Sample_Application_for_Payment.pdf
PDF 75 KB Posted
- Attached to
- Reconstruct Airport Perimeter Fence Phase 2-PIE
- Solicitation number
- 26-0618-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Sample Application for Payment document related to the Reconstruct Airport Perimeter Fence Phase 2 project at St. Pete-Clearwater International Airport in Florida. The document provides a template for contractors to submit payment requests during project execution. The application format includes sections for project identification, contractor information, description of work completed, quantities of materials and labor expended during the billing period, and detailed cost breakdowns by line item. The form requires certification that work has been performed in accordance with contract specifications and that all invoices for labor, materials, and equipment are accurate and substantiated. Payment applications must include supporting documentation such as lien waivers, payroll records, material receipts, and photographic evidence of completed work to substantiate the charges requested.
The payment application process establishes the mechanism for contractors to receive reimbursement for work completed on the airport fencing project, which involves removal and replacement of vulnerable perimeter fencing with 8-foot tall prefabricated, non-scalable fencing topped with razor wire and wildlife deterrent skirts. The document typically requires approval from the project engineer or owner's representative before payment is processed, and may include provisions for retainage or withholding a percentage of payment until final project completion. All payment applications must be submitted in compliance with contract terms and any applicable Florida Statutes or local ordinances governing public construction projects and payment procedures.
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Text version
APPENDIX 3 - SAMPLE APPLICATION FOR PAYMENT
APPENDIX 3 – SAMPLE APPLICATION FOR PAYMENT
APPLICATION AND CERTIFICATE FOR PAYMENT
From (Contractor Name) Pinellas County Department
Payment Application Number Purchase Order Number
Payment Period From:
to
CHANGE ORDER SUMMARY PAYMENT SUMMARY
Change Order #
Date Approved
Additions Deductions Original Agreement Amount $
Retainage __________ %
Total Earned Less Retainage $
Less Previous Payments $
TOTAL
NET CHANGE Current Payment Due $
I certify that the payment requested is in APPLICATION FOR PAYMENT APPROVED BY:
accordance with the terms of the agreement dated _____________ and that previous Consultant or Design Professional/Engineer of Record payments have been used to pay obligations for materials supplied and work performed in conjunction with this project. In accordance
Pinellas County ________ (Dept) Engineering Project Manager with the contract documents and in consideration of _____________ ____ paid.
___________________ (“Contractor”) releases
Pinellas County Public Works and waives for itself and its subcontractors, materialmen, successors, and assigns, all claims demands, damages, costs and Director of ___________________ (Dept) expenses, whether in contract or in tort, against the Board of County Commissioners of Pinellas County, Florida, Ex Officio the governing Board of the Pinellas County (“County”) relating in any way to the performance of the agreement between contractors and owner, dated for the period from _________________ to
Contractor Date
File details come from the government source that posted it. Updated .