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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 />From: (CONTRACTOR) <br />Contract: 2008029 <br />Project: Powerline Road from C.R. 510 North to the Sebastian City Limits <br />OWNER's Contract No.xxxx= <br />ENGINEER Indian River County <br />ENGINEER's Contract No.N/A <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 />$ <br />5.b 20% of stored equipment and material (0.20 x 4.4 <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 />Be DUE THIS APPLICATION (6 MINUS 7): <br />0 <br />00622 - Contractor's Application for Payment <br />00622-1 <br />FAEngineeringTapital Projects\0217-Powerline Road\Bid Documents\00622 - Contractor's Application for Payment.doc Rev. 05101 <br />