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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 />11/09/20
<br />In tabulations below, amounts are stated to the nearest dollar.
<br />PERIOD
<br />TO:
<br />11/30/20
<br />US SiteWork, Inc
<br />PROJECT NO.:
<br />19520-0033
<br />A B
<br />C
<br />D
<br />E F
<br />G
<br />H I
<br />WORK COMPLETED 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
<br />THIS PERIOD 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 />1 Allowance
<br />$20,000.00
<br />$20,000.00
<br />$20,000.00
<br />100.00%
<br />2 Erosion Control
<br />$26,989.00
<br />$26,989.00
<br />$26,989.00
<br />100.00%
<br />3 Site Clearing/Demolition
<br />$56,333.00
<br />$56,333.00
<br />$56,333.00
<br />100.00%
<br />4 Sitework
<br />$372,803.00
<br />$372,803.00
<br />$372,803.00
<br />100.00%
<br />5 Building Excavation
<br />$21,075.00
<br />$21,075.00
<br />$21,075.00
<br />100.00%
<br />6 Bond
<br />$5,000.00
<br />$5,000.00
<br />$5,000.00
<br />100.00%
<br />1 Lions Park Earthwork (CO #1)
<br />($1,975.00)
<br />($1,975.00)
<br />($1,975.00)
<br />100.00%
<br />1 Lions Park Earthwork (CO #2)
<br />$4,075.00
<br />$4,075.00
<br />$4,075.00
<br />100.00%
<br />1 Lions Park Earthwork (CO #4)
<br />($1,164.68)
<br />($1,164.68)
<br />($1,164.68)
<br />100.00%
<br />1 Lions Park Earthwork (CO #5)
<br />($2,452.32)
<br />($2,452.32)
<br />($2,452.32)
<br />100.00%
<br />1 Lions Park Earthwork (CO #6)
<br />($2,350.00)
<br />($2,350.00)
<br />($2,350.00)
<br />100.00%
<br />2 Geogrid (CO #3)
<br />$990.50
<br />$990.50
<br />$990.50
<br />100.00%
<br />1 Lions Park Earthwork (CO #1)
<br />($3,868.65)
<br />($3,868.65)
<br />($3,868.65)
<br />100.00%
<br />1 Lions Park Earthwork (CO #7)
<br />($7,526.35)
<br />($7,526.35)
<br />($7,526.35)
<br />100.00%
<br />1 Lions Park Earthwork (CO #8)
<br />($2,325.00)
<br />($2,325.00)
<br />($2,325.00)
<br />100.00%
<br />PAYMENT TOTALS
<br />$485,603.50
<br />$487,928.50
<br />($2,325.00)
<br />$485,603.50
<br />100.00%
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