FLOOD06073

• County: Ouray
• Community: Ouray
• Stream Name: Cascade Creek
• Basin: Gunnison
• Title: Contract Documents for Debris and Flood Control Improvements Cascade Creek, Phase II
• Date: 5/10/1984
• Prepared For: Ouray
• Prepared By: Simons Li & Associates Inc.
• Floodplain - Doc Type: Project

APPLICATION FOR P.4. YMENT NO. ___._.____

To ___~___.._._.____._..__._ _~__ (OWNER:
Contract for --________________Dated_____~____.
OWNER's Project No. ENGINEER', Project No.______________.
For Work accomplished through the date of_~__________._____.___ ________________ .

ITEM

CONTRP:cTOR.'~j;~v~
--.
Unit Pricr: Quantity

$

$

. .-
" Work Completed
Amount Quantity Amount
. -
$
'---'- -
$ I:
i

Total
(Orig. Contract)
CO. No. I
CO. No.2

$

Accompanying Documentation:

GROSS AMOUNT DUE. .. . .. .
i-ESS __'7, RIOT AINAGE. . . .
AMOUNT DUE TO DATE.........
I.ESS PREVIOUS PAYMENTS..... ".."'"
AMOUNT DUE THIS APPLlCA TION. .

$-----
$---.-
$-.--
$----
$----

CONTRACTOR's Certification:

The undersigned CONTRACTOR certifies that (1) all previous progress payments recc~ived from OWNER on account of Work
done under the Contract referred to above have been applied to discharge in full all obligations of CONTRACTOR incurred in
connection with Work covered by prior Applications for Payment numbered 1 through ~___ inclusive; and (2) title to all
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 aJltiens, claim~;, security interests and I~ncumbrilnces (except such as covered by
Bond acceptable to OWNER).

Dated

19

...----..- CON1:'"RACTOR

By _._____._._

ENGINEER's Recommendation:

This Application (with accompanying documentation) meets the requirement:; of the Contract Documents and payment of the
above AMOUNT DUE THIS APPLICA nON is recommended.

Dated

I9~

ENGINEi~R

By______._.._..____._.____.___________

191O~8-E (1979 Ed.)
@ Nalional SocielY of Professional Engineers