Certificate For Payment
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1
2ABC Form C-10
August 2001
ESTIMATE No.___________________
APPLICATION and
CERTIFICATE for PAYMENT
DATE:___________________________
Attach Schedule of Values
B.C. No.__________________________
TO OWNER:
PROJECT
FROM CONTRACTOR:
Architect/Engineer
FEIN _______________________
TOTAL ORIGINAL CONTRACT
$
CHANGE ORDER(S)
Numbers _______ through ______
$
TOTAL CONTRACT TO DATE
$
1. Work Completed to Date per attached Schedule of Values ( _____ %)
$
2. Stored Materials:
$
(Attach list or Form ABC C - SM, Inventory of Stored Materials.)
3. Total Completed Work and Stored Materials
$
4. Less Retainage
($
)
5. Total Due
$
6. Less Total Previous Payments
($
)
7. Balance Due This Estimate
$
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