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DocuSign Envelope ID: 27E728AS-E761-4D8D-8846-447BC430C75D <br />CONTINUATION SHEET <br />APPLICATION AND CERTIFICATION FOR PAYMENT, <br />APPLICATION NO.: <br />1 <br />containing Contractor's signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />APPLICATION DATE: <br />07/16/20 <br />PERIOD TO: <br />07/01/20 <br />SDDI Signs <br />PROJECT NO.: <br />19520-0033 <br />A B C <br />D <br />E <br />F <br />G <br />H <br />I <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM SCHEDULED <br />I DESCRIPTION OF WORK <br />FROM PREVIOUS i <br />PRESENTLY <br />COMPLETED % <br />BALANCE TO <br />RETAINAGE (IF <br />NUM VALUE . <br />APPLICATION (D <br />THIS PERIOD <br />STORED (NOT IN <br />AND STORED TO (G + C) <br />FINISH (C - G) <br />VARIABLE RATE) <br />+ E) i <br />D OR E) <br />DATE <br />1 Request for Payment of $8,843.00 <br />$8,843.00 <br />$8,843.00 100.00% <br />f <br />$442.15 <br />interior signage <br />1 Signage (CO #1) $1,490.30 <br />$1,490.30 <br />$1,490.30 100.00% <br />I <br />$74.52 <br />f 1 Signage (CO #2) $1,490.30 , <br />$78.80 I <br />_ <br />$78.80 , 5.29% <br />I[ <br />$1,411.50 <br />$3.94 <br />PAYMENT TOTALS! $11,823 60 <br />- <br />$10,412.10 E <br />-� <br />$10 41210 - 88.06% <br />1 <br />$1,411.50 <br />$520 61 <br />Page 1 of 1 <br />