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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 Contractor's signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />APPLICATION DATE: <br />07/07/20 <br />PERIOD TO: <br />07/31/20 <br />American Drapery Systems, Inc <br />PROJECT NO.: <br />19520-0033 <br />A B C D <br />E <br />F <br />G <br />H <br />I <br />1 WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS ' <br />PRESENTLY <br />COMPLETED % <br />BALANCE TO <br />RETAINAGE (IF <br />NUM VALUE APPLICATION (D <br />THIS PERIOD I <br />STORED (NOT IN ' <br />AND STORED TO (G + C) _ <br />FINISH (C - G) <br />VARIABLE RATE) 1 <br />+ E) <br />D OR E) <br />DATE <br />( Material $22,549 46 ; <br />$22,549.46 <br />? <br />$22,549.46 e 100.00% <br />$1,127.47 <br />Installation $3,833 29 € <br />$3,833.29 <br />$3,833.29 [ 100.00% l <br />$191.66 <br />Shop Drawings $429.50 1 <br />$429.50 f <br />$429.50 100.00%2 <br />$21.48 <br />s Freight $1,073.75 1 <br />i <br />$1,073.75 ' <br />$1,073.75 100.00% 3 <br />€ <br />$53.69 <br />1 I Window Coverings (CO #1) $773.10 <br />$773.10 <br />$773.10 { 100.00% ( <br />$38.66 <br />Y PAYMENT TOTALS $28,659.10 E - <br />$28,659.10 <br />$28,65910 100.00% 1 <br />$1,432.96 <br />Page 1 of 1 <br />