Laserfiche WebLink
JUL1. 01 2015 I <br /> i <br /> APPLICATION FOR PAYMENT NO. 3 FINAL_ <br /> To: Indian River County (OWNER) <br /> From: Tri-Sure Corporation (CONTRACTOR) <br /> Contract: IJCP4106 <br /> Project: 12"Transmission Water Main Extension on 107th Ave in Vero Lake Estates <br /> OWNER's Contract N0.2015017 ENGINEER's Project No. <br /> For Work accomplished through the date of: 6/30/15 <br /> 1 Original Contract Price. $ 380,975.00 <br /> 2. Net change by Change Orders and Written Amendments(+or-) $ 0.00 <br /> 3 Current Contract Price(1 plus 2): $ 380,975.00 <br /> 4 Total completed and stored to date $ 347,378.50 <br /> 5. Retainage(per Agreement)- <br /> 0 %of completed Work: $ 347,378.50 <br /> %of retainage: <br /> Total Retainage: 0% $ 0.00 <br /> 6. Total completed and stored to date less retainage(4 minus 5). $ 347,378.50 <br /> 7. Less previous Application for Payments: $ 327,549.08 <br /> S. DUE THIS APPLICATION(6 MINUS 7): $ 19,829.42 <br /> Accompanying Documentation: _ bU <br /> lo <br /> CONTRACTOR'S Certification: 9-]2-- <br /> � I _ r 0Z <br /> 2 2C )4Sc��1 l� 2 <br /> The undersigned CONTRACTOR certifies that(1)title to all Work, materials and equipmeri�inc8rporated in said <br /> Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment free <br /> and clear of all Liens,security interests and encumbrances;(2)all Work covered by this Application for Payment is <br /> in accordance with the Contract Documents and not defective; and (3) the labor and materials listed on this <br /> Application for Payment have been used in the construction of this Work and payment received from the last <br /> progress payment has been used to make payments to all subcontractors, laborers, materialmen and suppliers <br /> except as listed below, " <br /> 6/30/15 � <br /> Dated Tri-Sur o oration <br /> CONTRACTOR <br /> State of Florida By. <br /> County ofPolkJason Chambers <br /> Subscribed and sworn to befzod 5me thiS30th <br /> une LAURIE 6HEtFER <br /> day .� MY COMMJSSION 1 FF 109555 <br /> EXPIRES:ArA 16,?oiB <br /> Bonded Ttuu P"Pudic Undenrdten <br /> Notary Public <br /> My Commission expires: <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated <br /> ENGINEER <br /> EJCDC No.C-700-E(2002 Edition) By. <br /> Prepared by the Engineers Joint Contract Documents Committee and endorsed by The Associated General Contractors of America and the Construction <br /> Specification Institute. <br /> 00800-26 <br /> Attachment 1 64 <br />