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DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447SC430C75D
<br />!CONTINUATION SHEET
<br />APPLICATION AND CERTIFICATION FOR PAYMENT,
<br />APPLICATION NO.:
<br />5
<br />containing Contractor's signed Certification
<br />is attached.
<br />APPLICATION DATE: 07/14/20
<br />In tabulations below, amounts are stated
<br />to the nearest dollar.
<br />PERIOD
<br />TO:
<br />07/31/20
<br />Twin City Acoustics, Inc.
<br />PROJECT NO.:
<br />19520-0033
<br />A = B
<br />C
<br />D
<br />E
<br />F G
<br />y
<br />3
<br />H
<br />P
<br />WORK COMPLETED
<br />MATERIALS TOTAL
<br />1
<br />ITEM
<br />DESCRIPTION OF WORK
<br />SCHEDULED
<br />FROM PREVIOUS
<br />PRESENTLY COMPLETED
<br />%
<br />BALANCE TO y
<br />RETAINAGE (IF
<br />NUM
<br />VALUE
<br />APPLICAE ION (D
<br />THIS PERIOD
<br />STO IN AND STORED TO
<br />(G + C)
<br />FINISH (C - G) j
<br />VARIABLE RATE) ,
<br />)
<br />EOT
<br />DATE
<br />]
<br />1 095100 - Material
<br />$97,380.00 ;
<br />$97,380.00 =
<br />-'
<br />$97,380 00
<br />100.00% 1
<br />-'
<br />$4,869.00
<br />2 095100 - Labor
<br />$44,500.00
<br />$44,500.001
<br />-
<br />$44,500.00
<br />100.00%
<br />-
<br />$2,225.00
<br />3 098430 - Material
<br />$3,450.00
<br />$3,450.001
<br />_
<br />$3,450.00
<br />100.00% kp
<br />$172.50
<br />4 098430-Labor
<br />$1,830.001
<br />$1,830.00
<br />-�
<br />$1,830.00
<br />100.00%
<br />-
<br />$91.50;
<br />I5 Bonds
<br />$2,250.001
<br />$2,250.00
<br />-_
<br />$2,250.00
<br />100.00%
<br />-
<br />$112.501
<br />1 Acoustical Ceilings (CO #1)
<br />($15,105.00)
<br />($15,105.00)
<br />-'
<br />($15,105.00)
<br />100.00% 1
<br />($755.25)
<br />1 ;Acoustical Ceilings (CO #2)
<br />$14,827.00
<br />-
<br />$7,413.50
<br />-1 $7,413.50
<br />50.00% 1
<br />$7,413.50
<br />$370.68
<br />1 ° Acoustical Ceilings (CO #3)
<br />$2,238.00?
<br />$1,119.00
<br />$1,119.00 _
<br />50.00%
<br />$1,119.00
<br />$55.9.5
<br />1 Acoustical Ceilings (CO #4) [
<br />I [
<br />$2,249.20
<br />'
<br />$2,249.20'
<br />-;
<br />$2,249.20
<br />100.00% €
<br />-
<br />$112.46
<br />1 = Acoustical Ceilings (CO #5)
<br />($5,000.00),
<br />($5,000.00)3
<br />($5,000.00)
<br />100.00%
<br />-
<br />($250.00)
<br />11 Acoustical Ceilings (CO #6)
<br />$2,286.75
<br />-
<br />$2,286.75
<br />$2,286.75
<br />100.00%
<br />-?
<br />$114.34
<br />PAYMENT TOTALS ,
<br />$150,905.951
<br />$136,554.20 '.
<br />$5,819.25
<br />$142,373.45
<br />94.35% f
<br />$8,532.50 j
<br />$7,118.68 ,
<br />Page 1 of 1
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