22-Doc 00 62 76 Appl Payment.pdf
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- Solicitation number
- Not on record
- Issued by
- Bucks County, Pennsylvania
About this file
This is a Contractor's Application for Payment form (EJCDC C-620) used for documenting progress payments on construction contracts. The form serves as the primary document through which contractors request payment from owners for completed work on public works projects, such as the Borough of Doylestown's Fanny Chapman Memorial Pool Main Pool Repairs project. The application captures the original contract price, net changes from change orders, total completed and stored work to date, retainage amounts, and the amount due for the current application period. The form requires certification from the contractor, recommendation from the engineer, and approval from the owner, with supporting documentation including a detailed progress estimate that itemizes work by specification section and bid item, tracking scheduled value, work completed during the current period, materials stored, and the balance remaining to finish. The progress estimate sections allow for percentage of completion calculations and provide columns for tracking quantities, unit prices, and bid values across multiple line items.
The payment structure incorporates retainage provisions calculated as percentages of both completed work and stored materials, with the form indicating that retainage on the Doylestown pool project is initially set at 10 percent and may be reduced to 5 percent once the project reaches 50 percent completion. The application requires detailed tracking of change orders, with separate columns for additions and deductions, and includes certification language requiring the contractor to attest that all previous payments have been properly applied to legitimate obligations, that title to all work and materials will pass to the owner free of liens and encumbrances, and that all work complies with contract documents. The form is endorsed by the Construction Specifications Institute and provides spaces for the contractor's certification signature and date, engineer's recommendation with date, and owner's approval with date, ensuring a documented approval chain for each payment request throughout the project duration.
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Text version
Contractor's Application for Payment No.
Application Period: Application Date:
To (Owner): From (Contractor): Via (Engineer):
Project: Contract:
Owner's Contract No.: Contractor's Project No.: Engineer's Project No.:
1. ORIGINAL CONTRACT PRICE
2. Net change by Change Orders
3. Current Contract Price (Line 1 ± 2)
4. TOTAL COMPLETED AND STORED TO DATE
(Column F on Progress Estimate)
5. RETAINAGE:
a. X Work Completed
b. X Stored Material
c. Total Retainage (Line 5a + Line 5b)
6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c)
7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application)
8. AMOUNT DUE THIS APPLICATION
9. BALANCE TO FINISH, PLUS RETAINAGE
(Column G on Progress Estimate + Line 5 above)
Contractor's Certification
Payment of: $ is recommended by:
Payment of: $ is approved by:
By: Date:
Approved by:
Application For Payment
Funding Agency (if applicable)
(Line 8 or other - attach explanation of the other amount)
(Date)
(Date)(Engineer)
(Owner)
(Line 8 or other - attach explanation of the other amount)
(Date)
Number Deductions
CHANGE ORDERS
-$ TOTALS
Change Order Summary
Additions
Endorsed by the Construction Specifications Institute.
The undersigned Contractor certifies that to the best of its knowledge: (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 Work covered by prior
Applications for Payment; (2) title of 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 Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective.
NET CHANGE BY
Approved Change Orders
EJCDC C-620 Contractor's Application for Payment
© 2007 National Society of Professional Engineers for EJCDC. All rights reserved.
Progress Estimate
For (contract): Application Number:
Application Period: Application Date:
Item C D Materials Presently Total Completed Balance to Finish
This Period Stored (not in C or D) and Stored to Date (B - F)
(C + D + E)
Contractor's Application
Totals
(F)
B
A GE
Specification Section
No.
Description
Scheduled Value From Previous Application
(C+D)
Work CompletedB F
EJCDC C-620 Contractor's Application for Payment
Progress Estimate Contractor's Application
For (contract): Application Number:
Application Period: Application Date:
Balance to Finish
(B - F)
Totals
Total Completed and Stored to Date
(D + E)
(F)
B
Value Materials Presently
Stored (not in C)Bid Item No. Description
E F
Item
Bid Quantity Unit Price Bid Value
Estimated
Quantity
Installed
A B C D
EJCDC C-620 Contractor's Application for Payment
File details come from the government source that posted it. Updated .