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DocuSign Envelope ID: 27E728AB-E761-4D8D-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 />WEIDNER MECHANICAL
<br />APPLICATION NO.:
<br />APPLICATION DATE:
<br />PERIOD TO:
<br />PROJECT NO.:
<br />12
<br />07/15/20
<br />07/20/20
<br />19520-0033
<br />A
<br />I
<br />B
<br />C
<br />D
<br />E F
<br />G
<br />H
<br />I
<br />I ;
<br />WORK COMPLETED MATERIALS
<br />TOTAL
<br />ITEM
<br />NUM
<br />I =
<br />DESCRIPTION OF WORK
<br />SCHEDULED I FROM PREVIOUS
<br />VALUE i 1
<br />' PRESENTLY
<br />1 STORED (NOT IN
<br />COMPLETED
<br />AND STORED TO
<br />%
<br />(G + C)
<br />BALANCE TO 1
<br />FINISH (C - G) G
<br />RETAINAGE (IF
<br />VARIABLE RATE) j
<br />APPLICATION
<br />(D
<br />THIS PERIOD ;
<br />+ E)
<br />D OR E)
<br />DATE
<br />1
<br />10.105 Bond
<br />$10,333 00
<br />$10,333.00 1
<br />$10,333.00 ?
<br />100.00%
<br />$516.65
<br />j 2
<br />10.109 Allowance
<br />$7,500 00
<br />lj
<br />$7,500 00
<br />3
<br />10.115 Pipe & Fittings
<br />$235,689 00
<br />$226,000.00
<br />$9,000.00
<br />$235,000.00
<br />99.71 %
<br />$689 00
<br />$11,750.00
<br />14
<br />10.119 Drains & Carriers
<br />$47,196 00 =
<br />$47,196.001
<br />$47,196.00
<br />100.00%
<br />$2,359.80
<br />5
<br />' 10.123 Pumps & Tanks
<br />$5,400.00.$5,400.00
<br />s
<br />$5,400.00 J
<br />100.00%
<br />$270.00
<br />6
<br />10.127 Water Heaters
<br />$82,739 00 ;9
<br />$82,739.00 `
<br />$82,739.00 ;
<br />100.00%
<br />$4,136.95
<br />17
<br />10.137 Plumbing Fixtures &
<br />$79,004.00 s
<br />$79,004.00
<br />$79,004.00
<br />100.00%
<br />$3,950.20
<br />Trim
<br />18
<br />10.139 Misc Plumbin g
<br />$42,488 00 .
<br />$41,700.00
<br />$788.00 `
<br />$42,488.001
<br />°
<br />100.00/o
<br />$2,124.40
<br />9
<br />11.185 Labor - Plumbing
<br />$560,753 00 (
<br />$519,600.00
<br />$35,000.00
<br />$554,600.00
<br />98.90%
<br />$6,153 00'
<br />$27,730.00
<br />10
<br />30.300 Digging/Backfill (
<br />$37,034 00 =
<br />$37,034.00
<br />$37,034.001
<br />100.00%
<br />$1,851 70 j
<br />J 11
<br />30.325 Rentals
<br />$13,000 00 €
<br />$12,600.00 E
<br />$400.00
<br />$13,000.00?
<br />100.00%
<br />$650.00
<br />12
<br />130.360 Pipe Covering
<br />$84,864.00
<br />$82,000.00'
<br />$82,000.00'
<br />96.63%
<br />$2,864.00
<br />$4,100.00
<br />! 1
<br />Plumbing (CO #1)
<br />$7,430.00 1
<br />$7,430.00 °
<br />$7,430.001
<br />100.00%
<br />$371.50
<br />1
<br />F Plumbing (CO #2)
<br />($2,203.00)
<br />($2,203.00).
<br />]
<br />(
<br />($2,203.00)
<br />100.00%
<br />($110.15)
<br />1
<br />Plumbing (CO #3)
<br />($2,980.00)
<br />($2,980.00)
<br />($2,980.00)
<br />100.00%
<br />($149.00)1
<br />1
<br />= Plumbing (CO #4)
<br />$2,506 00
<br />$2,506.00
<br />$2,506.00 ?
<br />100.00%
<br />$125.30
<br />1
<br />Plumbing (CO #5)
<br />$10,815 00 F
<br />$10,815.00
<br />$10,815.00
<br />100.00%
<br />_
<br />$540.75
<br />1
<br />Plumbing (CO #6)
<br />$1,338 001
<br />$1,338.00,
<br />$1,338.001
<br />100.00%
<br />$66.90
<br />1
<br />Plumbing (CO #7)
<br />$15,209 00 ;
<br />$15,209.00
<br />$15,209.00
<br />100.00%
<br />$760.45
<br />=1
<br />Plumbing (CO #8)
<br />$2,645 00
<br />$2,645.00 `
<br />$2,645.00
<br />100.00%
<br />$132.25
<br />,1
<br />Plumbing (CO #9)
<br />$10,615 00
<br />$10,615.001
<br />$10,615.00
<br />100.00%
<br />$530.75
<br />=1
<br />Plumbing (CO #10)
<br />$25,562 001
<br />$25,562.001
<br />$25,562.00
<br />100.00%
<br />$1,278.10:
<br />1
<br />Plumbing (CO #6)
<br />$2,041.00
<br />$2,041.00 =
<br />$2,041.00
<br />100.00%
<br />$102.05
<br />1
<br />Plumbing (CO #11)
<br />$26,547.00
<br />$10,000.00 !
<br />-
<br />$10,000.00
<br />37.67% _
<br />$16,547.00
<br />$500.00
<br />PAYMENT TOTALS
<br />$1,305,525.00�
<br />$1,226,584.00
<br />$45,188.00E -
<br />$1,271,772.00_
<br />°
<br />97.42/°
<br />$33,753.00
<br />E63,58860
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