|
DocuSign Envelope ID: 27E728AB-E761-4D8D-8846-447BC430C75D
<br />CONTINUATION 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 />CROSSTOWN MASONRY, INCORPORATED
<br />A B C D
<br />E
<br />APPLICATION NO.: 12
<br />APPLICATION DATE: 07/22/20
<br />PERIOD TO: 07/31/20
<br />PROJECT NO.: 19520-0033
<br />F G H
<br />I
<br />WORK COMPLETED
<br />MATERIALS TOTAL
<br />ITEM DESCRIPTION OF WORK
<br />SCHEDULED
<br />FROM PREVIOUS
<br />PRESENTLY COMPLETED
<br />%
<br />BALANCE TO
<br />RETAINAGE (IF
<br />NUM
<br />VALUE
<br />APPLICATION (D
<br />THIS PERIOD
<br />STORED (NOT IN , AND STORED TO
<br />(G + C)
<br />FINISH (C - G)
<br />VARIABLE RATE)
<br />+ E)
<br />D OR E) DATE
<br />1 Concrete/Masonry (CO #1) ?'
<br />$697.00'
<br />$697.00'
<br />$697.001
<br />100.00%
<br />-'
<br />$34.85
<br />1 Concrete/Masonry (CO #2)
<br />$33,996.00
<br />_ $33,996.00
<br />$33,996.00 _
<br />100.00%,
<br />-
<br />$1,699.80
<br />1 ' Concrete/Masonry (CO #3)
<br />($3,778.00)
<br />_ ($3,778.00)
<br />($3,778.00) _
<br />100.00%
<br />-
<br />($188.90)'
<br />1 Concrete/Masonry (CO #4)
<br />$689.00
<br />$689.00
<br />$689.00
<br />100.00%
<br />-
<br />$34.45'
<br />1 ` Concrete/Masonry (CO #5) j
<br />($15,209.00)
<br />($15,209.00)'
<br />=
<br />($15,209.00)
<br />100.00%
<br />($760.45)
<br />1 Concrete/Masonry (CO #6) 1
<br />$2,930.00
<br />$2,930.00 _
<br />I $2,930.00
<br />100.00% -
<br />-
<br />$146.50
<br />1 Concrete/Masonry (CO #7)
<br />($8,500.00)
<br />($8,500.00)'
<br />j ($8,500.00)
<br />100.00%
<br />-
<br />($425.00)
<br />1 Concrete/Masonry (CO #6)
<br />$11,039.00
<br />$11,039.00;
<br />$11,039.00
<br />100.00% `
<br />-
<br />$551.95
<br />1 ' Concrete/Masonry (CO #8)
<br />($15,000.00)
<br />_ ($15,000.00)
<br />($15,000.00) _
<br />-
<br />s"� 1 Concrete/Mason CO #9
<br />ry ( )
<br />$10,085.00
<br />$10,085.00
<br />$10,085.00
<br />100.00% _'.
<br />$504.25
<br />1 Concrete/Masonry (CO #10) [
<br />($6,000.00)
<br />($6,000.00)'
<br />1 ($6,000.00)
<br />100.00%
<br />-
<br />($300.00)
<br />1 ;ConcretelMasonry (CO #11)
<br />($9,351.00)
<br />($9,351.00)'
<br />($9,351.00) ,
<br />100.00%
<br />($467.55)
<br />1 ' Concrete/Masonry (CO #10)
<br />($10,000.00)
<br />($10,000.00) 3
<br />_
<br />($10,000.00)
<br />100.00%.
<br />-
<br />($500.00)
<br />1 1 Concrete/Masonry (CO #12)
<br />($5,650.00)
<br />($5,650.00)
<br />($5,650.00)
<br />100.00% _
<br />- ]
<br />($282.50)
<br />1 Concrete/Masonry (CO #13)
<br />$2,275.00
<br />=
<br />$2,275.00
<br />$2,275.00 _
<br />100.00%,
<br />- _
<br />$113.75
<br />PAYMENT TOTALS
<br />$2,923,223.00
<br />$2,880,598.00 j
<br />$7,625.00 3
<br />- $2,888 223 00
<br />98.80%'
<br />$35,000.001
<br />$144,411 15
<br />Page 2 of 2
<br />
|