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DocuSign Envelope ID: 27E728AB-E7614D8D-8B46-447BC430C75D
<br />CONTINUATION SHEET
<br />APPLICATION AND CERTIFICATION FOR PAYMENT,
<br />containing Contractor's signed Certification is attached.
<br />In tabulations below, amounts are stated to the nearest dollar.
<br />APPLICATION NO.:
<br />2
<br />APPLICATION
<br />08/05/20
<br />DATE:
<br />PERIOD TO:
<br />08/31/20
<br />PROJECT NO.:
<br />19520-
<br />0033
<br />A
<br />B
<br />C
<br />D
<br />E F
<br />G
<br />H
<br />I
<br />ITEM DESCRIPTION OF
<br />ji
<br />[ UNIT SCHEDULED
<br />WORK COMPLETED ,
<br />MATERIALS PRESENTLY
<br />TOTAL COMPLETED °
<br />f /°
<br />BALANCE
<br />RETAINAGE
<br />NUM.]
<br />WORK
<br />COST VALUE
<br />FROM PREVIOUS
<br />THIS STORED (NOT IN D OR E)
<br />AND STORED TO [ (G + C)
<br />TO FINISH !
<br />(IF VARIABLE
<br />Ii
<br />E APPLICATION (D + E) -
<br />PERIOD ?
<br />DATE (
<br />(C - G)
<br />L
<br />RATE)
<br />1
<br />; WALK-IN FREEZER
<br />$10,783.48 AMT $10,783.48
<br />$10,783.48
<br />- [
<br />$10,783.48 1100.00% j
<br />-
<br />$539.1
<br />(CITY
<br />1.0p
<br />1.0
<br />1.0E
<br />-
<br />2
<br />`FREEZER
<br />$1,291.68 AMT
<br />$1,291.68[
<br />-
<br />$1,291.68 -
<br />$1,291.68 100.00%
<br />-
<br />$64.5
<br />!,EVAPORATOR
<br />[ CITY
<br />1.0 €
<br />1.0
<br />1.0 '
<br />I
<br />-
<br />3
<br />FREEZER
<br />$3,269.85 [ AMT :
<br />$3,269.85
<br />$3,269.85 -i
<br />$3,269.85 100.00%11
<br />-
<br />$163.4
<br />CONDENSER
<br />€ QTY ;
<br />1.01
<br />1.0 €
<br />1.0
<br />-
<br />4
<br />FREEZER SHELVING
<br />$2,197.16 AMT
<br />$2,197.16
<br />$2,197.16 -[
<br />$2,197.16 100.00%
<br />-
<br />$109.8
<br />E CITY
<br />1.01
<br />__
<br />1.0
<br />1.0 E
<br />5
<br />' MOP SINK
<br />$375.74 AMT `
<br />$375.74
<br />$375.74
<br />-�
<br />$375.74 E 100.00%'
<br />-
<br />$18 7'
<br />1 QTY
<br />1.0
<br />1.0
<br />- )
<br />1.0
<br />-
<br />5.1
<br />WALL MOUNT
<br />$54.93 AMT
<br />$54.93
<br />_
<br />$54.93 - 2
<br />$54.93 100.00% I
<br />$2.7
<br />SHELVING
<br />(
<br />: QTY
<br />1.0
<br />1.0
<br />1.0E
<br />_
<br />5
<br />' MOP BUCKET
<br />$51.95 AMT
<br />$51.95
<br />$51.95 -
<br />$51.95 100.00%
<br />$2.6
<br />CITY
<br />1.0
<br />1.0
<br />1.0
<br />7
<br />DRY STORAGE
<br />$1,982.68 AMT
<br />$1,982.68
<br />t
<br />$1,982.68
<br />$1,982.68 1 100.00%
<br />-
<br />$99.1
<br />SHELVING
<br />I CITY `
<br />1.0
<br />1.0
<br />1.0' E
<br />B
<br />FLOOR TROUGH
<br />$767.89 f AMT
<br />$767.89
<br />$767.891
<br />$767.89 100.00% I
<br />$38.3'
<br />CQTY
<br />1.0
<br />1.0
<br />1.0
<br />9
<br />i ICE MAKER
<br />$6,627.82 AMT
<br />$6,627.82
<br />-
<br />$6,627.82 1
<br />$6,627.82 f 100.00% £
<br />)
<br />$331.3'
<br />CITY
<br />1.0
<br />1.0 ?
<br />1.0
<br />14
<br />REACHIN
<br />$4,120.36 AMT
<br />$4,120.36
<br />$4,120.36
<br />$4,120.361 100.00%
<br />$206.0;
<br />REFRIGERATOR
<br />CITY
<br />1.0
<br />1.0
<br />1.0
<br />15
<br />1 REACH IN FREEZER
<br />$4,464.38 AMT
<br />$4,464.38
<br />$4,464.381
<br />$4,464.38 € 100.00%
<br />$223.2:
<br />CITY
<br />1.0 =
<br />1.01
<br />1.0
<br />€
<br />17
<br />WORKTABLE
<br />$864.29 AMT
<br />$1,728.58
<br />$1,728.58
<br />$1,728.581 100.00%.
<br />$86.4,
<br />CITY t
<br />2.0
<br />2.0�
<br />2.0'
<br />18
<br />' WALL MOUNT
<br />$79.59 ] AMT ''
<br />$159.18
<br />- I
<br />$159.18
<br />$159.18 100.00%
<br />$7.9
<br />SHELVING
<br />? CITY
<br />2.0
<br />-
<br />2.0
<br />2.0
<br />20
<br />MULTI COOK OVEN
<br />I $10,483.58 _AMT $10,483.58
<br />- `
<br />$10,483.58
<br />$10,483.58 100.00%
<br />$524.11
<br />CITY
<br />1.0
<br />-
<br />1.0
<br />1.0 t
<br />20.1
<br />HEATED LOW TEMP
<br />$2,106.86 AMT j
<br />$2,106.86;
<br />- €
<br />$2,106.86
<br />$2,106.86 100.00%
<br />$1053
<br />HOLDING CABINET
<br />CITY
<br />1.01
<br />-
<br />1.0
<br />1.0
<br />22
<br />E COUNTERTOP FOOD
<br />$278.40 _ AMT j
<br />$278.40
<br />- _
<br />$278.40
<br />$278.401 100.00%
<br />$13.9;
<br />PAYMENT TOTALS_ $101,739.831
<br />$11,92711 $89,812.72�
<br />$101,739.83'9 100.00%y
<br />$5,087.01
<br />Page 1 of 3
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