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RISE CONSTRUCTION LLC
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827 N Loop W Fwy Houston, TX 77008
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E-mail To: accounting@riseconstructiontx.com
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RISE CONSTRUCTION INVOICE
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Date:Billing Period:TO
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Owner:
Est Completion Date:
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Loss Type
:PO#
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Project Name:
Invoice#: 2
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Project Location:
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Signer's Name:
Signer's Email:
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Phone #:Fax #:
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Notary's Name:
Notary's Email:
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Accounting Contact:Accounting Email:
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This cover sheet must be attached to all invoices. Invoices received without this cover sheet will be returned and not considered for payment.
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THIS FORM IS REQUIRED TO BE SUBMITTED ELECTRONICALLY
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Original Contract Amount:$ 100,000.00
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Approved Change Orders to Date:$ 0.00
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Revised Contract Amount:$ 100,000.00
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Application for Payment Number:
2
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Summary to Date
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(a) Total Complete to Date (gross):
$
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(b) Amount Paid:
10.00%$
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(c) Net Due to Date:
$ 0.00
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(d) <Less> Previous Invoices (net):
$
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(e) Net Due This Draw:
$ 0.00
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Current Application
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Total Complete to Date (gross) Same as (a) above:
$
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<Less> Total Completed Prior Invoice (gross):
$
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Total Completed Current Application (gross):
$
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<Less> Retainage:
10.00%$ 0.00
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Net Due This Draw:
$ 0.00
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Schedule of Values: ATTACHED
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The undersigned is an authorized representative of Subcontractor. The undersigned certifies that the work performed and the materials supplied by the Subcontractor to date, as shown above, represent the actual value of the accomplishments under the terms of the Subcontract (and all authorized changes thereto).
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Contractor represents that it has fully paid for all of the work, labor, fuel, materials and/or equipment furnished by it or its Subcontractors, material and/or equipment suppliers (at any tier) for the Project through all previous periods for which Contractor has been paid. If requested by Rise Construction, the undersigned will provide proof of such payment in forms as may be requested prior to Rise Construction, making payment for current Billing Period.
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Contractor represents that it has performed in accordance with thethe Contract Documents, and in compliance with all federal, state and local laws. Contractor further certifies that it has complied with all federal, state and local tax laws, including but not limited to Social Security, unemployment, and worker's compensation laws.
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Subcontractor hereby waives and releases all rights to liens and claims against Owner (and its property), Rise Construction, and/or Rise Construction' surety (if any) for the performance of Subcontractor's contract from inception through the end of the Billing Period of this Application for Payment, excepting only (a) retention which is unpaid to date, and (b) work which has been performed beyond the Contract (if any) which is not the subject of an approved change order and which has been described on the Application for Payment (see next page) as a Pending Change Order or Pending Claim.
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This waiver and release is given with the understanding that Owmer will rely upon it and to induce Rise Construction to make payment to Subcontractors and Vendors. This waiver and release will become effective immediately upon payment by Owmer to Contractorr for the Billing Period.
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Contractor represents that this Application for Payment is just, fair, due and owning, and that with respect to work which has been paid for previously there are no liens or claims whatsoever.
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CUSTOMER
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SIGNATURE:
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TITLE:
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PRINTED NAME:
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Use next page to list any items not released.