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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 />1 <br />containing Contractors signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />APPLICATION DATE: <br />07/30/20 <br />PERIOD <br />TO: <br />07/31/20 <br />Acoustics Associates, Inc. <br />PROJECT NO.: <br />19520-0033 <br />A B <br />C D <br />E <br />F <br />G <br />H [ <br />I l <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM DESCRIPTION OF WORK <br />NUM <br />SCHEDULED FROM PREVIOUS <br />PRESENTLY <br />COMPLETED <br />% <br />BALANCE TO <br />RETAINAGE (IF <br />VALUE APPLICATION (D <br />THIS PERIOD <br />STORED (NOT IN <br />F AND STORED TO <br />(G + C) <br />FINISH (C - G) ;VARIABLE <br />RATE) <br />+ E) <br />D OR E) <br />DATE <br />1 <br />1 Floor Prep <br />$1,845.00 <br />$1,845.00 <br />$1,845.00 <br />100.00%y <br />$92.25 <br />2 Carpet Tile - Material <br />i <br />$59,405.00 _ <br />$59,405.00 <br />i $59,405.00 E <br />100.00% <br />$2,970.25 <br />3 I Carpet Tile - Labor <br />$13 059.00 <br />$13,059.00 <br />$13,059.00 <br />100.00%' <br />€ <br />$652.95 <br />4 Resilient Flooring - Materials <br />] <br />1 <br />$10 266 00 <br />$10,266.00 3 <br />$10,266.00' <br />100.00% <br />$513.30 <br />5 Resilient Flooring - Labor <br />$9 325 00 <br />$9,325.00 <br />$9,325.00 <br />° ' <br />100.00 /o <br />$466.25 1 <br />6 1 Allowance I <br />$10,000.00 <br />$10,000.001 <br />$10,000.00 <br />100.00% <br />$500.00 <br />1 Flooring (CO #1) i <br />$2,635.00 <br />$2,635.00 <br />$2,635.00 <br />100.00% ! <br />$131.75 i <br />I 1 Flooring (CO #2) � <br />($8,000.00) -, <br />($8,000.00) <br />, <br />($8,000.00) i <br />100.00% <br />($400.00 ) <br />x 1 = Flooring (CO #3) <br />($173.50) _ - <br />($173.50) <br />- ($173.50) : <br />1 <br />100.00%l <br />($8.68) <br />I PAYMENT TOTALS <br />$98,361.50 E - <br />$98,361.50 i <br />- $98,361.50 <br />100.00%1 <br />$4,918.07 j <br />Page 1 of 1 <br />