|
cuy or Far w�
<br />Busioen Ceater
<br />w:srzmz cu iva�rzozs
<br />Hakaomn Aodersoo
<br />ORIGIIVAL CONTRACT PRICE_._...........»...„........„......._...„.____._.
<br />Net chan�e 6y Cbange Orden._......_...__�..„.„„.,„,.,„,_,,,,,,,,,_M,
<br />Curreet Coqintl Price (Liue 1 t 2}..._.....�,.,.,_„_,,,.,.,,,.„...,,,,,,„,_,„..
<br />7�OTAL COMPLETED AND S7'ORED TO DATE
<br />Ii6TA1NiACE:
<br />a. S%. X Work Cou .„,,.,...,_
<br />b. 0'iL X Stored Materi�L........_...,,...,_.,.._„..__..,,,,,,
<br />a 1'otal Refainage (Line S.a + Liue 5.6j.....,___..�„,„.„.,,,,,,,...,_,..�
<br />AMOUNT EL1GtBLE TO DATE (Llne 4-Liae S.e}r......_.,_.,......,„,.,.
<br />MA7'ERIAL ON HAND NOT INSTALLfiD (TS% olCost}.�.,.._ .............
<br />LESS PREVIOUS PAVDIEW7S_ ................_....,...---.__.._....m......_.........
<br />AI1fOUN1' DUE TNIS APPi.ICATION ................�.�..........__.._�_.Y
<br />7Le undersignad Conlmetar catiftes, w die best oCils knowledgq tlro fdbwing:
<br />(1) All Pre.'ima progmss peymrnn reca.ed tlom Owner on seeomi af Worl dane uda the ConYeet }iave 6cn
<br />applied oo aeootmt m ditcLs�ge Cantraebrs IegiGmute obliga@ow inew�ed in ca�mecum wilh 1M Wak oo�med
<br />by prior Applicatioro forPaymdp;
<br />(2) TiOe w dl Wo�k. �te�ials md equiPam� mmRoratrd in mid Work or othen�ise lismd'm or aorered by Idis
<br />Applialim Por Peymmy uill pa� w ONner et tlme of pa�miw Rx rid daro[dl Lias, reciailv imercsu. md
<br />meumhrr�s (aoept wd� � ue oomed by a 6ond aecepiebte w Owner indmmi!?vig On.ner qgaiiat eny soch
<br />Lia�s. sanriry intaeot a aiaonb'anom): a�d
<br />(3) All �he Wwk eoverod by gtis ppplie�on for P�menl is in aceardanee aitd Ihe Contracl Da.wne�t� mid ia na
<br />dd'epiva
<br />/ �7
<br />Contractor's
<br />for Payment No.
<br />n.k' I
<br />Jtoutry 9, 21l23
<br />S Sl,%7,�29.71
<br />S 50.0D
<br />S SJ,967,329.71
<br />S 51,826,44831
<br />S
<br />S 591,347,C2
<br />S SQOQ
<br />S S913n7A2
<br />S Sl,?35,600.89
<br />S
<br />S 51,630.889.Od
<br />S 5104,711.55
<br />ENGINEER NAKANSONANDERSON
<br />Ce[tificaziat: We recammmd na,=nsnt fa work and qumpites shmvn.
<br />' -..-� /; ; -.. - — 2-14-23
<br />... ��B�T) Date
<br />OWNER: C17Y OR ELIC RIVER
<br />�a /,IZ�
<br />(Ownu) �ate
<br />"�z� S' �.c.(— �, �Z1c�— NS�r7
<br />��-- �-� - _ _
<br />Applintion For P�ynent
<br />
|