Sample_Application_for_Payment.pdf

This is a Sample Application for Payment form used by Pinellas County for contractor reimbursement on construction projects. The document serves as a standardized template for the Palm Harbor Recreation Center Addition project, a 28,000 square foot dual-purpose facility designed to function as both a community recreation center and an American Red Cross-compliant hurricane shelter. The General Contractor must submit payment applications that reference the original agreement amount, document any approved change orders with additions and deductions, and calculate retainage withholdings according to contract terms. The application requires certification that payments correspond to materials supplied and work performed, with signature approvals required from the Consultant or Design Professional, the County Engineering Project Manager, and the Director of the relevant department. The contract term is 425 consecutive calendar days from the Notice to Proceed, with liquidated damages assessed at $487.07 per calendar day for project delays.

The payment application form establishes retainage provisions as a percentage of earned amounts, with previous payments deducted to determine the current payment due. Contractors must track all change orders chronologically with approval dates and financial impacts to ensure accurate invoicing. The form includes a waiver and release clause wherein the contractor, upon payment, releases Pinellas County Public Works and the Board of County Commissioners from all claims, demands, and damages related to project performance for the specified payment period. The county has established a 15% Small Business Enterprise participation goal for subcontractors and requires contractors to meet E-Verify requirements and specific insurance and bonding specifications. While no explicit project budget is stated in the application template, the comprehensive nature of the recreation center project involving mechanical, electrical, plumbing, and technology systems indicates a significant capital investment requiring detailed financial tracking through the payment application process.