15-00670 Payment Application.pdf
PDF 125 KB Posted
- Attached to
- Route 54 Sanitary Sewer Extension Project
- Solicitation number
- Not on record
- Issued by
- Lycoming County, Pennsylvania
About this file
This is a Payment Application and Certificate for Payment document submitted to the West Branch Regional Authority for the Route 54 Sanitary Sewer Extension Project, Contract No. WB-1, located in Clinton Township, Lycoming County, Pennsylvania. The application demonstrates the contractor's request for payment (Application No. 127) for work completed on the project, which consists of approximately 1,520 linear feet of gravity sanitary sewer, 11 manholes, 13 lateral connections, one duplex sewage pumping station, 404 linear feet of force main, one stream crossing, surface restoration, and related appurtenances within easements on private property and Snaurytown Road right-of-way. The contractor certifies that work has been completed in accordance with contract documents and that all previous invoices have been paid. The engineer, Levine Engineering, LLC, must verify on-site that work has progressed as indicated and meets contract quality standards before certifying the payment amount.
The payment application includes fields for tracking the original contract sum, net changes via change orders, total contract sum to date, completed and stored work value, retainage (held at 0.00 percent), previous certificates for payment, and the current amount due. The document serves as a formal request for the current payment certification and includes certification statements from both the contractor and the engineer. No specific dollar amounts are visible in this particular application form, though the document structure indicates comprehensive financial tracking mechanisms are in place. The contractor is subject to Pennsylvania Department of Labor and Industry prevailing wage requirements and the Pennsylvania Steel Products Procurement Act of 1978.
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Text version
PROJECT APPLICATION AND CERTIFICATE FOR PAYMENT
TO: West Branch Regional Authority PROJECT: Route 54 Sanitary Sewer Extension APPLICATION NO.
127 Girton Drive Contract No. WB-1
Muncy, PA 17756 PERIOD FROM: ________________, 20____
TO: ________________, 20____
CONTRACTOR:
CONTRACT DATE: ______________, 20, 20____
COMPLETION DATE:____________, 20____, 20____
CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payments shown below in connection with the
Contract. Continuation Sheet (Page 2 of 2) attached hereto.
The undersigned Contractor certifies that to the best of his knowledge, information and belief, the work covered by this Application for Payment has The present status of the account for this Contract is as follows:
been completed in accordance with the Contract Document; that all amounts have been paid by him for work in which previous Certificates for Payment were TOTAL ORIGINAL CONTRACT SUM…………………………. -$ issued and payments received from the Owner; and that the current payment shown herein is now due. Total Net Changes by Change Orders……….………………………. -
CONTRACTOR: ________________________________ TOTAL CONTRACT SUM TO DATE.......................................… -$
By: ______________________________________ Date: ____________
Contractor, Title TOTAL COMPLETED & STORED TO DATE..............................… -$
State of: County of: RETAINAGE ...............................................................………. 0.00
Subscribed and sworn to before me this________day of _____________, 20____.
TOTAL EARNED LESS RETAINAGE.................................................. -$
Notary Public:
My Commission Expires: LESS PREVIOUS CERTIFICATES FOR PAYMENT........................... 0.00
CURRENT PAYMENT DUE.................................................................. -$
ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED........................................................................... -$
(Attach explanation if amount certified differs from the amount applied for)
In accordance with the Contract Document, based upon on-site observations and the data comprising the above application, the Engineer certifies to the ENGINEER: Levine Engineering, LLC
Owner that the work has progressed to the point indicated; that to the best of his knowledge, information and belief, the quality of the work is in accordance By: _________________________________________Date: ___________ with the Contract Document; and that the Contractor is entitled to payment of This Certificate is not negotiable. The AMOUNT CERTIFIED is payable the AMOUNT CERTIFIED. only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.
Contract No. WB-1 Page 1 of 2 January 2026
File details come from the government source that posted it. Updated .