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| 1 |
PROGRESS PAYMENT |
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Project Name: |
Well Field Control Building |
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Date of Application: |
6/29/2012 |
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Project Nos: |
CIP #707593 |
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Payment No: |
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Resolution No: |
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Invoice Date: |
6/21/2012 |
(see attached invoice) |
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Purchase Order No: |
4133 |
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Pay Period: |
Final Payment |
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The Contract was signed by City Manager on 02/21/ 2012 for $_44,227.35 |
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Contractor: |
CR Woods Trucking Inc. |
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A copy of the Purchase Order is attached. |
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Application is made for Payment, as shown below, in connection
with the Contract. Payment due date per Contract specification.
The present status of the account(s) for this Contract is as
follows: |
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| 19 |
THIS PAYMENT |
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Month |
Work Performed - See Payment Detail Page(s) |
Original Contract |
Change Orders |
Revised Contract |
This Payment Request |
This Retainage (5% overall) |
Total Payment |
Percentage Complete |
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Feb. 2012 |
04-5150-707593 |
$44,227.35 |
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$44,227.35 |
$2,211.37 |
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$2,211.37 |
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$450.00 |
$450.00 |
$450.00 |
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$450.00 |
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Total: |
$44,227.35 |
$450.00 |
$44,677.35 |
$2,661.37 |
$0.00 |
$2,661.37 |
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| 32 |
PROGRESS INVOICE HISTORY |
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THIS PAYMENT |
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Pay No. |
Progress Amt |
% Complete |
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1 |
$16,271.60 |
36.4% |
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2 |
$19,000.00 |
42.5% |
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ORIGINAL CONTRACT AMOUNT |
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44,227.35 |
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3 |
$6,744.38 |
15.1% |
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Net Change by Change Order(s) |
$ |
450.00 |
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4 |
$2,661.37 |
5.96% |
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CONTRACT SUM TO DATE |
$ |
44,677.35 |
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THIS PAYMENT FROM: |
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Account # 04-5150-707593 |
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2,661.37 |
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$ |
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$ |
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CURRENT PAYMENT DUE |
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Total |
$44,677.35 |
100.0% |
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$ |
2,661.37 |
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The undersigned Contractor certifies that the work covered by
this Application for Payment has been completed in accordance
with the Contract Documents, and that the current payment shown
herein is now due. (The same Contractor shall be responsible
for paying all his/her subcontractors/suppliers.)
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CITY OF NEWBERG |
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Jason Wuertz, Project Manager |
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Date |
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See Invoice |
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Firm/Contractor |
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Jay Harris, PE, City Engineer/Engineering Manager |
Date |
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Signature |
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Date |
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Daniel Danicic, MPA, PE, City Manager (if over $5,000.00) |
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Title |
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This certificate is not negotiable. It is payable only to the
payee named herein and its issuance, payment and acceptance are
without prejudice to any rights of the Owner or Contractor under
their Contract. |
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Contractor's copy |
Check Payment: |
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Please hold. |
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| 72 |
◊ |
Finance file |
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Please mail to - Deliver to Brian Kershaw |
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◊ |
Engineering file |
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Other |
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