00 62 76 - Contractor's Application for Payment.pdf

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Contractor's Application for Payment

Application No.:

West Manchester Township

Herbert, Rowland & Grubic, Inc.

Maintenance & Emergency Contract (Excavation)

Owner's Project No.:

Engineer's Project No.:

Contractor's Project No.:

Application Period:

Contract:

Owner:

Engineer:

Project:

Work Order No.:

7297.0444

Contract No. 2026-01

Contractor:

Approved by Funding Agency

By:

Title:

Date:

By:

Title:

Date:

Contractor's Certification

Contractor:

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.

Approved by OwnerRecommended by Engineer

Original Work Order Estimate -$

Date:Signature:

Total Work Completed and Materials Stored to Date

Less Previous Payments (Line 2 from Prior Application)

Amount Due This Application -$

By:

Title:

Date:

By:

Title:

Date:

Estimated Balance to Finish

Application Date:

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EJCDC C-620 Contractor's Application for Payment

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