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SECTION 00622 - Contractor's Application for Payment. doc <br /> r <br /> Application for Payment No. <br /> For Work Accomplished through the period of through <br /> To: Indian River County ( OWNER) <br /> From : (CONTRACTOR) <br /> Contract: 0209 & 9321 <br /> Project: 4` Str�/Conch Ditch Bridge Replacement & 11 'h Street SW Paving and Drainage <br /> OWNER' s Contract No. <br /> ENGINEER ENGINEER's Contract No . <br /> i <br /> 1 . Original Contract Price: $ <br /> 2 . Net change by Change Orders and Written Amendments (+ or -) : $ <br /> 3. Current Contract Price ( 1 plus 2) : $ <br /> 4 . Total Work to date : <br /> 4 . a Percentage of Work completed to date : % <br /> 4. b Total Work completed to date : $ <br /> 4. c Total equipment and material stored to date: <br /> 4 . d Total Work completed and stored to date: (4 . b plus 4 . c) ( 1 ) $ <br /> 5 . Retainage (per Agreement) : <br /> 5 . a 10% of completed Work (0. 10 x 4. b) : <br /> 5 . b 20% of stored equipment and material (0. 20 x 4. c) : <br /> 5 . c Total Retainage (5. a plus 5. b) : $ <br /> 6 . Total Work completed and stored to date less retainage <br /> (4 . d minus 5. c) : $ <br /> [7 . Previous Payments : $ <br /> 118. AMOUNT DUE THIS APPLICATION (6 MINUS 7) : $ <br /> (1 ) Attach detailed schedule and copies of all paid invoices . <br /> 1 . Original Contract Price : $ <br /> 2. Net change by Change Orders and Written Amendments (+ or -) : $ <br /> 3 . Current Contract Price ( 1 plus 2) : $ <br /> 4. Total completed and stored to date: $ <br /> 5 . Retainage (per Agreement) : <br /> of completed Work: $ <br /> % of Stored mater lai : $ <br /> Total Retainage : $ <br /> 6 . Total completed and stored to date less retainage (4 minus 5) : $ <br /> 17 . Less previous Application for Payments: $ <br /> 8 . DUE THIS APPLICATION (6 MINUS 7) : 4— <br />■ 0209-00622 - Contractor's Application for Payment.doc <br /> Peymerit-d oReva006/0 ProgctsW209-0th Street Bridge Over Conch Ditch102094N 00622 - 1 Street Bridge Over Gooch 07-20-0610209-00622 - Contrador's Application for <br />