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From <br />1. <br />2. <br />3. <br />4. <br />5. <br />a.X <br />b.X <br />c. <br />6. <br />7. <br />8. <br />9. <br />Contractor's Application for Payment <br />Application No.: <br />Orange County <br />Draper Aden Associates <br />C&D Landfill Phase 2 Construction <br />Owner's Project No.: <br />Engineer's Project No.: <br />Contractor's Project No.: <br />Application Period: <br />Contract: <br />Owner: <br />Contractor: <br />Engineer: <br />Project: <br />By: <br />Title: <br />Date: <br />By: <br />Title: <br />-$ <br />Date: <br />Signature:Date: <br />Contractor's Certification <br />Balance to finish, including retainage (Line 3 - Line 4) <br />Approved by Owner <br />The undersigned Contractor certifies, to the best of its knowledge, the following: <br />(1) All previous progress payments received from Owner on account of Work done under the Contract have been <br />applied on account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by <br />prior Applications for Payment; <br />(2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by this <br />Application for Payment, will pass to Owner at time of payment free and clear of all liens, security interests, and <br />encumbrances (except such as are covered by a bond acceptable to Owner indemnifying Owner against any such <br />liens, security interest, or encumbrances); and <br />(3) All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not <br />defective. <br />Recommended by Engineer <br />Application Date: <br />Approved by Funding Agency <br />By: <br />Title: <br />Date: <br />By: <br />Title: <br />Date: <br />to <br />Original Contract Price <br /> $ - <br />-$ <br /> $ - <br />Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) <br />Retainage <br />Work Completed <br />Stored Materials <br />Total Retainage (Line 5.a + Line 5.b) <br />Amount eligible to date (Line 4 - Line 5.c) <br />Less previous payments (Line 6 from prior application) <br />Amount due this application <br />-$ <br />-$ <br />-$ <br />-$ <br />-$ <br />-$ <br />-$ <br />R00592-226N <br />Current Contract Price (Line 1 + Line 2) <br />Contractor: <br />-$ <br />Net change by Change Orders <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />DocuSign Envelope ID: 0844D1D6-E311-4FC5-8B5B-BB1E27A908ED