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APPLICATION FOR PAYMENT NO. <br /> To <br /> (OWNER) <br /> Contract for <br /> OWNER' S Contract No . ENGINEER' s Project No . <br /> For Work accomplished through the date of <br /> CONTRACTOR' S Schedule of Values Work Completed <br /> ITEM <br /> Unit Price Quantity Amount Quantity Amount <br /> Total <br /> (Orig. Contract) <br /> C.O. No. 1 <br /> C. O. No . 2 <br /> Accompanying Documentation: GROSS AMOUNT DUE <br /> LESS % RETAINAGE $ <br /> AMOUNT DUE TO DATE $ <br /> LESS PREVIOUS PAYMENTS $ <br /> AMOUNT DUE THIS APPLICATION $ <br /> CONTRACTOR' S Certification: <br /> The undersigned CONTRACTOR certifies that: ( 1 ) all previous progress payments received from OWNER on account of <br /> Work done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR <br /> incurred in connection with Work covered by prior Applications for Payment numbered 1 through inclusive ; (2 ) <br /> title to all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for <br /> Payment will pass to OWNER at time of payment free and clear of all liens, claims, security interest and encumbrances <br /> (except such as are covered by Bond acceptable to OWNER indemnifying OWNER against any such lien, claim, security <br /> interest or encumbrances) ; and (3 ) all Work covered by this Application for payment is in accordance with the <br /> Contract <br /> Documents and not defective as that term is defined in the Contract Documents . <br /> Dated 92004 <br /> CONTRACTOR <br /> By: <br /> (Authorized Signature) <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated , 2004 <br /> ENGINEER <br /> By: <br /> (Authorized Signature) <br /> EJCDC No. 1910-8-E ( 1990) Edition ) <br /> Prepared by the Engineers Joint Contract Documents Committee and endorsed by The Associated General Contractors of America . <br /> APPLICATION FOR PAYMENT AP-2 <br />