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Application for Payment <br />Change Order Summary <br />Approved Change Orders <br />Number <br />Additions Deductions <br />t $ <br />259,991.59 <br />TOTALS <br />NET CHANGE BY <br />CHANGE ORDERS <br />$259,991.59 $0,09 <br />$259,991.59 <br />Contractor's Certification <br />The undersigned Contractor canines that (1) all previous pmgm <br />Payments received from Owner on a0peunt of Work done under t <br />Contract have been applied on account to discharge Contractor's lagitlml <br />obligations Inverted In connection with Work covered by prior Applicatlo <br />for Payment; (2) die of all Work, materials and equipment Incorporated <br />said Work or otherwise listed In or covered by this Application for Payne <br />Wil pass to Owner at Uma of payment free and clear of all Liens, secui <br />Interests and encumbrances (except such as are covered by a 6o <br />acceptable to Owner Indemnifying Owner against any such Llens, satin <br />interest or encumbrances); and (3) all Work covered by this Application <br />Payment Is In accordance wlih the Contract Documents and is t <br />defective. <br />1. ORIGINAL CONTRACT PRICE <br />2. Net change by Change Orders <br />3. CURRENT CONTRACT PRICE (Line 1 t 2) <br />4. TOTAL COMPLETED AND STORED TO DATE <br />(Column F on Progress Estimate) <br />5. RETAINAGE: <br />$16,525,200.00 <br />$259,091.59 <br />$16,785,191.59 <br />$9,138,009.64 <br />a. 5% x $9,136,009.64 Work Completed $458,800.48 <br />b. 5% x $0.00 Stored Materials $0.00 <br />c. Total Retalnaga(Line 5a+Line 5b) $456,800.48 <br />8. AMOUNT ELIGIBLE TO DATE (Line 4. Line 5c) $8,879,209.16 <br />T. LESS PREVIOUS PAYMENTS (Line 6 from prior Application) $7,923,945.24 <br />S. AMOUNT DUE THIS APPLICATION <br />9. BALANCE TO FINISH, PLUS RETAINAGE <br />(Column G on Progress Estimate + Line 5 above) <br />Payment of $755,263.92 <br />(Line 8 or other - attach explanation of other amount) <br />$755,263.92 <br />$8,105,982.43 <br />Is recommended by: Oct. 8, 2015 <br />(Engineer) (Daft) <br />Payment of: $755,263.92 <br />(Line 8 or other - attach explanation of other amount) <br />Is approved by: <br />Approved by: <br />(Finanee Director) (Date) <br />Funding Agency (if applicable) (Deft) <br />VCDC Na Cow (tam seam.) <br />P,sp is tFaam«n' Jolel Costntr Dotwese Commin"tad ta,IMM by rhtMWIlal etmrsh CwhecmwefAmerkasW ul Cwam of SWIffelmnr ivmun. <br />