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SECTION 00622 - Contractor's Application for Payment <br /> Application for Payment No. 3 <br /> For Work Accomplished through the period of 41116 4 through,T064 <br /> To : Indian River County (OWNER) <br /> From : (CONTRACTOR) <br /> Contract: KITCHING STATION TRAILHEAD <br /> Project: 0219 <br /> OWNER's Contract No. ENGINEER's Contract No. <br /> ENGINEER <br /> � e fs; ark a # iknat Table tfial Vitas a Ilftle n>Ebre� cte hetp ` oct ca[a b fi#� it o t <br /> i «; , <br /> e ppoperiy 7 ptp Us �f 'Irt akeg ft easier foc SWe 'to revlev� for:319(1 ra ti .pur osesj <br /> K_ . <br /> 'l . Ottgirtal= Con( act Price: i li <br /> 2. CVt t:hangeChange Orders and Written Arnendrrents * or =) ri <br /> F .1 E.`�lrrent.don&actPi de ('f-, plus; 2) �' , � <br /> p 4otafftlrr(c date <br /> a Parce tags of 1141, completed tair" datew <br /> 4 Ei To# �or complttedj tia dafe <br /> x <br /> c 1 . `. - Total egUfpment and' 6terialstored+ to date: <br /> VV <br /> i . . 3. <br /> O.d Total Work completed' . and stored'to date: (4 6 phus4. c' $' / � 50 <br /> ' & Retainage (per Agreemert' . <br /> ° 'ai60/6 df eompletect' Woek (b . ' 0`>� 4 : b) • <br /> . b 2GOA of stored°egwptnent and matenai (Ek2tl 4 c : <br /> Shc -Totat` Refainage (5: a plbs 5: b) <br /> 'EotaF Work completed and stored. tp date less` retainage <br /> a' 4F:'d mIr1U5:0: , {f <br /> Prey, aas P Ylpa )tis; ' <br /> 8AfIUNT , QttCS _ldl . L(tATIO'N 6 :NliiNEfS <br /> i,, SaAttac (t Bete led* sclhe�ld:�e , andreopies, cif all p iffln0 d0J <br /> s <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 /> a <br /> 00622 -1 <br /> 0219-00622 - Contractor's Applicadon for Payment <br /> F:1Englneering%Capital Projectst0219-IOtching Stedon Traiihesd10219 10tching-Contrad Docs%0219.006 2 . Contractor's AppticaUon for Payment.doe Rev. 05/01 <br />