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Project Schedule of Values
Project: For Use with DBIA Document No. 525, Standard Form of Agreement Between Owner and Design-Builder Application No. – Lump Sum (2010 Edition) and DBIA Document No. 530, Standard Form of Agreement Between Owner Application Date: and Design-Builder – Cost Plus Fee with an Option for A Guaranteed Maximum Price (2010 Edition) Period From To
Value of Work Completed
No. Description of Work Item Scheduled Value To Last Application This Period Materials Stored Total Value % Complete Amount Retained (Not in 2 or 3) (2+3+4) ( 1/5 ) 1 2 3 4 5 6 7 1 0.00 2 0.00 3 0.00 4 0.00 5 0.00 6 0.00 7 0.00 8 0.00 9 0.00 10 0.00 11 0.00 12 0.00 13 0.00 14 0.00 15 0.00 16 0.00 17 0.00 18 0.00 19 0.00 20 0.00 21 0.00 22 0.00 23 0.00 24 0.00 25 0.00
TOTAL 0.00 0.00 0.00 0.00 0.00 $0.00
DBIA Documents No. 500D1 - Project Schedule of Values
2. Net Change by Change Orders No(s) to: 3. Contract Price to Date:
4. Value of Work Completed To Date (Sum of Columns 2 & 3 on attached Project Schedule of Values): 5. Value of Materials (Column 4 on attached Project Schedule of Values): 6. Total Value of Work and Materials (Column 5 on attached Project Schedule of Values):
7. Retainage Amount ( % or amount stated at Column 7 on attached Project Schedule of Values):
8. Total Value of Work and Materials Less Retainage: 9. Total of Previous Applications for Payment:
10 Total Due This Application and Certified Below:
The undersigned Design-Builder represents that to the best of its knowledge, information and belief, the Work covered by this Application for Payment has been performed consistent with the Contract Documents and has progressed to the point indicated in the attached Schedule of Values, that Design-Builder has paid for Work covered by previous Applications for Payment and for which Owner has paid Design-Builder, and that the amount certified herein is properly due.
Subscribed and sworn to before me this DESIGN-BUILDER:
day of 20 (Signature)
Public Notary (Printed Name)
My Comission Expires (Title)
DBIA Documents No. 500D1 - Design-Builder's Application For Payment
