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CONTINUATION SHEET <br />APPLICATION AND CERTIFICATION FOR PAYMENT, <br />APPLICATION NO.: <br />5 <br />containing Contractor's signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />APPLICATION <br />DATE: <br />11/05/20 <br />PERIOD <br />TO: <br />11/30/20 <br />Building Material Supply, Inc. <br />PROJECT NO.: <br />19520-0033 <br />A B <br />C <br />D E <br />F <br />G <br />H 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 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) VARIABLE RATE) <br />+ E) <br />D OR E) <br />DATE <br />Toilet Partitions -Material <br />$41,131.00 <br />$41,131.00 <br />$41,131.00 <br />100.00% <br />Toilet Accessories -Material <br />$44,545.00 <br />$44,545.00 <br />$44,545.00 <br />100.00% <br />Toilet Partitions -Install <br />$26,700.00 <br />$26,700.00 <br />$26,700.00 <br />100.00% <br />Toilet Accessory -Install <br />$14,925.00 <br />$14,925.00 <br />$14,925.00 <br />100.00% <br />Bike Racks -Material <br />$4,887.00 <br />$4,887.00 <br />$4,887.00 <br />100.00% <br />Bike Racks -Install <br />$750.00 <br />$750.00 <br />$750.00 <br />100.00% <br />Insurance -Additional <br />$385.00 <br />$385.00 <br />$385.00 <br />100.00% <br />Endorsements <br />3 Lockers (CO #1) <br />$3,448.00 <br />$3,448.00 <br />$3,448.00 <br />100.00% <br />1 Toilet Partitions and <br />$2,518.00 <br />$2,518.00 <br />$2,518.00 <br />100.00% <br />Accessories (CO #2) <br />1 Toilet Partitions and <br />$1,476.00 <br />$1,476.00 <br />$1,476.00 <br />100.00% <br />Accessories (CO #3) <br />2 Bicycle Racks (CO #4) <br />($750.00) <br />($750.00) - <br />($750.00) <br />100.00% <br />1 Toilet Partitions and <br />$357.00 <br />$357.00 <br />$357.00 <br />100.00% <br />Accessories (CO #5) <br />PAYMENT TOTALS <br />$140,372.00 <br />$140,015.00 $357.00 <br />$140,372.00 <br />100.00% <br />Page 1 of 1 <br />