Laserfiche WebLink
APPLICATION FOR PAYMENT NO . <br /> To : (OWNER) <br /> From: (CONTRACTOR) <br /> Contract: <br /> Project: <br /> OWNER' s Contract No . ENGINEER' s Project No . <br /> For Work accomplished through the date of: <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 /> 8. DUE THIS APPLICATION (6 MINUS 7) : $ <br /> Accompanying Documentation: <br /> CONTRACTOR' S Certification: <br /> The undersigned CONTRACTOR certifies that ( 1 ) all previous progress payments received from OWNER on account <br /> of Work done under the Contract referred to above have been applied on account to discharge CONTRACTOR ' s <br /> legitimate obligations incurred in connection with Work covered by prior Applications for Payment numbered 1 <br /> through inclusive ; (2) title of all Work, materials and equipment incorporated in said Work or otherwise listed <br /> in or covered by this Application for Payment will pass to OWNER at time of payment free and clear of all Liens, <br /> security interests and encumbrances ; (3 ) all Work covered by this Application for Payment is in accordance with the <br /> Contract Documents and not defective ; and (4) 1 hereby certify that the labor and materials listed on this <br /> Application for Payment have been used in the construction of this Work and payment received from the <br /> last request for payment has been used to make payments to all subcontractors, laborers, material , men and <br /> suppliers except as listed below: " <br /> Dated <br /> CONTRACTOR <br /> By: <br /> State of <br /> County of <br /> Subscribed and sworn to before me this <br /> day of , <br /> Notary Public <br /> My Commission expires : <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated <br /> ENGINEER <br /> By: <br /> EJCDC No. C-700-E (2002 Edition) <br /> Prepared by the Engineers Joint Contract Documents Cortmtittee and endorsed by The Associated General Contractors of America and the Construction Specification Institute. <br /> 044572017 <br /> 00800-26 <br />