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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 />QC Companies <br />APPLICATION NO.: <br />2 <br />APPLICATION DATE: <br />08/24/20 <br />PERIOD TO: <br />08/31/20 <br />PROJECT NO.: <br />19520-0033 <br />A B C D E F G H I <br />ITEM SCHEDULED <br />DESCRIPTION OF WORK <br />WORK COMPLETED <br />FROM PREVIOUS <br />MATERIALS TOTAL <br />PRESENTLY COMPLETED <br />% <br />BALANCE TO RETAINAGE (IF <br />NUM VALUE <br />APPLICATION (D <br />THIS PERIOD <br />STORED NOT IN AND STORED TO <br />G - C) <br />FINISH (C - G) VARIABLE RATE) <br />+ E) <br />D OR E) DATE <br />- <br />1 09 6700 Fluid Applied Floor $8,370.00 <br />- <br />$8,370.00 <br />$8,370.00 <br />100.00% <br />$418.50 <br />Labor <br />2 09 6700 Fluid Applied Floor $3,255.00 <br />- <br />$3,255.00 <br />$3,255.00 <br />100.00% <br />$162.75 <br />Material <br />3 03 3511 SC 1 Labor $26,095.00 <br />$26,095.00 <br />$26,095.00 <br />100.00% <br />$1,304.75 <br />4 03 3511 SC1 Material $17,800.00 <br />$17,800.00 <br />$17,800.00 <br />100.00% <br />$890.00 <br />5 STC 1&2 Polished Flooring $34,305.00 <br />$34,305.00 <br />$34,305.00 <br />100.00% <br />$1,715.25 <br />Labor <br />6 STC 1&2 Polished Flooring $11,430.00 <br />$11,430.00 <br />- <br />$11,430.00 <br />100.00% <br />$571.50 <br />i Material <br />7 Bond Fee $3,135.00 <br />$2,689.00 <br />$446.00 <br />$3,135.00 <br />100.00% <br />$156.75 <br />1 Polished Concrete (CO #1) $5,595.00 <br />$5,595.00 <br />$5,595.00 <br />100.00% <br />$279.75 <br />PAYMENT TOTALS $109,985.00 <br />I $92,319.00 <br />$17,666.00 <br />$109,985.00 <br />100.00% <br />$5,499.25 <br />Page 1 of 1 <br />