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CONTRACTOR PROGRESS PAYMENT TEMPLATE
https://bit.ly/2StmJJZ
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APPLICATION FOR PAYMENT
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APPLICATION NUMBER
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TO OWNER
PROJECT
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PERIOD ENDING
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CONTRACT WORK
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FROM CONTRACTOR
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CONTRACT NO
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PREPARED BY
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CONTRACTOR'S APPLICATION FOR PAYMENT
CONTRACTOR'S CERTIFICATION
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Refer to backup sheets attached for detailed breakdown
The undersigned Contractor to the best of his knowledge, information and believe of the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid to him for Work for which previous Certificates for Payment were issues and payments received from the Owner, and that current payment shown herein is now due.
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Original Contract Amount:
 $ 20,000.00
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Net Changes to Contract:
 $ 600.00 CONTRACTORDATE
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Total Contract Amount:
 $ 20,600.00
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Total Completed To Date:
 $ 15,000.00 StateCountry
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Retainage:
Subscribed & sworn to before me
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a.15%of Completed Workthis day of
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Total Retainage:
 $ 2,250.00
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Notary Public NameCommission Expiration Date
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Total Completed Less Retainage:
 $ 12,750.00
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Less Previous Applications:
 $ 5,000.00
ENGINEER'S CERTIFICATE FOR PAYMENT
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The Engineer hereby confirms that based on site observations & to the best of his/her knowledge, this payment application accurately reflects the progression of work and that this work meets contract requirements sufficient enough to justify payment in the amount certified below:
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Current Payment Due:
 $ 7,750.00
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Balance to Finish Including Retainage:
 $ 7,850.00 AMOUNT CERTIFIED
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Provide explanation below or attached if amount certified does not match this application amount. Initial all figures & markups to agree with certified amount.
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EXTRA WORK SUMMARYADDITIONSDELETIONS
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Changes From Previous Applications $ 1,000.00 $ 400.00 ENGINEERDATE
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Changes From This Application $ - $ -
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Total $ 1,000.00 $ 400.00
The Amount Certified is payable to the contractor listed above.
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Net Changes $ 600.00
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CLICK HERE TO CREATE IN SMARTSHEET
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