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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 : P . I . N . W . R Upland Restoration . Project : #0386 . ' OWNER's Contract No . ENGINEER's Contract No . ENGINEER ' 1 . Original Contract 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 : $ ( 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 ) : 5 . b 20 % of stored equipment and material ( 0 . 20 x 4 . c) : 1 $ 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) : 0386-00622 - Contractor's Application for Payment ' 00622 - 1 F :\Engineering\Capital Projects\0386-Pelican Island Upland Restoration\0386-Pelican Island -Contract Docs\0386-00622 - Contractor's Application for Payment.doc Rev. 05/01