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SECTION 00622 — CONTRACTOR' S APPLICATION FOR PAYMENT Application for Payment No. _7_. (FINAL RETAINAGE) For Work Accomplished through the period of _February 10, 2006_ through _FEBRUARY 11 , 2006 ,_ 4 To: Indian River County (OWNER) From: CONE & GRAHAM (CONTRACTOR) Contract: ROADWAY & BRIDGE IMPROVEMENTS: FOR PROPOSED 'INDIAN :RIVER,-COUNTY tr: , ADMI N(STRATI OWC OM P LEX OWNER's Contract No. 7043 ENGINEER's Contract No. _47600000 ENGINEER: Indian River County Public Work's Department ENGINEER's CONSULTANT: _KIMLEY-HORNA NDASSOCIATES , INC.`- 1 Original Contract Price: 51 ,498,619.50 2 Net change by Change Orders and Written Amendments (+ or 2.a Change Order No. 1 (deduct for pavement reduction etc.) -49 , 570.02 2.b Change Order No. 2 (deduction for IRC inspection fees) -550.00 2.c Change Order No. 3 2.d Change Order No. 4 2.e Total change in Contract Price (2.a + 2.b + . . 2.n) S - 3Current Contract Price ( 1 plus 2e): S1 ,448,499.48 4Total Work to date: 4. a Percentage of Work completed to date: 4 . b Total Work completed to date: $1 ,448,499.48 4.c Total equipment and material stored to date: ( 1 ) 4 .d Total Work completed and stored to date: (4.b plus 4.c) $1 ,448,400.48 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) $ 5.c Total Retainage (5.a plus 5.b): $ B -rutal Work completed and stored to date less retainage (4.d minus 5.c) $ 1 ,448,499 .48 7Previous Payments: $1 ,304, 144.53 BAMOUNT DUE THIS APPLICATION (6 MINUS 7) $ 144,354 . 95 (1 ) Attach detailed schedule and copies of all paid invoices. CONTRACTOR'S CERTIFICATION: UNDER PENALTY OF PERJURY, the undersigned CONTRACTOR certifies that ( 1 ) the labor and materials listed on this request for payment have been used in the construction of this Work and payment received from the last request for payment has been used to make payments to all subcontractors, laborers, materrialmen and suppliers except as listed below; (2) title of all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment free and clear of all Liens, security interests and encumbrances (except such as are covered by a Bond acceptable to OWNER indemnifying OWNER against any such Lien. security interest or encumbrance); (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and not defective: and (4) If this Periodic Estimate is for a Final Payment to project or improvement, I further certify that all persons doing work upon or furnishing materials or supplies for this project or improvement under this foregoing contract have been paid in full, and that all taxes imposed by Chapter 212 Florida Statutes, (Sales and Use Tax Act, as Amended) have een paid and discharged, and that I h a claims Inst eOWNER. Dated 4 6 sly'. /! {CONT C R Cav6 � 00622 - Contractors Application for Payment 4- 11#7 revised 5-16.doo 00622 - 1 SAI' uwnte,CONE & GRAF VTCUFISN7 !OBS'FZ5C4 NOWN RIVER AWN C0MIPLEX4'622 - Cp O'S A;>.:I.a:knla7aynler:alt:7 feria[ i16 &,c Rev. 051