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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 />American Sandblasting, Inc <br />APPLICATION NO <br />APPLICATION DATE: 03/24/20 <br />PERIOD TO: 04/15/20 <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 NUM <br />DESCRIPTION OF <br />SCHEDULED <br />FROM PREVIOUS <br />PRESENTLY <br />COMPLETED <br />% <br />BALANCE TO <br />RETAINAGE (IF <br />WORK <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 />Material Charges <br />Costs for blasting media, <br />$81,000.00 <br />$45,000.00 <br />$45,000.00 <br />55.56% <br />$36,000.00 <br />$2,250.00 <br />lift rental, prep materials, <br />fuel, etc. <br />Labor Charges <br />Cost for labor to blast <br />$90,000.00 <br />$55,000.00 <br />$55,000.00 <br />61.11 % <br />$35,000.00 <br />$2,750.00 <br />and clean up area. <br />(Before Change Order) <br />1 <br />Joist Sandblasting (CO <br />$20,000.00 <br />- <br />$20,000.00 <br />#1) <br />PAYMENT TOTALS <br />1 $191,000.00 <br />1 $100,000.00 <br />$100,000.00 <br />1 52.36% <br />$91,000.00 <br />$5,000.00 <br />Page 1 of 1 <br />