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MATERIALS PURCHASED AND
STORED AT PROJECT SITE
TO: City's Project Manager or Consultant's Name
City's Project Manager or Consultant's Title
FROM: Contractor's Project Manager or Consultant's Name
Contractor's Project Manager or Consultant's Title
Project Information
Project Number:
Project Title:
Project Address/Location:
Material Information
Payment Application No.:
This document is submitted in accordance with Contract (contract number) and accompanies
payment request/invoice number (number) for the purposes'`of payment of materials or equipment
purchase exclusively for use on the above reference'Projectand stored at the Project Site.
The undersigned stipulates that the following described material(s) has/have been
purchased/fabricated for the exclusive use in'this Project
(describe all materials purchased or fabricated).:.
The material is to be stored at the Project_Site and physically identified as City property for use only
on the above named Project. The;;City shall inspect, check, or audit, the materials stored on site. It is
expressly understood and agreed that these actions are solely for the purpose of payment for the
above materials before payment as approved forth materials and/or equipment. The City shall only
pay for the cost of the materials and shall not pay any indirect cost, profit or other direct costs
including the installation'ofthe materials or equipment.
All materials shall be stored; Jei accordance with the manufacturer's instructions. It is further
understood that payment made on account of said materials not incorporated in the Work does not
relieve the Contractor from the responsibility for proper insurance coverage and transportation to the
site, or for replacing said materials that may be subsequently damaged, lost, or rejected for non-
compliance with the Contract prior to or during installation, or prior to final acceptance by the City.
Contractor Information
Name of Contractor:
Signature:
cc:
Date:
Title:
Date Received: Received By:
Little Haiti Park Cultural Center, B-30295 Page 93