4.2. SR 09-21-2015 - Laserfiche WebLink

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Application for Payment Contractor's Certification The undersigned Contractor cortifles that: (1) all previous pnlgh payments reralved from Owner on account of Work done under Contract have been applied on account to discharge Contrecl legitimate obligations Incurred in connection with Work covered by I Applications for Payment; (2) title or as Work, materials and equipn incorporated In said Work or otherwise listed in or covered by Application for Payment will pees to Owner at time of payment free dear of all Liens, security interests and encumbrances (except such as covered by a Band acceptable to Owner indemnifying Owns against such Liens, security interest or encumbrances); and (3) all Work cove by this Application for Payment is In accordance with the Cont Documents and is not defective. Contractor's Application For Payment No. 10 ORIGINAL CONTRACT PRICE Net change by Change Orders CURRENT CONTRACT PRICE (Line 1 t 2) TOTAL COMPLETED AND STORED TO DATE (Column F on Progress Estimate) RETAINAGE: 5% x $6,340,994.99 Work Completed . 5% x $0.00 Stored Materials Total Retalnage (Line 5a+ Line fib) AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c) LESS PREVIOUS PAYMENTS (Line 6 from prior Application) AMOUNT DUE THIS APPLICATION BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate+ Line 6 above) $16,525,200.00 $259,991.59 $16,785,191.59 $8,340,994.99 $417,049.75 $417,049.75 $7,923,945.24 $6,600,400.97 $1,323,544.27 $8,861,246.35 Payment of: $1,323,544.27 (Line B or other-F�Rtlon of other amount) Is recommended by: O" A • 11 Sept. 2015 (Engineer) (Date) Payment of: $1,323,544.27 (Line 8 or other - attach explanation of other amount) is approved by: Approved by: (Finance Director) (Date) Funding Agency (if applicable) (Date) VJCW Na. C420 (2002 Mr..) Pnpaal by Ibe Enh{i.-dolor O."d eummane Ceamied and mderrM by the Adaeiaad nenerd Cwindnn of A.H. wd dr Cemrnldan SaMf deem Imtiloe.