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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 />4 <br />Containing Contractor's signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />APPLICATION DATE: 07/17/20 <br />PERIOD <br />TO: <br />07/31/20 <br />CD Tile and Stone, Inc. <br />PROJECT NO.: <br />19520-0033 <br />A B C <br />D f <br />E F <br />} <br />G <br />H <br />l <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />E <br />ITEM SCHEDULED <br />DESCRIPTION OF WORK <br />I FROM PREVIOUS <br />PRESENTLY <br />COMPLETED <br />% <br />BALANCE TO <br />RETAINAGE (IF <br />NUM VALUE <br />APPLICATION (D <br />THIS PERIOD STO IN <br />AND SDTORE D TO <br />(G + C) <br />FINISH (C - G) ;VARIABLE <br />RATE) <br />)ATE <br />D OR EOT <br />0 Labor ) $85,790.00 <br />$85,790.00 <br />$85,790.00 ` <br />100.00% <br />$4,289.50 <br />I 0 Materials � $70,190.00 <br />, $70,190.00 = <br />- � <br />$70,190.00 <br />100.00% <br />- <br />$3,509.50 <br />1 Tile (CO #1) ($14,500.00) <br />($14,500.00) <br />-� <br />($14,500.00) <br />100.00% <br />($725.00) <br />1 Tile #2 ) ($3,000.00) <br />(CO <br />_ <br />($3,000.00)_ <br />- - <br />($3,000.00) <br />100.00% <br />($150.00) <br />t <br />1 Tile (CO #3) I $2,885.00 <br />$2,885.00 <br />- - <br />$2,885.00 i <br />100.00% <br />$144.25 <br />1 Tile (CO #4) ( $26,650.00 <br />$26,650.003 <br />-I <br />$26,650.00 <br />100.00%; <br />$1,332.50€ <br />1 Tile (CO #5) € $5,247.40 <br />, <br />$5,247.40 ! - <br />$5,247.40 1 <br />100.00% l <br />$262.37 i <br />PAYMENT TOTALS i $173,262.40 <br />= $168,015.00 1 <br />$5,247.40 € - J <br />$173,262.401 <br />100.00% <br />$8,663.12 <br />Page 1 of 1 <br />