00 62 76 - App for Payment.pdf
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- Solicitation number
- Not on record
- Issued by
- Lancaster County, Pennsylvania
About this file
This is a Contractor's Application for Payment form (EJCDC C-620) used by the Elizabethtown Area Water Authority for the Water Main Replacement Project Phase 4 (Contract No. WR-4). The form serves as a standardized progress payment application document that contractors submit to request compensation for work completed and materials stored during specified application periods. The form accommodates both lump sum and unit price work, allowing contractors to document progress across multiple line items, track work completion percentages, and itemize materials stored on-site or at designated locations. The application requires detailed breakdown of scheduled values, work completed in the current period and cumulatively to date, materials stored not yet incorporated into the work, and calculation of retainage amounts. The form includes sections for the contractor's certification regarding application of previous payments, title transfer of materials and work, and conformance with contract documents, along with signature blocks for approval by the owner, engineer, funding agency, and contractor.
The application form does not specify pricing, bid amounts, or financial thresholds, as it functions as a payment request mechanism rather than a procurement document. No set-asides, incumbent contractors, or specific funding sources are identified within this form. The document is designed to facilitate transparent financial tracking throughout project execution by requiring detailed documentation of work progress, material costs, and payment calculations, with retainage amounts withheld according to contract terms. Contractors must provide supporting documentation such as submittal numbers, supplier invoices, and storage location details for materials claimed in applications. The form's structure ensures compliance with standard construction contracting practices and provides clear audit trails for all payments requested and received throughout the project duration.
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Text version
From
1.
2.
3.
4.
5.
a. X
b. X c.
6.
7.
8.
9.
Current Contract Price (Line 1 + Line 2)
Contractor:
Net change by Change Orders to
Original Contract Price
Total Work completed and materials stored to date
(Sum of Column G Lump Sum Total and Column J Unit Price Total)
Retainage
Work Completed
Stored Materials
Total Retainage (Line 5.a + Line 5.b)
Amount eligible to date (Line 4 - Line 5.c)
Less previous payments (Line 6 from prior application)
Amount due this application
Application Date:
Approved by Funding Agency
By:
Title:
Date:
By:
Title:
Date:
By:
Title:
Date:
By:
Title:
Date:
Signature: Date:
Contractor's Certification
Balance to finish, including retainage (Line 3 - Line 4 + Line 5c)
Approved by Owner
The undersigned Contractor certifies, to the best of its knowledge, the following:
(1) All previous progress payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for Payment;
(2) Title to all Work, 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, security interests, and encumbrances (except such as are covered by a bond acceptable to Owner indemnifying Owner against any such liens, security interest, or encumbrances); and
(3) All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective.
Recommended by Engineer
Contractor's Application for Payment
Application No.:
Owner's Project No.:
Engineer's Project No.:
Contractor's Project No.:
Application Period:
Contract:
Owner:
Contractor:
Engineer:
Project:
EJCDC C-620 Contractor's Application for Payment
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.
Owner:
Engineer:
Contractor:
Project:
Contract:
Application No.: From to
A C D E F G H I
(D + E) From
Previous
Application
This Period
-$ -$ -$ -$ -$ -$ Original Contract Totals
Work Completed
Item No. Description
Scheduled Value
Application Period: Application Date:
Progress Estimate - Lump Sum Work Contractor's Application for Payment
Owner's Project No.:
B
Original Contract
% of Scheduled
Value (G / C)
Balance to Finish (C
- G)
Materials Currently
Stored (not in D or
E)
Work Completed and Materials
Stored to Date
(D + E + F)
Engineer's Project No.:
Contractor's Project No.:
Lump Sum
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 2 of 6
Contractor:
Project:
Contract:
Application No.: From to
A C D E F G H I
(D + E) From
Previous
Application
This Period
Work Completed
Item No. Description
Scheduled Value
Application Period: Application Date:
Progress Estimate - Lump Sum Work Contractor's Application for Payment
Owner's Project No.:
B
% of Scheduled
Value (G / C)
Balance to Finish (C
- G)
Materials Currently
Stored (not in D or
E)
Work Completed and Materials
Stored to Date
(D + E + F)
Engineer's Project No.:
Contractor's Project No.:
Change Order Totals
Project Totals
Original Contract and Change Orders
Change Orders
Lump Sum
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 3 of 6
From to
A C D E F G H I J K L
Item Quantity Units
Unit Price
Value of Bid Item
(C X E)
Estimated
Quantity
Incorporated in the Work
Value of Work
Completed to Date
(E X G)
-$ -$ -$ -$ -$ Original Contract Totals
B
Original Contract
% of
Value of
Item
(J / F)
Balance to Finish (F
- J)
($)Description
Work Completed
Materials Currently
Stored (not in G)
Work Completed and Materials
Stored to Date
(H + I)
Contract Information
Bid Item
No.
Engineer:
Contractor:
Project:
Contract:
Application Date:Application Period:Application No.:
Contractor's Application for PaymentProgress Estimate - Unit Price Work
Owner's Project No.:
Engineer's Project No.:
Contractor's Project No.:
Owner:
Unit Price
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 4 of 6
From to
A C D E F G H I J K L
Item Quantity Units
Unit Price
Value of Bid Item
(C X E)
Estimated
Quantity
Incorporated in the Work
Value of Work
Completed to Date
(E X G)
B
% of
Value of
Item
(J / F)
Balance to Finish (F
- J)
($)Description
Work Completed
Materials Currently
Stored (not in G)
Work Completed and Materials
Stored to Date
(H + I)
Contract Information
Bid Item
No.
Engineer:
Contractor:
Project:
Contract:
Application Date:Application Period:Application No.:
Contractor's Application for PaymentProgress Estimate - Unit Price Work
Owner's Project No.:
Engineer's Project No.:
Contractor's Project No.:
Owner:
Change Order Totals
Original Contract and Change Orders
Change Orders
Project Totals
Unit Price
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 5 of 6
Contractor:
Project:
Contract:
Application No.: Application Period: From to
A B C D E F G H I J K L M
Previous Amount
Stored
Amount Stored this
Period
Amount Stored to
Date (G+H)
Amount Previously
Incorporated in the
Work
Amount
Incorporated in the
Work this Period
Total Amount
Incorporated in the
Work
(J+K)
Stored Materials Summary
Totals
Storage Location
Description of Materials or
Equipment Stored
Submittal No.
(with
Specification
Section No.)
Supplier
Invoice No.
Item No.
(Lump Sum Tab) or Bid Item No.
(Unit Price Tab)
Application Date:
Contractor's Application for Payment
Materials Stored Incorporated in Work
Materials
Remaining in
Storage
(I-L)
Application
No. When
Materials
Placed in
Storage
Owner's Project No.:
Engineer's Project No.:
Contractor's Project No.:
Stored Materials
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 6 of 6
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