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SECTION 00622 - Contractor's Application for Payment.doc <br /> i <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: <br /> Project: INDIAN RIVER DRIVE SOUTH SIDEWALK IMPROVEMENTS , <br /> OWNER's Project No. 0201 <br /> ENGINEER's Contract No . <br /> ENGINEER <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 /> $ (1 ) <br />_ 4 .d Total Work completed and stored to date : (4 . b plus 4 . c) $ <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 /> 8. 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 material : $ <br /> Total Retainage: $ <br /> 6 . Total completed and stored to date less retainage (4 minus 5) : $ <br /> 7. Less previous Application for Payments : $ <br /> 8. DUE THIS APPLICATION (6 MINUS 7) : <br /> 0201 -00622 - Contractor's Application for Payment <br /> 00622 - 1 <br /> F:\Engineering\Capital Projects\0201 -03128-Indian River Dnve Sidewalk-Soulh-Highland Drive SW\0201 Indian River Drive South Sidewalk - Contract Docs\0201 .00622 <br /> M Contractors Application for Payment.doc Rev. 05101 <br />