35-Doc 00 62 76 - Application for Payment.pdf
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- Attached to
- 2500999 - Canterbury Storm Sewer Replacement State and local contract opportunity
- Solicitation number
- Not on record
- Issued by
- Montgomery County, Mount Aetna CDP, Pennsylvania
About this file
This is an Application for Payment form (EJCDC Form C-620) related to the Canterbury Storm Sewer Replacement project being executed by Montgomery Township in Pennsylvania under Contract 2025-00999. The project involves the removal and replacement of approximately 1,800 feet of corroded storm sewer infrastructure on Canterbury Lane and Devonshire Drive, including removal of corrugated metal pipe (CMP) ranging from 12 inches to 57 inches by 38 inches in diameter, installation of new circular HDPE pipe and elliptical RCP storm sewer, replacement of three precast concrete storm sewer structures, and restoration of concrete curb, sidewalk, driveway apron, and asphalt roadway. The sealed bid deadline was September 1, 2026, with bids submitted electronically through the PennBid Program. No pre-bid meeting was held for this project.
The Application for Payment form is used by the contractor to request payment for work accomplished through a specified date, detailing unit prices, quantities, and amounts for completed work items. The form includes provisions for original contract amounts, change orders, retainage deductions, and previous payments, with certification requirements from both the contractor and engineer. The project is subject to Pennsylvania's Act 422 Prevailing Wage Act and Act 127 Public Works Employment Verification requirements. Bid security of not less than ten percent (10%) of the bid amount was required, with a PennBid administrative fee of 0.33% of the bid amount (minimum $150, maximum $6,000) assessed only to awarded bidders. Performance and Payment Bonds were required as conditions of contract award.
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Text version
DOCUMENT 00 62 76
APPLICATION FOR PAYMENT NO.
TO: (OWNER)
Contract for:
OWNER'S Contract No. ENGINEERs Project No:
For Work accomplished through the date of
Unit Price Quantity Amount
Total (Original Contract) $
Change Order No. 1 $
Change Order No. 2 $
Accompanying Documentation: GROSS AMOUNT DUE. . . . . . . . . . . . . $
LESS % RETAINAGE . .. . . . . $
AMOUNT DUE TO DATE . . . . . . . . . . . $
LESS PREVIOUS PAYMENTS . . . . . . . $
AMOUNT DUE THIS APPLICATION . . .$
CONTRACTOR's Certification:
Dated:
CONTRACTOR
By:
(authorized signature)
Payment of the above AMOUNT DUE THIS APPLICATION is recommended.
Dated: , 20___
ENGINEER
By:
(authorized signature)
The undersigned CONTRACTOR certifies that: (1) all previous progress payments received from OWNER on account of Work done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR incurred in connection with Work covered by prior Applications for Payment numbered 1 through _________ inclusive; (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, claims, security interest and encumbrances (except such as are covered by Bond acceptable to OWNER indemnifying OWNER against any such lien, claim, security interest or encumbrance); and (3) all Work covered by this Application for Payments is in accordance with the Contract Documents and not defective as that term is defined in the Contract Documents.
Amount
ITEM
Quantity
Montgomery Township
Canterbury Storm Sewer Replacement
2025-00999
CONTRACTORs Schedule of Values
2025-00999
Work Completed
EJCDC Form C-620
APPLICATION FOR PAYMENT
00 62 76-1
File details come from the government source that posted it. Updated .