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SECTION 00622 - Contractor's Application for Payment. doc Application for Payment No . ' For Work Accomplished through the period of through To : Indian River County (OWNER) ' From : ( CONTRACTOR) Contract : Project: OWNER's Contract No . ' ENGINEER's Contract No , ENGINEER 1 . OriginalContract Price : $ ' 2 . Net change by Change Orders and Written Amendments ( + or -): $ 3 . Current Contract Price ( 1 plus 2): $ 4 . Total Work to date : ' 4. a Percentage of Work completed to date : 4 . b Total Work, completed to date: $ 4 : c Total equipment and material' stored ' to date : t $ ( 1 ) 4 . d Total' Work completed and stored to date : (4 . b plus 4 . c) $ 5. Retainage ( per Agreement) : ' 5, a 10 % of completed Work (0 . 10 x 4 . b ) : 5b 20% of stored equipment and material (0 . 20 x 4 . c) $ 5 : c Total Retainage (5 . a plus 5 . b ) $ 6 Total Work completed and stored to; date less retainage (4 . d minus 5 . c) : $ 7 . Previous Payments: $ 8 . AMOUNT `DUE THIS APPLICATION 6 MINUS 7) $ ' ( 1 ) Attach detailed schedule and copies of all paid invoices. ' 1 . Original Contract Price : $ 2 . Net change by Change Orders and Written Amendments (+ or - ) : $ 3 . Current Contract Price ( 1 plus 2) : $ ' 4 . Total completed and stored to date : $ 5 . Retainage ( per Agreement) : of completed Work : $ % of stored material : ' Total Retainage : $ 6 . Total completed and stored to date less retainage (4 minus 5 ) : $ 7 . Less previous Application for Payments : $ ' 8 . DUE THIS APPLICATION 6 MINUS 7) : ' 0399-00622 - Contractor's . Application for Payment. doc 00622 - 1 F:\Engineering\Capital Projects\0399 North County Regional Park, Phase II\0399 Contract Docs\0399-00622 - Contractor's Application for Payment.doc Rev. 05/01