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DocuSign Envelope ID: BCE22727-B3F4-40B7-AA4D-BAA950BA8D07 <br />CONTINUATION SHEET <br />APPLICATION AND CERTIFICATION FOR PAYMENT, <br />APPLICATION NO.: <br />16 <br />containing Contractor's signed Certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />APPLICATION DATE: 11/30/20 <br />PERIOD TO: <br />11/30/20 <br />WEIDNER MECHANICAL <br />PROJECT NO.: <br />19520-0033 <br />A B C _ <br />_ <br />D F E <br />F <br />G <br />H i I <br />WORK COMPLETED <br />MATERIALS <br />TOTAL <br />ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS <br />PRESENTLY <br />COMPLETED % <br />BALANCE TO i RETAINAGE (IF <br />NUM VALUE s APPLICATION (D THIS PERIOD <br />STORED IN AND STORED TO (G = C) i <br />FINISH (C - G) VARIABLE RATE) <br />+E) i <br />R(NEOT <br />ATE <br />[ <br />i <br />_. <br />1 Plumbing (CO #16) $6,996.00 i <br />$6,996.001 - <br />- <br />$6,996.00 100.00% <br />- - <br />1 Plumbing (CO #17) ? $1,884.22 ` <br />$1,884.22 <br />_ <br />$1.884.22 100.00% i <br />PAYMENT TOTALS $1,324,981.22 ` <br />$1,323,097.00 $1,884.22 <br />- <br />$1,324,981.22 i 100.00%1 <br />Page 2 of 2 <br />