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Get AL ABC C-10 2001

ABC Form C-10 August 2001 ESTIMATENo. 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 CONTRACTOR S CERTIFICATION ARCHITECT S CERTIFICATION The undersigned Contractor certifies that to the best of his knowledge information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents that all amounts have been paid by him for Work for which previous Certificates for Payments were issued and payments received from the Owner and that current payment shown herein has not yet been received* to the Owner that to the best of the Architect s knowledge and quality of the Work is in accordance with the Contract Documents and the Contractor is entitled to payment of the amount approved* By Date Architect Title Sworn and subscribed before me this day of Notary Public Date APPROVALS Approved by Owner Signature. 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. 3. Total Completed Work and Stored Materials 4. Less Retainage 5. Total Due 6. Less Total Previous Payments 7. Balance Due This Estimate CONTRACTOR S CERTIFICATION ARCHITECT S CERTIFICATION The undersigned Contractor certifies that to the best of his knowledge information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents that all amounts have been paid by him for Work for which previous Certificates for Payments were issued and payments received from the Owner and that current payment shown herein has not yet been received* to the Owner that to the best of the Architect s knowledge and quality of the Work is in accordance with the Contract Documents and the Contractor is entitled to payment of the amount approved* By Date Architect Title Sworn and subscribed before me this day of Notary Public Date APPROVALS Approved by Owner Signature. 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 CONTRACTOR S CERTIFICATION ARCHITECT S CERTIFICATION The undersigned Contractor certifies that to the best of his knowledge information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents that all amounts have been paid by him for Work for which previous Certificates for Payments were issued and payments received from the Owner and that current payment shown herein has not yet been received* to the Owner that to the best of the Architect s knowledge and quality of the Work is in accordance with the Contract Documents and the Contractor is entitled to payment of the amount approved* By Date Architect Title Sworn and subscribed before me this day of Notary Public Date APPROVALS Approved by Owner Signature. .

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