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Home My WebLink AboutSouthland Construction East Panama Rd Application for Payment -1999 03 02 .' .. .. CONTRACTOR'S APPLICATION FOR PAYMENT PAYMENT REQUEST NO. 3 ENGINEERS FILE NO. W0476F r "'" .~.}"'" f"~~:i .....;; a~,~- ". ~"~~ BID NO. 98-021 MAR 0 ~ \999 WIN IE'.k ~~RING~ erN Of- e Oepaltm811\ FInane FINANCE ACCOUNT NO. CONTRACTOR Southland Construction, Inc. October 30, 1998 COMPLETION DATE May 19,1998 CONTRACT DATE March 2,1999 FOR PERIOD ENDING APPLICATION DATE December 31, 1998 STATEMENT OF WORK Original Contract Price $ 530,067.00 Work to Date $ 330,978.22 Net Change Order Work $ 13,242.03 Amount Retained $ 33,097.82 Current Contract Price $ 543,309.03 Subtotal $ 297,880.40 Work to be Done $ 212,330.81 Previous Payments Approved $ 212,188.32 Amount Due This Payment $ 85,692.08 The Undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress payments received from the Owner on account of work performed under the Contract referred to above have been applied by the undersigned to discharge in full all obligations of the undersigned incurred in connection with work covered by prior Application for Payment under said contract, being Applications for Payment numbered 1 through ~ inclusive; and (2) all materials and equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment are free and clear of all liens, claims, security interests and encumbrances. DATED 3/ 2.- I 1991- BY COUNTY OF SEMINOLE PAYMENT REQUEST No. 3 STATE OF FLORIDA ENGINEERS FILE NO. Before me on thi....? ~6J2y Of~~199.!f.-, personally appear ~~nown ~;~as produced a identification an oath who, being duly sworn did depose and say the he is th above-mentioned; the he executed the above Application for Pa men and stateme Contractor; and that all statem tained therein are true, correct and complete. SEAL (Notary Public) "'6~ Brenda J Hila *1(*My Commission CC7l30B3 My commission expire);.:;I Expires October 26, 2002 by y/~I rl JJ't/17 ;' , .) I'"' /1 i Date by Date by Date General Contractor: Southland Construction, Inc. Project: East Panama Road. Roadway. Drainage and Water Main Improvements Contract Start Date: November 20. 1998 It.._~_ .......~ ~/..JiiIB > ...... ......d ........... .... ) Item No Item Description Quantity Unit Unit Cost I Item Total Quantity Amount i i 1 Mobilization 1.00 LS 46,000.00 I 46,000.00 0.50 23,000.00 2 Clear and Grub 1.00 LS 20,000.00 20,000.00 0.95 19,000.00 3 8" PVC Water Main 4,774.00 LF 10.50 50,127.00 4,774.00 50,127.00 4 Fittings (restrained) 3.77 i TN 4,000.00 15,080.00 3.75 15,000.00 5 ,8" Gate Valve & Box 7.00 ! EA 650.00 4,550.00 7.00 : 4,550.00 6 Fire Hydrant and Valve Assembly -- I --~I 1,800.00 I 10,800.00 I --- 6.00 I EA 10,800.00 I 7 Connect to Existing Main 2.00 LS 1,350.00 I 2,700.00 2.00 i 2,700.00 8 2" PVC Sleeve at Roadway Crossings 315.00 LF 9.80 3,087.00 315.00 3,087.00 9a Service Connections (single-short) 5.00 EA 370.00 1,850.00 5.00 1,850.00 9a Service Connections (single-long) 12.00 EA 370.00 4,440.00 12.00 4,440.00 9b Service Connections (double-long) 4.00 EA 400.00 1,600.00 4.00 1,600.00 10 Waming/lndentification Tape 4,774.00 LF 0.10 477.40 4,774.00 477.40 11 Storm Manholes 1.00 EA 2,200.00 2,200.00 2.00 4,400.00 12 FOOT Type 'C' Inlet i 6.00 EA 2,000.00 I 12,000.00 ! 6.00 12,000.00 ,- 13 12"x18" ERCP 679.00 LF 31.60 21,456.40 679.00 21,456.40 14 18" RCP 799.00 LF 29.00 23,171.00 799.00 23,171.00 15 24" RCP 143.00 LF 36.00 5,148.00 401.00 14,436.00 16a Mitered End Section 12"x18" 3.00 EA 580.00 1,740.00 1.50 870.00 16b Mitered End Section 24" W/Energy Dissipater 1.00 EA 880.00 880.00 0.00 17 TrashlFloatables Separation Box 1.00 LS 10,000.00 10,000.00 0.90 9,000.00 18 Swale Checks 49.00 EA 170.00 8,330.00 0.00 19 Modify Existing 'C' Inlet 1.00 EA 1,000.00 1,000.00 1.00 1,000.00 20a Remove Existing 12"x18" MES 1.00 EA 140.00 140.00 1.00 140.00 20b Remove Existing 12"x18" ERCP 22.00 LF 10.00 220.00 22.00. 220.00 20c Remove Existing 12" PVC Culvert 22.00 LF 10.00 220.00 22.00 220.00 20d Remove Existing CMP Culvert 22.00 LF 10.00 220.00 22.00 220.00 21a Erosion and Sediment Control - Silt Fence 550.00 LF 1.00 550.00 500.00 500.00 21b Erosion and Sediment Control - Turbidity Barrier 65.00 LF 3.50 227.50 0.00 22 12" Sub-base 14,468.00 SY 2.20 31,829.60 2,500.00 5,500.00 23 8" Umerock Base 11,957.00 SY 6.80 81,307.60 0.00 24 1.5" S-1 Asphaltic Concrete 11,957.00 SY 3.40 40,653.80 0.00 25 l' Concrete Ribbon Curb 8,717.00 LF 3.30 28,766.10 0.00 26 2' Concrete Drop Curb 643.00 LF 8.90 5,722.70 0.00 27 6" Concrete Header Curb 66.00 LF 8.90 587.40 0.00 28 Crushed Shell Driveways & Path 4,689.00 SY 4.50 21,100.50 0.00 29 Remove and Replace Concrete Drive 220.00 SY 27.50 6,050.00 0.00 ' 30 Remove and Replace Asphalt Road 60.00 SY i- - 28.50T 1,710.00 , I 0.00 31 ROal Grading. -- LSi-40,OOO.oor- 40,000.00 ! _u___ _____ 1.00 0.00 32 Sodding -~ _______n___, SY +---- --------.----r.------J--.- ----_.- . .--.........- ---- 9,700.00 ~---~~!U----- 12,125.00 I 0.00 -- Traffic Control and BarriCades--i' - -o:SO---- 33 1.00 LS i 12,000.00 I 12,000.00 ! 6,000.00 I Sheet Subtotal i , 530,067.00 235,764.80 I Page 1 of 2 .............._--.-................. .-......... ..""..........-.................".. .. .... ...wfik:~icfthiiP8riod....i ..............................................-........ .._---......,................................-.-..... (#f.lmmt~m!Nf> ....... Quantity 0.25 0.05 -=-1 ~,~ ~ - - iy'~!l -n-<- :, ~~ :0 S6~ t::) 'i' ~ .z:- ~T ~ 3~ cD ~-z ..... -"/~ - 0.90 - - - - - - - - - 11,244.60 3,666.00 - 8,640.00 - - - 27.00 - - I , +-- 0.25 i Amount I Quantity I i 11,500.00<0;15: 1,000.00 !um 0.00 I> 4Wl4';pq.. 0.00 .3,75 . I 0.00 7.00 ! 0.00 6,OOi 0.00 i<?QQ' 0.00315;00 0.00 ..... ."<>5,00:: '". 0.00.J2,(J(t. , :: 0.00 <4.;pq. " " 0.00 ,4~n:4'~QO #' 0.00 !2;00 't~, 0.00 1>6;00 t' 0.00619;00 0.007~~;pq. '~O.OO 401;00 0.00 '<1;50. 1:~ O.OO! . ....,....1\"', 0.001.QQ 0.00 i > 22;1m 0.00 22j)O 0.00 .22,00 0.00 I@();oo 0.00 I 24,738.12 I... .1:i,7.QJ5Q 24,928.80 3;6EiIl'OO 0.00 ......>~ 28,512.008,040;00 0.00 .. >. 0.00 0.00 I 742.50 i 0.00 0.00 0.00 i 3,000.00 95,213.42 27,00 ---r ! 0.75 i I I Contract No.: Date: Estimate No. Amount 34,500.00 20,000.00 50,127.00 15,000.00 4,550.00 i 10,800.00 I 2,700.00 3,087.00 1,850.00 4,440.00 1,600.00 477.40 4,400.00 12,000.00 21,456.40 23,171.00 14,436.00 870.00 792.00 9,000.00 0.00 1,000.00 140.00 220.00 220.00 220.00 500.00 0.00 30,238.12 24,928.80 0.00 28,512.00 0.00 0.00 0.00 742.50 0.00 0.00 0.00 i 9,000.00 ! 330,978.22 98-021 3/2199 3 % Complete 75.00% 100.00% 100.00% 99.47% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 200.00% 100.00% 100.00% 1 00 .00% 28Q.42% 50.00% 90.00% 90.00% 0.00% 100.00% 100.00% 100.00% 100.00% 100.00% 90.91 % 0.00% 95.00% 30.66% 0.00% 99.12% 0.00% 0.00% 0.00% 12.27% 0.00% 0.00% 0.00% 75.00% General Contractor: Southland Construction, Inc. Project: East Panama Road. Roadway. Drainage and Water Main Improvements Contract Start Date: November 20.1998 Item No Item Description Quantity Unit Unit Cost Change Orders 34 35 -~---- 36 37 38 39 1 Sheet Subtotal III Base Bid Change Orders TOTAL Field Verification ~ Utility Inspector .--.-,.....,...-......................".---..........-..... . .............W9r:l~ff:~!c.i'thl$fflt~.......... . .(#~~~m~m) . Item Total Quantity Amount Quantity Amount 0.00 ; 0 0.00 0.00 0 0.00. 0.00 0 0.00 0.00 0 0.00 0.00 i 0 0.00 0.00 0 0.00 0.00 0.00 530,067.00 235,764.80 95.213.42 530,067.00 235,764.80 95,213.42 Date g-~-q9 Date U '- ".j - ~ 7 % ~o 0)""" g~ ro-z 0..-; rom ~"JJ ~% ro:;O ::>- ...-z G) (f) -; ~p!, 'c' :3 ~ o .l:" ~. - (Jj (Jj (Jj i'~ ; Page 2 of 2 Contract No.: Date: Estimate No. 98-021 3/2/99 3 '. Quantity Amount 0.00 0.00 I 0.00 0.00. 0.00 0.00 . 0.00 330,978.22 330,978.22 % Complete 62.44% ~ 62.44%