Hwy 103 Waterline - Project Manual - Bidding.pdf

Contractor's Application for Payment Owner: City of Idaho Springs Owner's Project No.: 1000.6e Engineer: JVA, Inc Engineer's Project No.: 1000.6e Contractor: Contractor's Project No.:

Project: Highway 103 Waterline Contract: City of Idaho Springs - Highway 103 Waterline Application No.: Application Date:

Application Period: From to

1. Original Contract Price $ -

2. Net change by Change Orders $ -

3. Current Contract Price (Line 1 + Line 2) $ -

4. Total Work completed and materials stored to date

(Sum of Column G Lump Sum Total and Column J Unit Price Total) $ -

5. Retainage

a. X $ - Work Completed $ -

b. X $ - Stored Materials $ -

c. Total Retainage (Line 5.a + Line 5.b) $ -

6. Amount eligible to date (Line 4 - Line 5.c) $ -

7. Less previous payments (Line 6 from prior application)

8. Amount due this application $ -

9. Balance to finish, including retainage (Line 3 - Line 4) $ -

Contractor's Certification The undersigned Contractor certifies, to the best of its knowledge, the following:

(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 the Work covered by prior Applications for Payment;

(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, 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 the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective.

Contractor:

Signature: Date:

Recommended by Engineer Approved by Owner

By: By:

Title: Title:

Date: Date:

Approved by Funding Agency

By: By:

Title: Title:

Date: Date:

EJCDC C-620 Contractor's Application for Payment

(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.

Progress Estimate - Unit Price Work Contractor's Application for Payment

Engineer: JVA, Inc Engineer's Project No.: 1000.6e Contractor: Contractor's Project No.:

Project: Highway 103 Waterline Contract: City of Idaho Springs - Highway 103 Waterline

Application No.: Application Period: From to Application Date:

A B C D E F G H I J K L

Bid Item No. Description

Contract Information Work Completed

Materials Currently Stored (not in G)

Work Completed and Materials Stored to Date

(H + I)

% of Value of

Item (J / F)

Balance to Finish (F

- J) ($)Item Quantity Units

Unit Price

Value of Bid Item (C X E)

Estimated Quantity

Incorporated in the Work

Value of Work Completed to Date

(E X G)

Original Contract

Original Contract Totals $ - $ - $ - $ - $ -

Unit Price

(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 2 of 4

Change Orders

Change Order Totals $ - $ - $ - $ - $ -

Original Contract and Change Orders Project Totals $ - $ - $ - $ - $ -

Progress Estimate - Unit Price Work Contractor's Application for Payment Owner: City of Idaho Springs Owner's Project No.: 1000.6e Engineer: JVA, Inc Engineer's Project No.: 1000.6e Contractor: Contractor's Project No.:

Project: Highway 103 Waterline Contract: City of Idaho Springs - Highway 103 Waterline

Application No.: Application Period: From to Application Date:

A B C D E F G H I J K L

Bid Item No. Description

Contract Information Work Completed

Materials Currently Stored (not in G)

Work Completed and Materials Stored to Date

(H + I)

% of Value of

Item (J / F)

Balance to Finish (F

- J) ($)Item Quantity Units

Unit Price

Value of Bid Item (C X E)

Estimated Quantity

Incorporated in the Work

Value of Work Completed to Date

(E X G)

Unit Price

(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 3 of 4

Stored Materials Summary Contractor's Application for Payment

Engineer: JVA, Inc Engineer's Project No.: 1000.6e Contractor: Contractor's Project No.:

Project: Highway 103 Waterline Contract: City of Idaho Springs - Highway 103 Waterline

Application No.: Application Period: From to Application Date:

A B C D E F G H I J K L M

Item No.

(Lump Sum Tab) or

Bid Item No.

(Unit Price Tab)

Supplier Invoice No.

Submittal No.

(with

Specification Section No.)

Description of Materials or Equipment Stored Storage Location

Application No. When Materials Placed in Storage

Materials Stored Incorporated in Work Materials

Remaining in Storage

(I-L)

Previous Amount Stored

Amount Stored this Period

Amount Stored to Date (G+H)

Amount Previously Incorporated in the

Work

Amount Incorporated in the

Work this Period

Total Amount Incorporated in the

Work (J+K)

Totals $ - $ - $ - $ - $ - $ - $ -

Stored Materials

(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. 4 of 4