TranSystems Corporation - LGM Construction

C-2-2
APPLICATION FOR PAYMENT
Project: FedEx Central File No.
Finance Project No. 8634515
Location: FedEx Contract No.
Application No.
CONTRACTOR'S Invoice No. Date
APPLICATION FOR PAYMENT Period From To
Page 1 of _____
The undersigned Contractor certifies that, to the The present status of the Agreement, inclusive of Change Orders, is as
best of Contractor's knowledge, information and follows:
belief, the Work covered by this Application for FEE AMOUNT....................$
Payment has been completed in accordance with
the Contract Documents, that all amounts have REIMBURSABLES.............$
been paid by Contractor for Work which previous
Applications for Payment were issued TOTAL COMMITMENT AMOUNT.....$
and payments received from the Owner, and that
current payment shown herein is now due and
there is no reason why payment should not be made
as requested. Work Completed This Period To Date
FINAL PAYMENT YES � NO � Fee Earned _________________ ___________
Contractor: Reimbursables _________________ ___________
Address: Total Earned _________________ ___________
Retainage _________% _________________ ___________
Signature: Total earned less retainage _________________ ___________
CURRENT PAYMENT DUE________________
___________________________________________________________________________________
FOR FEDEX USE ONLY
Gross Invoiced Amount $
Contractor/Architect/Engineer Cost Center/Acct. No.
Retainage $
Contract Number Cost Center/Acct. No.
Net Payment $
Project Number
Coordinator Date
Project Manager Date
Manager Date
Senior Manager Date
Managing Director Date
Transmitted to Vendor Accounting Date
(Signature)
___________________________________________________________________________________
FEDERAL EXPRESS CORPORATION ®
BOX 727
DEPT.
MEMPHIS, TN 38194 MAIL CODE _____ PHONE