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SECTION 00622 • Contractor's Application for Payment.doc <br /> Application for Payment No. <br /> For Work Accomplished through the period of through <br /> To: Indian River County (OWNER) <br /> r From : (CONTRACTOR) <br /> Contract: <br /> Project: 9611 . <br /> OWNER's Bid No . 2008012. ENGINEER's Contract No. N/A. <br /> ENGINEER IRC <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 /> t. 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 /> r % 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 /> r <br /> 00622 - Contractor's Application for Payment REV 04-07.doc <br /> r <br /> 00622 - 1 <br /> F:1Engineedng\Capital Pmjectal9011-CR 512WIng19511 CR 512 PHASE W ontrad Cocume W00522 - Contractors Applicatlon for PaMeia REV 04-07.doc <br />