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2025-157
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Last modified
9/11/2025 2:38:52 PM
Creation date
9/11/2025 2:37:43 PM
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Template:
Official Documents
Official Document Type
Change Order
Approved Date
08/19/2025
Control Number
2025-157
Agenda Item Number
9.P.
Entity Name
Proctor Construction Company, LLC
Subject
Change Order No. 2 for Fire Station 11, Renovations to make final adjustments
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SECTION 00622 - Contractor's Application for Payment <br />FS#11 Renovations <br />Application for Payment No. 6 <br />For Work Accomplished through the period of 7/1/2025 through 7/31/2025 . FINAL COMPLETION <br />To: Indian River County (OWNER) <br />From: Proctor Construction, LLC.( CONTRACTOR) <br />Bid No.: 2022061 <br />1) Attach detailed schedule and copies of all paid invoices. <br />1. <br />Original Contract Price: <br />$451,512.00 <br />2. <br />Net change by Change Orders and Written Amendments (+ or -): <br />$35,995.55 <br />3. <br />Total Work Change Directives <br />$66,719.36 <br />4. <br />Current Contract Price (1+2+3): <br />$554,226.91 <br />5. <br />Total completed and stored to date: <br />$554,226.91 <br />6. <br />Retainage (per Agreement): <br />5% retainage: <br />$N/A <br />7. <br />Total completed and stored to date less retainage (4 minus 5): <br />$554,226.91 <br />8. <br />Less previous Application for Payments: <br />$492,486.20 <br />9. <br />DUE THIS APPLICATION (6 MINUS 7): <br />$61,740.71 <br />CONTRACTOR'S CERTIFICATION: <br />UNDER PENALTY OF PERJURY, the undersigned CONTRACTOR certifies that (1) the labor <br />and materials listed on this request for payment have been used in the construction of this Work; (2) <br />payment received from the last pay request has been used to make payments to all subcontractors, <br />laborers, materialmen and suppliers except as listed on Attachment A, below; (3) title of all Work, <br />materials and equipment incorporated in said Work or otherwise listed in or covered by this <br />Application for Payment will pass to OWNER at time of payment free and clear of all Liens, security <br />interests and encumbrances (except such as are covered by a Bond acceptable to OWNER <br />indemnifying OWNER against any such Lien, security interest or encumbrance); (4) all Work <br />covered by this Application for Payment is in accordance with the Contract Documents and not <br />defective; and (5) If this Periodic Estimate is for a Final Payment to project or improvement, I further <br />certify that all persons doing work upon or furnishing materials or supplies for this project or <br />improvement under this foregoing contract have been paid in full, and that all taxes imposed by <br />Chapter 212 Florida Statutes, (Sales and Use Tax Act, as Amended) have been paid and <br />discharged, and that I have no claims against the OWNER. <br />Attached to or submitted with this form are: <br />1. Signed release of lien forms (partial or final as applicable) from all subcontractors, laborers, <br />materialmen and suppliers except as listed on Attachment A, together with an explanation as <br />to why any release of lien form is not included; <br />IRC BUILDING & FACILITIES SERVICES <br />APPROVED <br />OI9Xally slgnea Ey: ROEM <br />DIVISION HEAD Rob Skok�,°m;°�� <br />Date'. 2025 00.11 <br />ACCOUNT # 11412022-066510-22040 <br />00622-1 <br />GAProject Files\IRCFD Station #11 RemodelV. Project Accounting\1. Owner Pay App\6. July 2025 <br />
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