FLOOD09416

• County: Ouray
• Community: Ouray
• Stream Name: Portland Creek
• Basin: Gunnison
• Title: Contract Documents for Debris and Flood Control Improvements Portland Creek, Phase II
• Date: 7/1/1987
• Prepared For: Ouray
• Prepared By: Simons Li & Associates Inc.
• Floodplain - Doc Type: Project

APPLICATION FOR pAYMENT NO.

To
Contract foc
OWl' ER's Project No,
For Work accomplished through the date of

(OWNER)

Dated__

, ENGINEER's Project No,

ITEM

CONTRACTOR's Schedule of Values
Unit Price Quantify ~=--I

" $

Amount

Work Compleled
QuantJ{~ Amounl

$

$

Total
(O,.ig, Contract)
CO, No, I
CO, No, 2

$

$

Ace Jmpanying Documentation:

GROSS AMOUNT DUE, ,
LESS _,,0,', RETAINAGE"",,'
AMOUNT DUE TO DATE"",,"
LESS PREVIOUS PA YMENTS"""
AMOUNT DUE THIS APPLlCA TION, ,

$---

$--,-,
$--,_.
$---
$--,-

CONTRACTOR's Certifica'ion:

The undersigned CONTRACTOR certifies that-(l) all previous progre:i$ payments received from OWNER on account of Wcrx
done under the Contract ref.erred (0 above have been applied to discharge in full all obligations of CO~TRACTOR incurred in
connection with Work covered by prior Applications for Payment num::,ered I through __ inclusive; and (2) title to all
materials and equipment incorporated in said Work or otherwise listc~d in or covered by this Application for Payment -will pass to
OWNER at time of payment free and clear of all liens, claims, security interests anel encumbrances (except such as covered by
Bond.cceptable to OWNER),

Dared

19_

CONTRACTOR

By____,_____,_________

ENGINEER's Recommenda,ion:

This Application (\vilh accompanying documentation) meets the requirements of the Contract Docurn(~nts and payment of the
above "'MOUNT DUE THIS APPLlCA nON is recommended,

Dated

19_

ENGINEER

By______________

191O.8-E (1979 Ed.)
'0 Nalional SOC1~IY of Professional Engineers