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DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC <br />NTINUATION SHEET <br />APPLICATION AND CERTIFICATION FOR PAYMENT, <br />containing Contractor's signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />Rachel Contracting, Inc. <br />APPLICATION NO.: 3 <br />APPLICATION DATE: 04/24/20 <br />PERIOD TO: 04/30/20 <br />PROJECT NO.: 19520-0033 <br />A <br />B <br />C <br />D <br />E <br />F <br />G <br />H <br />I <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM <br />DESCRIPTION OF WORK <br />SCHEDULED <br />FROM PREVIOUS <br />PRESENTLY <br />COMPLETED <br />% <br />BALANCE TO <br />RETAINAGE (IF <br />NUM <br />VALUE <br />APPLICATION (D <br />THIS PERIOD <br />STORED (NOT IN <br />AND STORED TO <br />(G + C) <br />FINISH (C - G) <br />VARIABLE RATE) <br />+ E) <br />D OR E) <br />DATE <br />1 <br />Building Demolition <br />$158,890.00 <br />$154,890.00 <br />$4,000.00 <br />$158,890.00 <br />100.00% <br />$7,944.50 <br />2 <br />Allowance <br />$20,000.00 <br />$15,000.00 <br />$2,041.00 <br />$17,041.00 <br />85.21% <br />$2,959.00 <br />1 <br />Mass Structure Demoltion (CO <br />($945.49) <br />($945.49) <br />($945.49) <br />100.00% <br />#1) <br />1 <br />Mass Structure Demoltion (CO <br />($15,000.00) <br />($15,000.00) <br />($15,000.00) <br />100.00% <br />#2) <br />1 <br />Mass Structure Demoltion (CO <br />$8,255.00 <br />$8,255.00 <br />$8,255.00 <br />100.00% <br />#3) <br />1 <br />Mass Structure Demoltion (CO <br />($2,041.00) <br />($2,041.00) <br />($2,041.00) <br />100.00% <br />($102.05) <br />#4) <br />PAYMENT TOTALS <br />1 $169,158.51 <br />$162,199.51 <br />1 $4,000.00 <br />$166,199.51 <br />1 98.25% <br />$2,959.00 <br />$7,842.45 <br />Page 1 of 1 <br />