4-Application for Payment.pdf
PDF 97 KB Posted
- Attached to
- SB-FP-06-2526 Herbicide Weed Management Bid
- Solicitation number
- SB-FP-06-2526 Herbicide Weed Management Bid
- Issued by
- Kane County, Illinois
About this file
This document is an Application for Payment Form issued by Kane County Forest Preserve District, located in Geneva, Illinois, as part of their centennial celebration (1925-2025). The form is a standardized financial document designed for contractors to document and request payment for work completed on a project, with columns tracking the contracted work, adjusted total contract amount, work completed, retained amounts, previously paid funds, net amount due, and balance becoming due.
The form includes spaces for detailed financial tracking, including the original contract amount, extras to the contract, total contract value, credits, and net amounts. It requires a sworn statement from the contractor and provides a comprehensive breakdown of project financial progress. The document is part of Kane County's mission "to preserve and restore the nature of Kane County" and is branded with their centennial logo, suggesting this is part of a broader conservation, recreation, and education initiative.
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Text version
To preserve and restore the nature of Kane County
1996 South Kirk Road, Suite 320, Geneva, Illinois 60134
Bill Lenert, President Benjamin Haberthur, Executive Director
(630) 232-5980 Fax: (630) 232-5924 www.kaneforest.com
APPLICATION FOR PAYMENT FORM
Project Name:____________________________________________Date:______________________
Contractor:______________________________________________Payment Application #_______
Period Work Completed:___________________________________Change Order #_____________
1 2 3 4 5 6 7
Contractor
Work/Material
Contracted
For
Adjusted
Total
Contract
Including
Change
Orders
Work
Completed
Materials
Stored
Total
Retained
Including
This
Application
Previously
Paid
Net
Amount
Now Due
Col 3 –
Col 4 & 5
Balance
Become
Due
Col 2 – Col
5 & 6
Amt of Original Contract $ ____________________Work Completed (Col 3) $___________________
Extras to Contract $__________________________ Total Retained (Col 4) $_____________________
Total Contract + Extras $______________________ Net Earned (Col 3+Col 4) $__________________
Credits to Contract $_________________________ Previously Paid (Col 5 ) $____________________
Adjusted Total Contract $_____________________ Net Amount Due (Col 7) $____________________
Sworn Statement for Contractor_________________________________________Date:_____________ http://www.kaneforest.com/
File details come from the government source that posted it. Updated .