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SECTION 00622 - Contractor's Application for Payment. doc <br /> Application for Payment No . <br /> For Work Accomplished through the period through Jan 12 2006 <br /> To: Indian River County (OWNER) <br /> From : Timothy Rose Contracting , Inc. (CONTRACTOR) <br /> Contract: <br /> Project: Discharge Outlet and Rip Rap Spillway Mat-North County R/O Brine Project <br /> OWNER's Contract No . ENGINEER's Contract No . x. <br /> ENGINEER x. <br /> [Here is an alternate Table that has a little more detail to help Contractor fill it out <br /> properly -plus it makes it easier for State to review for 319( h) Grant purposes] <br /> 1 . Original ContractPrice : $ 106 . 735 . 00 <br /> 2 . Net change by Change Orders and Written Amendments (+ or -) : $ 8 , 350. 00 <br /> 3. Current Contract Price ( 1 plus 2 ): $ 1151085 . 00 <br /> 4. Total Work to date : <br /> 4 . a Percentage of Work completed to date : 100% <br /> 4 . b Total Work completed to date : $ 115 , 085 . 00 <br /> 4 . c Total equipment and material stored to date : <br /> $_L0_0__0 ) <br /> 4 . d Total Work completed and stored to date: (4 . b plus 4 . c) $ 0 . 00 <br /> 5 . Retainage (per Agreement) : <br /> 5 .a 10% of completed Work (0 . 10 x 4 . b): <br /> $ 0_00 <br /> 5 . b 20% of stored equipment and material (0 . 20 x 4. c): <br /> $-0 . 00 <br /> 5 . c Total Retainage (5 . a plus 5 . b) : $ 0 . 00 <br /> 6 . Total Work completed and stored to date less retainage <br /> (4 . d minus 5 . 4 $ 0 . 00 <br /> 7. Previous Payments : $-0 . 00 <br /> 8 . AMOUNT DUE THIS APPLICATION (6 MINUS 7) : $ 115 . 085. 00 <br /> (1 ) Attach detailed schedule and copies of all paid invoices . <br /> 1 . Original Contract Price : $ 106 , 735 . 00 <br /> 2 . Net change by Change Orders and Written Amendments (+ or $8 , 350M <br /> 3. Current Contract Price ( 1 plus 2) : $ 115 , 085 . 00 <br /> 4 . Total completed and stored to date : $ 115 , 085 . 00 <br /> 5 . Retainage (per Agreement) : <br /> 100% of completed Work: $ 115 , 085 . 00 <br /> 0% of stored material : 0 . 00 <br /> Total Retainage : 0 . 00 <br /> 6 . Total completed and stored to date less retainage (4 minus 5) : $ 115 , 085 . 00 <br /> 7 . Less previous Application for Payments : 0 . 00 <br /> 8. DUE THIS APPLICATION (6 MINUS 7) : $ 115 , 085 . 00 <br /> Contractor's Application for Payment-00622 <br /> 00622 - 1 <br /> P aJrlitles\UTILITY - EMPLOYEE FOLDERSWA t PfefferWorth RO\Conlractor's Application for Payment-00622.doc Rev_ 06/01 <br />