Arkansas - McClave Water Tank Replacement_Disbursements

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GMS, INC. APPLICATION AND CERTIFICATE FOR PAYMENT Project: Ohlson Tank Reconstruction No: 13059.100 Owner: McClave Water Association Contractor: Carrigan Excavating, LLC Application No. Two(2)Final Period from 2/25/2014 to 4/25/2014 Application is made for payment,as shown below and on the attached Continuation Sheet(s)in accordance with the Contract Documents: Original Contract $ 61,200.00 Change Order No._ $ Change Order No._ $ Change Order No._: $ Adjusted Contract Price $ 61,200.00 Total Amount Due To-Date(from attached Continuation Sheet(s)) $ 61,200.00 Retainage of Amount Due 0.0% $ 0.00 Total Earned Less Retainage $ 61,200.00 Less Previous Certificate for Payment $ 40,446.25 Current Payment Due $ 20,753.75 Contract Scheduled %Time Commencement: 2/1/2014 Completion: 4/1/2014 Used: 100% Complete: 100% Contractor's Certifications Engineer's Certification The undersigned Contractor certifies that the work covered by this The Engineer has reviewed this Application accompanying Application for payment has been completed in accordance with the data and schedules and, having made on-site observations of Contract Documents, that all amounts have been paid by him for work the work, consistent with his assigned responsibilities, certifies for which previous Certificates for Payment were issued and payments that to his best knowledge and belief, the quality of the work received from the Owner, and that the current payment shown herein is performed is in accordance with the Contract Documents, that now due. the work has progressed as indicated herein, and that the Contractor is entitled to payment in the amount shown above. Contractor: Carrigan Excavating, LLC Engineer: GMS, Inc. 30687 County Road 19 611 N.Weber,Suite 300 Lamar,CO 81052 Col• -•o • 'ngs,CO 80903 IBy: I G�-1 By: •.4a9 Date: 05/06/14 Date: v '8 OWNER APPROVAL: By: ( Date: 6 GMS,Inc. C:NJsers\Sheryl\Documents\McClave Ohlson Tank Reconstruction PayApp No.2xls