00620-B Certificate for Payment.pdf

Section 00620-B

CERTIFICATE FOR PAYMENT

TO EWEB: __________________________ ATTENTION: ______________________________ CERTIFICATE #: __________________

PROJECT NAME: ____________________ FROM: ____________________________________ PERIOD TO: ______________________

CONTRACT FOR: ____________________ EWEB JOB #: _______________________________ CONTRACT DATE: _______________

APPLICATION FOR PAYMENT

CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application is made for Payment, as shown in connection with Contract | | | Continuation Sheet, is attached.

Change Orders approved in | | | previous months by EWEB. | | | 1. ORIGINAL CONTRACT SUM......................................... $__________ TOTAL: | | | 2. NET CHANGE BY CHANGE ORDER............................. $__________ Approved this Month | | | 3. CONTRACT SUM TO DATE (Line 1 and 2).................... $__________

NUMBER DATE | | |

| | | 4. TOTAL COMPLETED & STORED TO DATE................ $__________

| | | (Total Column G, Page 2)

| | | 5. RETAINAGE:

| | | a. ___% of Completed Work $________ | | | (Column D + E on Page 2) MONTHLY TOTALS | | | b. ___% of Stored Material $_________ | | | (Column F on Page 2) Net Change by Change Orders | | | c. Total Retainage (Line 5a + 5b).................................. $__________

6. TOTAL EARNED LESS RETAINAGE............................. $__________

The undersigned Contractor certifies that to the best of the Contractor's (Line 4 less Line 5 Total) knowledge, information and belief, the Work covered by this Certificate for Payment has been completed in accordance with the Contract Documents, 7. LESS PREVIOUS PAYMENTS............. ..... ................. $<________> that all amounts have been paid by Contractor for Work for which previous (Line 6 from prior payments) Certificates of Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 8. CURRENT PAYMENT DUE......................... ................ $__________

9. ADD RETAINAGE WITHHELD THIS PAYMENT.......... $__________

10. BALANCE TO FINISH....................................................... $__________

CONTRACTOR: ________________________________________________ CONTRACT ADMINISTRATOR: ________________________________

By: ___________________________ Date: __________________________ DATE: _______________________________________________________

PROCEDURE FOR PROCESSING

At least 15 working days before the date established for each progress payment, the Contractor shall submit to the EWEB Contract Administrator an itemized Certificate for Payment for operations completed in accordance with the Schedule of Work. Such certificate shall be notarized and supported by such data substantiating the Contractor's right to payment as EWEB may require, such as copies of requisitions from Subcontractors and material suppliers, and reflecting retainage. Certificate shall include requests for payment on account of changes in the Work which have been properly authorized by Change Orders. Certificate shall not include requests for payment of amounts the Contractor does not intend to pay to a Subcontractor or material supplier because of a dispute or other reason.

The Contractor warrants that title to all Work covered by a Certificate for Payment will pass to EWEB no later than the time of payment.

The Contractor further warrants that upon submittal of a Certificate for Payment all work, to the best of the Contractor's knowledge, be free and clear of liens, claims, security interests or encumbrances in favor of the Contractor, Subcontractors, material suppliers, or other persons or entities making a claim by reason of having provided labor, materials and equipment relating to the Work.

The issuance of the Certificate for Payment will constitute a representation by the Contract Administrator that, based on observations at the site and the data comprising the payment, the Work has progressed to the point indicated and that, to the best of the Contract Administrator's knowledge, information and belief, quality of the work is in accordance with Contract Documents. The foregoing representations are subject to an evaluation of the Work for conformance with the Contract Documents upon Substantial Completion, to results of subsequent tests and inspections, to minor deviations from the Contract Documents correctable prior to completion and to specific qualifications expressed by the Contract Administrator. The issuance of a Certificate for Payment will further constitute a representation that the Contractor is entitled to payment in the amount certified.

CONTINUATION SHEET

TABULATIONS BELOW ARE TO BE STATED TO THE NEAREST DOLLAR. CERTIFICATE #__________________

USE COLUMN I ON CONTRACTOS WHERE VARIABLE RETAINAGE FOR THE

LINE ITEMS MAY APPLY. CERTIFICATE DATE: _____________

PERIOD FROM: ___________________________

PERIOD TO: ___________________________ EWEB JOB #_____________________

A B C D E F G G I

Item No. Description of Work Scheduled Work Completed From Previous

Application

Work Completed This Period

Materials Presently

Stored (Not in D or E)

Total Completed and Stored to

Date (D + E + F)

Balance to Finish (C-G)

Retainage

DOCUMENT LINE DESCRIPTIONS

CONTINUATION SHEET - PAGE 2

(A), (B), (C) These columns should be completed by identifying the various portions of the project and their scheduled value consistent with the schedule submitted to the Contract Administrator at the commencement of the project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the project. Multiple pages should be used when required.

Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the project.

(D) Enter in this column the amount of completed Work covered by the previous application. This is the sum of columns D and E from the previous application. Values from column F (Materials Presently Stored) from prior payments should not be entered in this column.

(E) The value of Work completed until the time of this application, including the value of materials incorporated in the project which were listed on the previous Certificate for Payment under Material Presently Stored (column F).

(F) The value of Material Presently Stored for which payment is sought. The total of the column must be recalculated at the end of pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the project. Mere payment by EWEB for stored materials does not result in a deduction from this column. Only as materials are incorporated into the project is their value deducted from this column and incorporated into column E (Work Completed

- This Period).

(G) The total of columns D, E, and F. Calculate the percentage completed by dividing column G by column C.

(H) The difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).

(I) This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount.