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APPLICATION AND CERTIFICATE FOR PAYMENT Invoice#: 3325*22 Invoice Date:8/31/2016 <br /> To Owner: City of Everett Public Works Project: 3325.Everett WPCF Phase Cl GC CM Application No.: 22 Distribution to: <br /> 3200 Cedar Street Period From: (`1 Owner <br /> 2/27/2016 I--I Architect <br /> Everett,WA 98201 Period To: 8/18/2016 n Contractor <br /> p <br /> From Contractor: IMCO General Construction, Inc Via Architect Carollo Engineers Q <br /> 2116 Buchanan Loop 1218 Third Ave Suite 1600 Project Nos: <br /> Ferndale,WA 98248 .. Seattle WA 98101 <br /> Contract For: Contract Date: <br /> CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, <br /> information,and belief,the work covered by this Application for Payment has been <br /> Application is made for payment,as shown below,in connection with the Contract. completed in accordance with the Contract Documents.That all amounts have been <br /> continuation Sheet is attached. paid by the Contractor for Work for which previous Certificates for Payment were <br /> issued and payments received from the Owner, and that current payment shown <br /> herein is now due. <br /> 1. Original Contract Sum $27,934,377.51 <br /> 2.Net Change ByChange Order CONTRACTOR: IMCO General Construction, Inc. <br /> 9 9 $740,181.62 <br /> 3.Contract Sum To Date $28,674,559.13 <br /> 4.Total Completed and Stored To Date $21,700,644.05 By: \ i b Date: ti 1- <br /> 5. Retainage: <br /> a. 0.00% of Completed Work $0 00 State of: Wet t ew hj� County of: (A/N;(7.0141 <br /> Subscribed and sw rn to betake me this day of <br /> b. 0.00%of Stored Material $0.00 Notary Public: <br /> My Commission expires: 13-6/17\97(91 �....... Nik\v1/4 <br /> Total Retainage $0.00 I° —r _ !!o =°VIN j04\11 <br /> 4, c17-37' 9A 10 <br /> 6.Total Earned Less Retainage $21,700,644.05 P a4� lrfA•;9t' <br /> z txoTggy90;; tj <br /> • <br /> 7. Less Previous Certificates For Payments $21,412,712.73 v ~�~ 9 <br /> 8. Current Payment Due $287,931.32 ,t1N9:,� V8�.1C 0=/, <br /> +. ro <br /> Sales Tax 9.2000%on 287,931.32 , •• �t ZO a�.' r <br /> ( ) 26,489.68 1�\�\WA=��� <br /> Current Payment Due Plus Sales Tax 314,421.00 <br /> 9. Balance To Finish, Plus Retainage $6,973,915.08 <br /> L'HANGE ORDER SUMMARY Additions Deductions <br /> Total changes approved $740,181.62 $0.00 <br /> in previous months by Owner <br /> Total Approved this Month $0,00 $0.00 <br /> - <br /> TOTALS $740,181.62 $0.00 <br /> Net Changes By Change Order $740,181.62 <br />