00 62 76 - App for Payment.pdf
PDF 461 KB Posted
- Attached to
- WCTA Meter Replacement Project
- Solicitation number
- US.257570
- Issued by
- Lancaster County, Pennsylvania
About this file
Summary of Contractor's Application for Payment
This is a standardized Contractor's Application for Payment form (EJCDC C-620) used for progress payment requests on construction contracts. The form is designed for the West Cocalico Township Authority's Meter Replacement Project (Project No. 011364.0448) in Pennsylvania. The application facilitates the submission of payment requests by contractors for work completed and materials incorporated into the project. The form accommodates both lump sum and unit price contract structures, allowing contractors to document completed work, stored materials, retainage amounts, and cumulative progress to date. It includes sections for original contract pricing, change order adjustments, work completion percentages by bid item, and stored materials documentation with supplier references and invoice numbers.
The application requires certification by the contractor that all prior payments have been appropriately applied to legitimate project obligations, that title to all work and materials will transfer to the owner free of liens and encumbrances, and that all work complies with contract documents and is not defective. The form necessitates approvals from the owner, engineer, and funding agency, with signature lines and dating requirements for each party. Payment calculations deduct retainage and prior payments from the total value of work completed and materials stored to determine the amount currently due. The document provides a comprehensive mechanism for tracking contract expenditures, change order impacts, and project financial status throughout the construction period.
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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. 25-331-07011364.0448
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) ($)Description
Work Completed
Materials Currently Stored (not in G)
Work Completed and Materials Stored to Date
(H + I)
Contract Information
Bid Item No.
Engineer:
Contractor:
Project:
Contract:
Application Date:Application Period:Application No.:
Contractor's Application for PaymentProgress Estimate - Unit Price Work
Owner's Project No.:
Engineer's Project No.:
Contractor's Project No.:
Owner:
Unit Price
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 25-331-07011364.0448
From to
A C D E F G H I J K L
Item Quantity Units Unit Price
Value of Bid Item (C X E)
Estimated Quantity
Incorporated in the Work
Value of Work Completed to Date
(E X G)
B
% of Value of
Item (J / F)
Balance to Finish (F
- J) ($)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. 25-331-07011364.0448
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 EJCDC C-620 Contractor's Application for Payment
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 25-331-07 011364.0448
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