HomeMy WebLinkAbout2000-0274W
CI
INDIAN RIVER COUNTY, FLORIDA
✓ APPLICATION FOR PAYMENT NO. &I$ cin"
PROJECT NO.9625B 4N -
PROJECT: DONALD h"CDOI`rALD PARK LMPROVEMENTS rREJFD
CONTRACTOR NAME/ADDRESS: Summ t ConshructionManagement. fVero Beach. Florida32966APPLICATION DATE: Janua[y 3.2000 FOR PERIOD ENDING: Jawng= 3.2000m t)L�
Original Contract Price
Net Change Orders
Current Contract Price
Work to Date:
Under Orig. Contract
Under Change Order
Percent of Work comp.to date:
STATEMENT OF WORK
$252,717.00
Materials Stored
(Attached detailed schedule)
+$1,469.00
t� S
Total Work/Material to Date
$254,186.00
67
Less 1W. Retainage
ZSF 7/7 OD
Sub Total
$23 .00
f
that (s) he is the
of the CONTRACTOR above mentioned; that (s)he executed the
Less Prior Payments
$1,469.00
Payment �o
100%
�E
$254,186.00
42S4+8•:6e— O
su�:�,2Sy /8Gr ofl
BALANCE DUE THIS PAYMENT $25,418.60 ✓
RETAINAGE
CONTRACTORS CFRTIFICATION
The undersigned CONTRACTOR hereby certifies that all items and amounts on the face of this application for payment are correct;
that all work has been performed and/or materials supplied in full accordance with the terms and conditions of the contract.
The undersigned CONTRACTOR hereby swears under penalty that (1) all previous progress payments received from OWNER on
account of work performed under the contract referenced to above have been applied by the undersigned to discharge in full all
obligations of the undersigned incurred in connection with work covered by prior Applications for t under said contract 'ng
Applications for Payment numbered 1 through 5 inclusive; and (2) all materials and equipment i o711.
d in said prof 0
otherwise listed in or covered by this Application for Payment are free and clear of all liens, cl msty interes encumbrances. //�i I
Dated L�z \. 19 To�
,� /A�Architect aU
Summit Construction Management. Inc
(Contractor)
Division Approval
t� S
By:
(Name/Title)
Public Works Director
COUNTY OF INDIAN RIVER
STATE OF FLORIIZA
Beforeme this t.10 day of" C
19_1, personally appeared
— known to me, who being duly swom, deposes and says
f
that (s) he is the
of the CONTRACTOR above mentioned; that (s)he executed the
ab— Applica,ion f_r Payment and Stalc.• n M f -'d PftTl'fP A!`TnP end Stt_'T�/lll,pf tl,r crate vents rnrttair�vt herr in �.r
r SUT1 �fEsG'6i.Yity
true correct and complete %�.
• r- Approved for
VNI
Payment �o
FIT --q OWAYY PV6UC
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DATZFebruary 1 , 2000 Dat 4
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COMMISSION CC Arg+qc
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