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.

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

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

Owner:

Engineer:

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