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AIA Document G703'" -1992 <br />,"-' <br />Continuation Sheet <br />Page 3 <br />AIA Document G7021n-1992, Application and Certificate for Payment, or G732T 2009, <br />APPLICATION NO: 6 <br />Application and Certificate for Payment, Construction Manager as Adviser Edition, <br />APPLICATION DATE: <br />containing Contractor's signed certification is attached. <br />1/17/2,020 <br />In tebulatims below, amounts am, in US dollars. <br />PERIOD TO: 1/20/2020 <br />Use Column I on Contracts where variable rommage for line items may apply. <br />ARCHITECT'S PROJECT NO: <br />A <br />B <br />C <br />D I E <br />F <br />G <br />H <br />I <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM <br />NO, <br />DESCRIPTION OF WORK <br />SCHEDULED <br />FROMTCATIO US <br />PRESENTLY <br />COMPLETED AND <br />% <br />DALANCETO <br />FMISH <br />RETAMAGE <br />VALUE <br />APPLICATION <br />THIS PERIOD <br />STORED <br />STOREDTODATE <br />(G+CJ <br />(C GJ <br />(]fvariable rme) <br />(D+5) <br />(Nor is os&) <br />(D+E+F) <br />14 <br />40.400: CH ORDER #4 <br />2,5D6.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0 <br />2,506.00 <br />0.00 <br />15 <br />40.500: CH ORDER #5 <br />10,815.00 <br />0.00 <br />O.OD <br />0.00 <br />0.00 <br />0 <br />10,815.00 <br />0.00 <br />16 <br />40.600; CH ORDER #6 <br />3,379.00 <br />0.00 <br />3,379.00 <br />0.00 <br />3,379.00 <br />ITO <br />0.00 <br />168.95 <br />GRAND TOTAL <br />1,219,720.M <br />304,733.00 <br />127,379.00 <br />0.00 <br />432,112.00 <br />35 <br />787,60E.DO <br />21,605.60 <br />UAu I ON: You should sign an original MA Oontacl Document, on which this text appears in RED. An original assures Nat changes will holds obscured. <br />AIA DopUm M G703TM —1992. CO"Kght®IN3,1966, 1%6,1967,1970,1978, 1983 aend IN2 by The American InsItUe of Ambitects. M rights hiserved. WARNING: This AlOtiocument Is protecmd by .S. Copyright <br />Law and International Treaties. Unauthorized reproduction or distribution of this AIA Gocument, or any ponlon of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum indent <br />possibleunderthetaw.Purchaserserepermdledtorepmduwten(10)copies MthisdacumMwhencompleted.Toreportmpoghtvi tionsof AIAContractDocuments, email The American IretiMeof Architects'legal <br />counsel, wpyri9ht®ala.mg. 1az1— <br />