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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: 2/27/2016 L i Owner <br /> Architect <br /> Everett,WA 98201 Period To: 8/18/2016 Q Contractor <br /> (i <br /> From Contractor: IMCO General Construction, Inc VlaArchitect: Carollo Engineers 1=1 <br /> 2116 Buchanan Loop 1218 Third Ave Suite 1600 Project Nos: <br /> Ferndale,WA 98248 Seattle WA 98101 <br /> Contract For: Contract Data <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 By Change Order $740,181.62 CONTRACTOR: IMCO General Construction,inc. <br /> 3.Contract Sum To Date $28,674,559.13 .-,-f' <br /> 4.Total Completed and Stored To Date r <br /> p $21,700,644.Q5 By: Date: b <br /> 5.Retainage: <br /> a. 0.00% of Completed Work State of: (� �_ Countyof: ' r mr <br /> $0.00 • Subscribed and ss rn to befdreJmethis day of <br /> V <br /> b. 0.00%of Stored Material $0.00 Notary Public: <br /> My Commission expires: .��4� w <br /> $0.00 i -I - goo '-bg•ti.`.a\4 \ <br /> Total Retainage I t \i1 <br /> 6.Total Earned Less Retainage $21,700,644.05 Q.•.,� 4. : f! <br /> • <br /> J " <br /> G!`r 0TA/? �: t7. Less Previous Certificates For Payments $21,412,712.73 1 —r•10.r v'= <br /> _ � <br /> 8.Current Payment Due V : PUBLIC <br /> $287,931.32 • '1�•-1fP ,+O ��*•°C3`',,,/ <br /> Sales Tax 9.2000%on 287,931.32 ��i, Q• l_ Q. ,,,,,dc. ..1 <br /> t ) 26,489.68 N. p wAV <br /> Current Payment Due Plus Sales Tax 314,421.00 <br /> 9.Balance To Finish, Plus Retainage $6,973,915.08 <br /> NFIANGE 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 /> TOTALS • $740,181.62 $0.00 • <br /> Net Changes By Change Order $740,181.62 <br /> C <br />