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,4PPLICATION AND CERTIFICATE FOR PAYMENT TO(OWNER): PROJECT: APPLICATION NO: 12 Distribution to: Indian River County-Chris Kafer NORTH COUNTY REGIONAL PARK ® OWNER(2) 1840 25th Street 9450 County Road 512 PERIOD TO: 12/19/02 © ARCHITECT(2) Vero Beach,FL 32960 Sebastian,FL 32958 21 CONTRACTOR(1) FROM(CONTRACTOR): VIA(ARCHITECT): Proctor Construction Company Brad Smith Associates In. PROJECT NO: NCRP-9926 1401 Highway A-1-A,Suite 301 1800 W.Hibiscus Blvd.Suite 112 Vero Beach,FL 32963 Melbourne,FL 32901 Completion Date CONTRACT FOR: New Construction CONTRACT DATE: 10/10/00 11/14/2002 CONTRACTOR'S APPLICATION FOR PAYMENT CHANGE ORDER SUMMARY Application is made for Payment,as shown below,in connection with the Contract. Detail Sheet is attached. previous months by Owner ADDITIONS DEDUCTIONS t• ORIGINAL CONTRACT SUM 3,352,892.00 TOTAL 2. CHANGE ORDERS -570,249.83 Approved this Month 3. CONTRACT SUM TO DATE 2,782,642.17 Number Date Approved 4. TOTAL COMP&STORED TO DATE 2,782,642.17 (Column G on Detail Sheet) 1 4/1 --239,000.00 5. RETAINAGE: 2 Indian Riv ar County Approved Date 331,249.83 Retainage Held to Date 0.00 Administra.tion I Budget 3 10%of Stored Material 0.00 CO.Attorn 3yfx �1 fel Total in Column I on Detail Sheet Risk Mane gement TOTAL RETAINAGE(Total in Column I of Detail Sheet) 0.00 1 •3 O y Departme it I tZ 6. TOTAL EARNED LESS RETAINAGE 2,782,642.17 (Line 4 less Line 5 Total) or '-570,249.83 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 2,533,553.83 Net change by Change Orders -570,249.83 (Line 6 FROM PRIOR Certificate) The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the 6. CURRENT PAYMENT DUE 249,088.34 Work covered by this Application for Payment has been completed in accordance with the Contract Documents, 9. BALANCE TO FINISH,PLUS RETAINAGE 0.00 that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were (Line 3 less Line 6) issued and payments received from the Owner,and that current payment shown herein is now due. State of: Florida County of: Indian River CONTRACTDB Subscribed and swornafore me is 19th a of Decembe 02. Notary Public: By: Date: 12/19/2002 Donal . si ant i dy Higgins,Vice President My Commission expires: JANET of Florida ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT C IED canto #�D096631 1 In accordance with the Contract Documents,based on on-site observations and the data (Atta h ti n m unt certified differs from the amount applied for.) comprising the above application,the Architect certifies to the Owner that to the best of the ARC I Architect's knowledge,information and belief,the Work has progressed as indicated,the quality ' Z of the Work is in accordance with the Contract Documents,and the Contractor is entitled to By: Date: payment of the AMOUNT CERTIFIED. This C rtifi a is of n iable. The AMOUNT CERTIFIED is payable only to the Con orrAamed ti herein. Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner or ` Contractor under this Contract. *. h