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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 />Building Material Supply, Inc. <br />APPLICATION NO.: 3 <br />APPLICATION DATE: 08/13/20 <br />PERIOD TO: 08/31/20 <br />PROJECT NO.: 19520-0033 <br />A B C D E F G H I <br />WORK COMPLETED <br />MATERIALS <br />TAIL <br />ITEM <br />DESCRIPTION OF WORK <br />SCHEDULED <br />FROM PREVIOUS <br />PRESENTLY <br />COMPLETED % <br />BALANCE TO RETAINAGE (IF <br />NUM <br />VALUE <br />APPLICATION (D <br />THIS PERIOD <br />STORED (NOT IN <br />AND STORED TO (G + C) <br />FINISH (C - G) VARIABLE RATE) <br />+ E) <br />D OR E) <br />DATE <br />Toilet Partitions -Material <br />$41,131.00 <br />$41,131.00 100.00% <br />$2,056.55 <br />$41,131.00 <br />Toilet Accessories -Material <br />$44,545.00 <br />$44,545.00 <br />$44,545.00 100.00% <br />$2,227.25 <br />Toilet Partitions -Install <br />$26,700.00 <br />$26,700.00 <br />$26,700.00 100.00% <br />$1,335.00 <br />Toilet Accessory -Install <br />$14,925.00 <br />$14,925.00 <br />$14,925.00 100.00% <br />$746.25 <br />Bike Racks -Material <br />$4,887.00 <br />$4,887.00 <br />- <br />$4,887.00 100.00% <br />$244.35 <br />Bike Racks -Install <br />$750.00 <br />- <br />$750.00 <br />$750.00 100.00% <br />$37.50 <br />Insurance -Additional <br />$385.00 <br />$385.00 <br />- <br />$385.00 100.00% <br />$19.25 <br />Endorsements <br />3 Lockers (CO #1) <br />$3,448.00 <br />- <br />$3,448.00 <br />$3,448.00 100.00% <br />- $172.40 <br />1 Toilet Partitions and <br />$2,518.00 <br />- <br />$2,518.00 <br />$2,518.00 100.00% <br />- $125.90 <br />Accessories (CO #2) <br />1 Toilet Partitions and <br />$1,476.00 <br />- <br />$1,476.00 <br />$1,476.00 100.00% <br />- $73.80 <br />Accessories (CO #3) <br />2 Bicycle Racks (CO #4) <br />($750.00) <br />- <br />($750.00) <br />($750.00) 100.00% <br />- ($37.50) <br />PAYMENT TOTALS <br />$140,015.00 <br />1 $132,573.001 <br />$7,442.00 <br />$140,015.00 <br />100.00% <br />- <br />$7,000.75 <br />Page 1 of 1 <br />