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CONTINUATION SHEET <br />APPLICATION AND CERTIFICATION FOR PAYMENT, <br />APPLICATION NO.: <br />13 <br />containing Contractor's signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />APPLICATION DATE: <br />10/20/20 <br />PERIOD TO: <br />10/31/20 <br />High Five Erectors II, Inc. <br />PROJECT NO.: <br />19520-0033 <br />A B C <br />D E <br />F <br />G <br />H I <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM DESCRIPTION OF WORK SCHEDULED <br />FROM PREVIOUS <br />PRESENTLY <br />COMPLETED % <br />BALANCE TO RETAINAGE (IF <br />NUM VALUE <br />APPLICATION (D 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 />#11) <br />1 Structural Steel Erection (CO $266.00 <br />$266.00 - <br />$266.00 100.00% <br />#12) <br />1 Structural Steel Erection (CO $366.00 <br />- $366.00 <br />$366.00 100.00% <br />#13) <br />PAYMENT TOTALS $457,855.00 <br />$457,489.00 $366.00 <br />$457,855.00 1 100.00% <br />Page 2 of 2 <br />