Laserfiche WebLink
<br />9.':~.;':;';~:-1 <br /> <br />". r . <br />, <br />\ . <br />..~ <br /> <br />EXHIBIT C <br />CITY OF SAN ~tARCOS <br />ARCHITECT/CONSUL TANTIENGINEERJSURVEYOR <br />PAYMENT REQUISITION <br /> <br />Project Name: <br /> <br />Project Number: <br /> <br />Firm Name: <br /> <br />Payment Requisition #: <br /> <br />Date: <br /> <br />Covering Period From: <br /> <br />to <br /> <br />days <br />days <br />days <br /> <br />Contract Time Used to Date: <br />% Time Used to Date: <br />Preliminary Work: $ <br /> <br />days <br />% <br /> <br />Contract time: <br />~dd/(Less)Change Orders: <br />~evised Contract Time: <br /> <br />COWlcil Approved Appropriation: ............................ $ <br /> <br />Original Contract Amount: ................................. $ <br /> <br />Add/(Less) Amendments: <br /># Am t/# f D # Am t/# f D <br /> <br />Source of Monies: <br /> <br />oun 0 ays oun 0 avs <br /> <br />. . . .. . . . . . . . . . . .. ..... . .. . . .. . . .. .. . . . . . . ... . . . . .... . .. $ <br /> <br />tevised Contract Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ <br /> <br />fotal Work Performed to Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ <br /> <br />% Contract Work Completed: ................................ <br /> <br />% <br /> <br />Total Work Performed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ <br /> <br />Less Previous Payments: ................................... $ <br /> <br />Balance Due This Estimate: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ <br /> <br />.:\pproved by: <br /> <br />Firm: <br /> <br />Date: <br /> <br />Title: <br /> <br />City Project Director: <br /> <br />Date: <br /> <br />Finance: <br /> <br />Date: <br /> <br />City Manager: <br /> <br />Date: <br /> <br />(Final Payments Only) <br /> <br />Requisitions should be submitted in triplicate originals. <br /> <br />(Rev. 4'97) <br />