation <br />CONTRACTOR'S Certification: <br />GROSS AMOUNT DUE S-8-0-1-91200 <br />LESS 0 % RETAINAGE ................... S -0- <br />AMOUNT DUE TO DATE ..................... SR ,0 q 12 , 00. <br />LESS PREVIOUS PAYMENTS ................ S 79 870.90 <br />AMOUNT DUE THIS APPLICATION ......... S B-091 .20 <br />The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of <br />Work done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR <br />incurred in connection with Work covered by prior Applications for Payment numbered 1 through Inclusive; and <br />(2) title to all materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for <br />Payment will pass to OWNER at time of payment free and clear of all liens, claims, security interests and encumbrances <br />(except such as covered by Bond acceptable to OWNER): <br />Dated 10/ 17 lY 2000 TKI-. UR�RPORAONr0"By bYtP — <br />JAhIES H. CHAMBFRS, PRESIDENT <br />Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br />Dated-- November 7,.M <br />kA4l'_� <br />By Fran 9 Adams chairman <br />EJCDC No. 1910.8-E (1987 Edition) <br />Prepucd by the Enpneert' Joint Contract bocumente Committee and endonci by The Auociued Genera! ContraetOrt of Aencriea. <br />4 00800-33 <br />