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rr <br /> SECTION 00622 - Contractor's Application for Payment . doc <br /> Application for Payment No . <br /> For Work Accomplished through the period of through <br /> w <br /> To : Indian River County (OWNER) <br /> From : ( CONTRACTOR) <br />+� Contract: <br /> Project: 0016 & 0236 . <br /> OWNER's Contract No . ENGINEER's Contract No . <br /> ENGINEER <br /> 1 . Original Contract Price : $ <br /> w 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 /> w 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 /> r. $ <br /> 5 . b 20 % of stored equipment and material (0 . 20 x 4 . c) : <br /> w 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 /> w Total Retainage : $ <br /> 6 . Total completed and stored to date less retainage (4 minus 5 ) : $ <br /> 7 . Less previous Application for Payments : $ <br /> r <br /> 8 . DUE THIS APPLICATION 6 MINUS 7) : $ <br />■ <br /> 0016-00622 - Contractor's Application for Payment <br /> 00622 - 1 <br /> F:\Engineering\Capital Projects\0016 & 0236- 41st Street Improvements\0016 & 0236-41st St Contract Docs\0016-00622 - Contractor's Application for Paymenl.doc <br /> Rev. 05/01 <br />