00 62 76 - Contractor's Application for Payment.pdf
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- Lancaster County, Pennsylvania
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Contractor's Application for Payment
This document is a standard Contractor's Application for Payment form (EJCDC C-620) submitted by Herbert, Rowland & Grubic, Inc. to the Borough of Elizabethtown for work performed under Contract No. 2026-01, the Sewer Maintenance & Emergency Contract. The application serves as a formal request for payment reimbursement for work completed during a specified application period on Work Order No. 000598.0465. The form requires the contractor to certify that all previous progress payments have been properly applied to legitimate work-related obligations, that title to all incorporated materials and equipment will pass to the Owner free of liens and encumbrances upon payment, and that all work completed complies with contract documents and is not defective. The application includes line items for the original work order estimate, total work completed and materials stored to date, less previous payments, with the amount due calculated for the current application period. The document requires approval signatures from the contractor, engineer, owner, and funding agency, along with an estimated balance remaining to finish the project.
The application form does not contain pricing information, set-aside provisions, or funding source details within its content. Rather, it functions as a administrative and certification mechanism for processing progress payments under an existing contract. The form requires all parties involved—contractor, engineer, owner, and funding agency—to review and approve the application before payment is processed. Completion of this application is a standard requirement in municipal construction contracts to ensure proper documentation and authorization of contractor payments as work progresses.
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Text version
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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.
Estimated Balance to Finish
Application Date:
to
By:
Title:
Date:
By:
Title:
Date:
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 -$
Contractor's Certification
Approved by Funding Agency
By:
Title:
Date:
By:
Title:
Date:
Engineer:
Project:
Work Order No.:
000598.0465
Contract No. 2026-01
Contractor:
Contractor's Application for Payment
Application No.:
Borough of Elizabethtown
Herbert, Rowland & Grubic, Inc.
Sewer Maintenance & Emergency Contract
Owner's Project No.:
Engineer's Project No.:
Contractor's Project No.:
Application Period:
Contract:
Owner:
EJCDC C-620 Contractor's Application for Payment
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.
File details come from the government source that posted it. Updated .