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DocuSign Envelope ID: B21CAEBD-7600-4BB5-BB91-7BFCFA6AOB90 <br />CONTINUATION SHEET <br />APPLICATION AND CERTIFICATION FOR PAYMENT, <br />APPLICATION NO.: <br />4 <br />containing Contractor's signed Certification is attached. <br />APPLICATION DATE: <br />09/16/20 <br />In tabulations below, amounts are stated to the nearest dollar. <br />PERIOD <br />TO: <br />09/30/20 <br />Custom Caseworks <br />PROJECT NO.: <br />19520-0033 <br />A B <br />C <br />D E <br />F <br />G <br />H <br />I <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM DESCRIPTION OF WORK <br />SCHEDULED <br />FROM PREVIOUS <br />PRESENTLY <br />COMPLETED <br />% <br />BALANCE TO <br />RETAINAGE (IF <br />NUM <br />VALUE <br />APPLICATION (D THIS PERIOD <br />STORED (NOT IN <br />AND STORED TO <br />(G + C) <br />FINISH (C - G) <br />VARIABLE RATE) <br />+ E) <br />D OR E) <br />DATE <br />1 Architectural Casework Supply <br />$41,622.99 <br />$41,622.99 <br />$41,622.99 <br />100.00% <br />$2,081.15 <br />2 Architectural Casework Install <br />$15,185.90 <br />$15,185.90 <br />$15,185.90 <br />100.00% <br />$759.30 <br />3 Solid Surface & Quartz Supply <br />$47,559.60 <br />$47,559.60 <br />$47,559.60 <br />100.00% <br />$2,377.98 <br />& Install <br />4 Stainless Steel Countertops <br />$7,897.33 <br />$7,897.33 <br />$7,897.33 <br />100.00% <br />$394.87 <br />(Qty 4) - John Wiecht Park <br />5 Claridge Prefeb Trophy Cases <br />$15,652.18 <br />$15,652.18 <br />$15,652.18 <br />100.00% <br />$782.61 <br />6 5K Allowance <br />$5,000.00 <br />$5,000.00 <br />$5,000.00 <br />100.00% <br />$250.00 <br />1 Millwork (CO #1) <br />$6,141.84 <br />$6,141.84 <br />$6,141.84 <br />100.00% <br />$307.09 <br />1 Millwork (CO #2) <br />$150,588.00 <br />$150,588.00 <br />$150,588.00 <br />100.00% <br />$7,529.40 <br />1 Millwork (CO #3) <br />($5,000.00) <br />($5,000.00) <br />($5,000.00) <br />100.00% <br />($250.00) <br />1 Millwork (CO #4) <br />$2,145.00 <br />$2,145.00 - <br />$2,145.00 <br />100.00% <br />$107.25 <br />1 Millwork (CO #5) <br />$545.24 <br />$545.24 <br />$545.24 <br />100.00% <br />$27.26 <br />1 Millwork (CO #6) <br />$3,353.90 <br />$3,353.90 <br />$3,353.90 <br />100.00% <br />$167.70 <br />PAYMENT TOTALS <br />$290,691.98 <br />$286,792.84 $3,899.14 <br />$290,691.98 <br />100.00% <br />$14,534.61 <br />Page 1 of 1 <br />