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DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D <br />C�INHI011MV40010NM A <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 />Summit Companies <br />APPLICATION NO.: 10 <br />APPLICATION DATE: 06/05/20 <br />PERIOD TO: 07/01/20 <br />PROJECT NO.: 19520-0033 <br />' i A <br />B <br />C [ <br />D <br />E <br />F <br />G <br />E <br />H <br />I <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />] <br />j <br />ITEM <br />I DESCRIPTION OF WORK <br />SCHEDULED <br />FROM PREVIOUS ; <br />PRESENTLY I <br />COMPLETED <br />% <br />BALANCE TO <br />RETAINAGE (IF <br />NUM <br />VALUE <br />APPLICATION (D <br />THIS PERIOD I STORED (NOT IN AND STORED TO <br />(G + C) <br />FINISH (C - G) I <br />VARIABLE RATE) <br />+ E) <br />D OR E) <br />DATE <br />1 <br />Labor <br />$87,885.00 <br />$79,096.50 <br />$4,394.25 <br />' <br />$83,490.75 <br />95.00% <br />$4,394.25 <br />$4,174.55 <br />2 <br />Material <br />$111,200.00 <br />$100,080.00 <br />$5,560.00 <br />_ <br />$105,640.00 E <br />95.00%- <br />$5,560.001 <br />$5,282.00 <br />3 <br />[ Design <br />$31,200.00 <br />$31,200.001 <br />$31,200.00 <br />100.00%s <br />$1,560.00 <br />14 <br />IFabrication <br />$20,200.00 <br />$18,180.00_ <br />$1,010.00 <br />$19,190.uo <br />95.00%_ <br />$1,010.00 <br />$959.50 <br />5 <br />[Bonds <br />$6,000.00 <br />$6,000.00 _ <br />$6,000.00 <br />100.00% 3 <br />$300.00 <br />" 1 <br />Fire Protection (CO #1) <br />$11,955.00 <br />$10,759.50 _ <br />$1,195.50 <br />$11,955.00 <br />100.00%1 <br />$597.76 <br />1 <br />Fire Protection (CO #2) <br />$5,952.00 <br />i <br />$5,952.00 <br />j <br />i 1 <br />Fire Protection (CO #3) <br />$3,955.00 I <br />$3,955.00 <br />$3,955.00 { <br />100.00% <br />1 <br />I Fire Protection (CO #4) <br />$1,475.00 <br />- _ <br />- <br />- <br />- <br />- <br />$1,475.00 1- <br />PAYMENT TOTALS I <br />$279,822.00 I <br />$245,316.001 <br />$16,114.75 <br />- <br />$261,430.75 <br />93.43% <br />$18,391 25 - <br />$12,873.81 <br />Page 1 of 1 <br />