HomeMy WebLinkAbout2000-328•
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® APPLICATION FOR PAYMENT NO. 2-r ' ina
To Indian River County --- DOWNER)
Contnctfor Rackrid e Area County•Sewer Project
OWNER'S Project No. Us (JR (M.",, ENGINEER'S Project No.
For work accomplished through the date of
MEM
COK RACrOR's Schedule oFYaluct
work Completed
Unit P*a Quantity
//mount
Quantity Amount
$ r.
S
SEE ATTACHED SCHED
LE OF VALUES
Tool
S
S 80,912.00
(Orig. Contract)
C.O. No. t
C.O. No. 2
Accompanying Documentation
CONTRACTOR'S Certification:
GROSS AMOUNT DUE S-8-0-1-91200
LESS 0 % RETAINAGE ................... S -0-
AMOUNT DUE TO DATE ..................... SR ,0 q 12 , 00.
LESS PREVIOUS PAYMENTS ................ S 79 870.90
AMOUNT DUE THIS APPLICATION ......... S B-091 .20
The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of
Work done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR
incurred in connection with Work covered by prior Applications for Payment numbered 1 through Inclusive; and
(2) title to all materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for
Payment will pass to OWNER at time of payment free and clear of all liens, claims, security interests and encumbrances
(except such as covered by Bond acceptable to OWNER):
Dated 10/ 17 lY 2000 TKI-. UR�RPORAONr0"By bYtP —
JAhIES H. CHAMBFRS, PRESIDENT
Payment of the above AMOUNT DUE THIS APPLICATION is recommended.
Dated-- November 7,.M
kA4l'_�
By Fran 9 Adams chairman
EJCDC No. 1910.8-E (1987 Edition)
Prepucd by the Enpneert' Joint Contract bocumente Committee and endonci by The Auociued Genera! ContraetOrt of Aencriea.
4 00800-33
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