HomeMy WebLinkAbout2007-286B i
SECTION 00622 - Contractor's Application for Final Payment
FINAL PAY REQUEST Application for Payment No . 2
For retainage for work accompolished through the period of through febuary 28 2007
To : Indian River County Utilities (OWNER)
From : Danella Companies Inc. (CONTRACTOR)
Contract: annual utilities labor contract
Project: Reflections U . S . 1 from Wabasso to Sebastian utility relocates
OWNER's Contract No. UCP#2787 ENGINEER's Contract No .
ENGINEER IRCU .
( 1 ) Attach detailed schedule and copies of all paid invoices.
1 . Original Contract Price : $ 114. 762 . 38
2 . Net change by Change Orders and Written Amendments (+ or -) : $ 51 , 785. 88
3 . Current Contract Price ( 1 plus 2) : $ 166 , 548. 26
4. Total completed and stored to date : $ 166, 548 . 26
5 . Retainage (per Agreement) :
0 % of completed Work: $ 0
0 % of retainage: $ 0
Total Retainage: 0 . 00
6. Total completed and stored to date less retainage (4 minus 5) : $ 166, 548 . 26
7 . Less previous Application for Payments : $ 149 , 893.44
8 . DUE THIS APPLICATION (6 MINUS 7) : $ 16, 654 . 82
CONTRACTOR'S CERTIFICATION :
I hereby certify that the labor and materials listed on this request for payment have been used in the construction of this work and payment
received from the last request for payment has been used to make payments to all subcontractors , laborers, material men and suppliers, except
as noted below.
The acceptance of final payment shall be and shall operate as a release of the OWNER from all claims and all liability to the CONTRACTOR
00622 - 1 Attachment 2
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other than claims in stated amounts as may be specifically excepted by the CONTRACTOR for all things done or furnished in connection with
this Work and for every act and neglect of the OWNER and others relating to or arising out of this Work. Any payment, however, final or
otherwise, shall not release the CONTRACTOR or his sureties from any obligations under the Contract Documents or the Payment and
Performance Bonds.
Dated 7/31 /07 Darnelta CoAania& Inc
(CON T
r� By:
State of
County of Trj�!\ ro \ uer
Subscribed and sworn to before me this t =%� � Ex
tate of Florida
of U 't,�� onDD646497
Notary public /2 0 1 1
My Commission expires: d , ; ' O L1 - fit) \\
CERTIFICATION OF ARGM VITEGT OR G0481611C44MG ENGINEER (WHERE APPLICABLE) :
I certify that I have checked and verify the above and foregoing Periodic Estimate for Partial Payment; that to the best of my knowledge
and belief it is a true andcorrect statement of the work performed and/or material supplied by the Contractor.
Dated — 0
7 A21��, 441A
/ ENGINEE SIGNATURE
CERTIFICATION OF ENGINEER MNSPEeTOR:
I have checked the estimate against the Contractor's Schedule of Amounts for Contract Payments and the notes and reports
of my
inspections of the project. It is my opinion that this statement of work performed and/or materials supplied is accurate, that the Contractor
is
observing the requirements of the Contract, and that the Contractor should be paid the amount requested above.
4 Dated O ' — o ae
(Mcrtr=T / ENGINE ) SIGNATURE
Accompanying Documentation :
final pay request for relfections retainage
00622 - 2
CiDowments and SettingsymcfallMy DocumentsgRC Annual robs\REFLECTIONS IRC\final billing\final pay request for relfedions retainage cm Rev. 05101