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RECEIVED <br /> CONTRACTORS APPLICATION FOR PAYMENT <br /> (Unit Price Schedule and Change Order Backup Attached) AUGG <br /> 1 1996 <br /> FgDI i= <br /> IVI&(,,r, J <br /> OWNER: State of Colorado-Attn: Maggie Van Cleef FROM: ERLNFnviA0C§A-A Lgy1 AQ n,Inc. APPLICATION NO: 2 <br /> Division of Minerals&Geology 5950 South Willow Drive APPLICATION DATE: July 31, 1996 <br /> 1313 Sherman Street,Room 215 Suite 206 APPLICATION PERIOD: July, 1996 <br /> Denver,Colorado 80203 Greenwood Village,CO 80111 <br /> CONTRACT NO: PKA-6-372 PROJECT NO: ECOR960007.00 I t <br /> CONTRACT DATE: June 20, 1996 r <br /> SUBJECT: Coal Basin Rock Tunnel r <br /> f r>� <br /> CHANGE ORDER SUMMARY <br /> ADDITIONS DEDUCTIOr$S f "f_•' CONTRACT WORK <br /> � ` I <br /> PREVIOUS MONTHS i 1. 01� GIkAL CONTRACT SUM $77,974.00 <br /> TOTALS: $0.00 N 0 i <br /> THIS MONTH 2. K Et CHANGE BY gHANGE ORDERS -{$61 1.40) <br /> TOTALS: $1,338.60 '�$1,950.00 , 1� <br /> 3. CONTRACT SUM O DATE(Line 1 +2) $77,362.60 <br /> NET CHANGE BY CHANGE ORDERS: $1,338.60 ($1,950.00) <br /> 4. TOTAL 4NTRACT WORK COMPLETED/S RED $41,639.05 <br /> A. <br /> 5.i RL4INAGE ( $0.00 <br /> Undersigned Contractor certifies that to the best of the Contractor's <br /> knowledge,information,and belief,the Work covered by this Applic�gon 6. TOTAL AMOUNT IN4010EDrLESS RETAINAGE $41,639.05 <br /> for Payment has been completed in accordance with the Contract Documents, <br /> all amounts have been paid by the Contractor for Work for which previous 7. LESS PREVIOUS CE�11`15 TES FOR PAYMENT $4,387.00 <br /> Certificates for Payment were issued and payments received from the Owner, \1.. <br /> and that all current payment shown herein is now due. 8. CURRENT PAYME, 1. 4T DUE $37,252.05 <br /> 9. BALANCE TO FINISH,PLUS RETAINAGE $35,723.55 <br /> CONTRACTOR: ERM EnviroClean-Rocky Mountain,Inc. DATE: <br /> P:\ec\r\colo-dmg\960007\INV.APP2.XLS Page 1 of 3 <br />