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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= ENGINEER' s Contract No . N/A <br /> ENGINEER Indian River County <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) : L— <br /> 00622 - Contractor's Application for Payment <br /> 00622 - 1 <br /> FAEngineeringTapital Projects\0217-Powerline Road\Bid Documents100622 - Contractor's Application for Payment.doc Rev. 05101 <br />