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DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D
<br />CONTINUATION SHEET
<br />APPLICATION AND CERTIFICATION FOR PAYMENT,
<br />APPLICATION NO.:
<br />9
<br />containing Contractors signed Certification
<br />is attached.
<br />APPLICATION DATE:
<br />07/27/20
<br />In tabulations below, amounts are stated
<br />to the nearest dollar.
<br />PERIOD TO:
<br />07/31/20
<br />High Five Erectors II, Inc.
<br />PROJECT
<br />NO.:
<br />19520-0033
<br />A
<br />B
<br />C
<br />D
<br />E
<br />F I G
<br />H
<br />WORK COMPLETED
<br />MATERIALS TOTAL
<br />ITEM
<br />j DESCRIPTION OF WORK
<br />SCHEDULED FROM PREVIOUS
<br />PRESENTLY COMPLETED
<br />%
<br />BALANCE TO
<br />RETAINAGE (IF
<br />NUM
<br />VALUE APPLICATION (D
<br />THIS PERIOD
<br />STORED (NOT IN , AND STORED TO i
<br />(G + C)
<br />FINISH (C - G)
<br />VARIABLE RATE)
<br />+ E)
<br />D OR E) DATE
<br />1
<br />051200 Structural Steel
<br />$129,841.001
<br />$129,841.00
<br />$129,841.00
<br />100.00%
<br />$6,492.05 .
<br />2
<br />052100 Steel Joists
<br />$100,523.00 l
<br />$100,523.00 i$100,523.00
<br />100.00%
<br />$5,026.15
<br />3
<br />' 053100 Steel Decking
<br />$45,888.00
<br />$45,888.00
<br />]
<br />( $45,888.00
<br />100.00%'
<br />$2,294.40
<br />4
<br />055000 Metal Fabrications
<br />$8,508.00
<br />$8,508.001
<br />_
<br />i $8 508 001 y
<br />100.00%
<br />$425.40
<br />5
<br />055100 Metal Pan Stairs
<br />$43,996.00
<br />$43,996.00
<br />( $43 996 00
<br />100.00%
<br />$2,199.80
<br />6
<br />055213 Pipe 1£ Tube Railings
<br />$71,614.00
<br />$71,614.00
<br />j
<br />$71 614 00
<br />100.00%
<br />F $3,580.70
<br />7
<br />Allowance
<br />$30,000.00
<br />$29,696.15
<br />$303.85 i,
<br />$30,000.00 =
<br />100.00%
<br />- [ $1,500.00
<br />8
<br />;Bond
<br />$5,380.00 E
<br />$5,380.00
<br />-
<br />$5,380.00
<br />100.00%
<br />- $269.00
<br />1
<br />Structural Steel Erection (CO 3
<br />$4,190 00 11
<br />$4,190.00
<br />z
<br />$4 190 00 `
<br />100.00% _
<br />$209.50
<br />#1)
<br />1
<br />Structural Steel Erection (CO
<br />($6,888 15)
<br />($6,888.15)
<br />-�
<br />($6,888.15)
<br />100.00%i
<br />- ($344.41)1
<br />#
<br />C 1
<br />;Structural Steel Erection (CO
<br />$500.00 _
<br />$500.00 _
<br />-
<br />- $500.00
<br />100.00%
<br />$25.00
<br />#3)
<br />x 1
<br />Structural Steel Erection (CO
<br />$672.001
<br />$672.00
<br />-
<br />- _ $672.00 =
<br />100.00%
<br />- $33.60
<br />I #4)
<br />€
<br />1
<br />Structural Steel Erection (CO
<br />$3,000.00
<br />$3,000.00-
<br />-
<br />-- $3,000.00
<br />100.00%a
<br />- $150.00
<br />#5)
<br />1
<br />Structural Steel Erection (CO
<br />$8,650.00
<br />$8,650.00 -
<br />-
<br />- _ $8,650.00
<br />100.00%
<br />- $432.50
<br />#6)
<br />1
<br />E Structural Steel Erection (CO
<br />$600.00
<br />$600.00
<br />-
<br />$600.00 E
<br />100.00%'
<br />- $30.00
<br />I
<br />£ #7)
<br />s
<br />I
<br />I 1
<br />Structural Steel Erection (CO
<br />$1,200.00
<br />$1,200.00 °
<br />-
<br />-_ $1,200.00 E
<br />100.00%
<br />- $60.00
<br />#7)
<br />1
<br />Structural Steel Erection (CO
<br />$3,040.00'
<br />$3,040.00
<br />-
<br />-_ $3,040.00 €
<br />100.00%-
<br />- $152.00
<br />#8)
<br />1
<br />[Structural Steel Erection (CO
<br />$1,752.00_
<br />-?
<br />$1,752.00
<br />$1,752.001
<br />100.00%1
<br />-? $87.60
<br />#9)
<br />1
<br />Structural Steel Erection CO
<br />(
<br />($303.85)
<br />-
<br />($303.85)
<br />- _ ($303.85) i
<br />100.00% 1
<br />- ($15.19)
<br />#10)
<br />1
<br />e Structural Steel Erection (CO
<br />$4,217.00 _
<br />- (
<br />$4,217.00
<br />- $4,217.00
<br />100.00% 3
<br />- $210.85
<br />#10)
<br />]
<br />( PAYMENT TOTALS !
<br />$456,379.00
<br />$450,410.00
<br />$5,969.00
<br />$456,379.00
<br />100.00%
<br />- 3 $22,818.95
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