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i Task 12 — Reimbursable Ex enses ( 1 ) $4,400 . 00 TOTAL GROSS CONTRACT AMOUNT DUE THIS PAY REQUEST AMOUNT OF RETAINAGE ( 10% of Total Gross Contract Amount Due This Pay Request) ( ) • CONTRACT AMOUNT EARNED TO DATE (Total Gross Contract Amount Due This Pay Request minus Amount of Retainage) TOTAL AMOUNT PAID TO ENGINEER PRIOR TO THIS PAY REQUEST ( ) AMOUNT DUE THIS PAY REQUEST (Contract Amount Earned To-Date minus Total Amount Paid To Engineer Prior To This Pay Request) ( 1 ) Attach copies of all invoices for Reimbursable Expenses ENGINEER' S CERTIFICATION : THE UNDERSIGNED ENGINEER ' S REPRESENTATIVE CERTIFIES that I have checked and verified the above Application for Payment No . and that to the best of my knowledge and belief, it is a true and correct statement of work performed and/or material supplied by the ENGINEER; that all work and/or materials included in the Application for Payment have been inspected by me and/or by my duly authorized representative or assistants ; that it has been performed and/or supplied in full accordance with the requirements of the referenced Contract and with sound engineering practice and judgment; and that the payment amount claimed and requested by the ENGINEER is correctly computed on the basis of work performed and/or materials supplied to date . THE UNDERSIGNED ENGINEER ' S REPRESENTATIVE ALSO CERTIFIES that all previous progress payments received from the COUNTY on account of Work done under the Contract referred to above have been applied on account to discharge ENGINEER ' s legitimate obligations incurred in connection with Work covered by prior Applications for Payment numbered 1 through inclusive ; and if this is a Final Pay Request, I further certify that all persons doing work upon or furnishing materials or supplies for this project under this foregoing Contract have been paid in full . Dated ENGINEER: CARTER ASSOCIATES , INC . ENGINEER ' S REPRESENTATIVE : 1708 21st Street Vero Beach, Florida 32960 (561 ) 562 -4191 Name and Title : State of Florida. County of Indian River. Subscribed and sworn to before me this day of , 200_ Notary Public My Commission expires : FAPublic Works\KeithM\Stcrmwater Projects\East IRC\Contracts\Consultant Contract with Carter & Associates\Wak Order No. 2 - Replacement of Radial Arm Gates\Wak Order No. 2 - Latest Revision.doc 10 EAST INDIAN RIVER COUNTY MASTER STORMWATER MANAGEMENT PLAN