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SECTION 00622 - Contractor's Application for Final Payment Application for Payment No. 3 - FINAL . For Work Accomplished through the period of 10-01 -07 through 11 -02-07 To : Indian River County (OWNER) From : Underground Utilities Inc (CONTRACTOR ) Contract: Labor Contract Bid No . 2007026 Project : CR 512 Utility Conflict Resolutions for 10" and 12" OWNER's Contract No . WIP No . 471 -23536-044699-06543 ENGINEER's Contract No . 2952 ENGINEER Gordon Sparks P . E . . ( 1 ) Attach detailed schedule and copies of all paid invoices . 1 . Original Contract Price : $51 , 554 . 36 2 . Net change by Change Orders and Written Amendments (+ or $2 , 530 . 84 3 . Current Contract Price ( 1 plus 2) . $54 , 085 . 20 4 . Total completed and stored to date : $54 , 085 . 20 5 . Retainage ( per Agreement): 100% of completed Work : $54 , 085 . 20 5% of retainage : N/A Total Retainage : N/A 6 . Total completed and stored to date less retainage (4 minus 5 ): $54 , 085 . 20 L7 . Less previous Application for Payments : $46 , 527 . 81 8. DUE THIS APPLICATION 6 MINUS 7) : JL557 . 39 CONTRACTOR'S CERTIFICATION : I hereby certify that 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, material men and suppliers, except as noted below. The acceptance of final payment shall be and shall operate as a release of the OWNER from all claims and all liability to the CONTRACTOR Y AAAA - 00622 - Contractor's Application for Final Payment - 11 -7-07.doc p 00622 - 1 (� _ F:AUlilitiesWTILITV - ENGINEERINGAProjects - Utility Construction PermitsVIRC - CR 512 & CR 510 Utility Conflicts by nacelle UCP #283]VNAA - 00822 - Contractors Application for Fina l Payment - ll -]-07.ran Rev. 05/01 J Attachment 1 , � �