4-Application for Payment.pdf

This is an Application for Payment form used by Kane County Forest Preserve District, located in Geneva, Illinois, for processing contractor payment requests on projects related to the preservation and restoration of natural areas. The form serves as the standardized payment application document for contractors to submit reimbursement requests during the contract period. It requires contractors to document the project name, payment application number, period of work completed, and any associated change orders. The form is designed to track contract status through columns that capture the original contract amount, work completed with corresponding percentages and dollar amounts, materials stored, retained funds, previously paid amounts, and the net amount due for the current payment application.

The Application for Payment form requires contractors to provide a sworn statement and includes summary sections for calculating key financial metrics including the original contract amount, extras to contract, total contract plus extras, credits to contract, total retained funds, previously paid amounts, net earned amounts, adjusted total contract value, and final net amount due. This document is applicable to projects such as the Pond Management contract (SB-FP-08-2526) in Illinois, which involves aquatic herbicide and nutrient management applications across preserve properties. The form's structure ensures transparent tracking of contract finances and payment schedules throughout project execution, with contact information provided for the Kane County Forest Preserve District at 630-232-5980.