Subcontractor Application For Payment
ADVERTISEMENT
1
2EXHIBIT "A"
SUBCONTRACTOR APPLICATION FOR PAYMENT
AND
PARTIAL RELEASE OF LIEN
TO:
Capstone Building Corp.
DATE:
_______________________________
3415 Independence Drive
Birmingham, AL
35209
CONTRACT NO.: _________________________
FROM:
(Name) ________________________________
DATE OF SUBCONTRACT: ________________
(Address)______________________________
_____________________________________
OPTIONAL DISCOUNT FOR EARLY PAYMENT
1% < 15 days
2% < 10 days
PROJECT: _____________________________________
$ _____________________
_____________________________________
Do Not Include Discount Amount
_____________________________________
In Calculations Below
APPLICATION NO. _____________
1) Our subcontract billing for this period ___________________ , 20 _____
to ______________________ , 20 _______ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
-
2) Less _________________ % Retainage or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (-)
$
-
3) Release Retainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (+)
$
-
4) Net Billing (Sum of lines 1, 2 and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (=)
$
-
STATEMENT OF SUBCONTRACT
5) Original Subcontract Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
-
6) Approved and Executed Change Order Nos.
- . . . . . . . . . . . . . . . . . . . . . . . . . (+)(-)
$
-
7) Revised Subcontract to Date (Sum of lines 5 and 6) . . . . . . . . . . . . . . . . . . . . . . . (=)
$
-
JOB TO DATE CALCULATIONS
8) ________________% Work Completed to Date . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
-
9) ________________% Change Order Complete. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (+)(-)
$
-
10) Material Stored on Job Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(+)
$
-
11) Total Work Completed and Material Stored on Job Site(Sum of lines 8, 9, &10)
(=)
$
-
12) Less _____% Retainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(-)
$
-
13) Less Previous Applications for Payments (Sum of prior net billing amounts). . . (-)
$
-
14) Less Owner Purchased Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(-)
$
-
$
-
15) AMOUNT OF THIS REQUISTION (Sum of lines 11, 12, 13 and 14) . . . . . . . . . . . . . (=)
$
-
NOTE: If stored material cost is listed, sales tax on that material must be shown.
__________________________________________________________________________________________
REVERSE SIDE MUST BE COMPLETED
__________________________________________________________________________________________
Revised 11-02
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Payment From Unclaimed Funds, Form W-9 - Request For Taxpayer Identification Number And Certification - 2011
Financial
Application For Payment Plan For Court Costs, Fines And/or Fees - In The Circuit Court Of Cook County, Illinois
Legal
Related Categories
Parent category: Legal