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SECTION 00622 Contractor's Application for Payment - Page 2 <br /> Dated ylCo � o7 SNE�T2q + Sort CoNsTZ� Cr , pn1 Cq• rl � <br /> (CONTRACTOR) <br /> By: <br /> State of <br /> Countyof k ) 1Ar -Vi � <br /> Subscribed and sworn to before me this b <br /> day of _ ti�v� 4' ZeC� 1 <br /> t <br /> c `'t.. <br /> Aly A. Comfort <br /> Notary Public : Commission # DD284684 <br /> My Commission expires: ��,F FAQ Expires May 26, 2008 <br /> , Inc. 900J95-7019 <br /> CERTIFICATION OF ARCHITECT OR CONSULTING ENGINEERTHERE <br /> APPLICABLE) : <br /> I certify that I have checked and verify the above and foregoing Periodic Estimate for Partial <br /> Payment; that to the best of my knowledge and belief it is a true and correct statement of the work <br /> performed and/or material supplied by the Contractor. <br /> . �p <br /> Dated � ' O G - O � ��1C1 �1 <br /> 4 � <br /> (ARCHITEC'Y / GINEER) SIGNATURE <br /> CERTIFICATION OF ENGINEER / INSPECTOR / OWNER: <br /> I have checked the estimate against the Contractor's Schedule of Amounts for Contract Payments <br /> and the notes and reports of my inspections of the project. It is my opinion that this statement of work <br /> performed and/or materials supplied is accurate, that the Contractor is observing the requirements of the <br /> Contract, and that the Contractor should be paid the amount requested above. <br /> Dated ::7 �1 <br /> (ENGINEER / INS E OR/ OWNER) SIGNATURE <br /> Accompanying Documentation: Detailed Schedule <br /> * * END OF SECTION <br /> 00622 - 1 0605Paym entAppl ication08-RevFinal.doc <br />