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Page 2 of 2 <br />Application and Certification for Payment, containing <br />Application No.: <br />1 <br />Contractor's signed certification is attached. <br />In tabulations below, amounts are stated to the nearest dollar. <br />Application Date: <br />03121123 <br />Use Column I on Contracts where variable retainage for line items may apply. <br />To: <br />03/31123 <br />Architect's Project No.: <br />Invoice # : 234033-1 Contract: 230033 Former Elk River Meat Market Demo <br />A <br />...__,___ _ <br />B C <br />_... ... ............_... ..._..__ _ .,,......... __ <br />D E <br />...... .___..... ..... <br />F <br />G... <br />H f <br />Item <br />Description of work Scheduled <br />Work Completed <br />_...._..._.. _....._... _,._...._ <br />Materials <br />Total <br />.. ..... <br />% <br />_ <br />Balance Retainage <br />No. <br />i Value <br />From Previous This Period <br />Presently <br />Completed <br />i (G / CJ I <br />To Finish <br />Application In Place <br />Stored <br />and Stored <br />(C-G) <br />i <br />(D*E) <br />To Date <br />1 Former Elk River Meat Market Demo <br />64,500.001 <br />0.00; <br />64,500 00 <br />0.00 i <br />64,500.00 <br />100,00% j <br />0.00 I <br />0.00 <br />2 Change Order#1 <br />1 <br />2,880.001 <br />0.001 <br />2188000 <br />0.00 <br />2,880,00j <br />100.00% <br />0.001 <br />0.00 <br />3 Change Order #2 <br />2,208A0 j <br />0.00i <br />2,208 00 �,; <br />0.00 i <br />2,208.00 11 <br />100,00% <br />0.00 i <br />0.00 <br />Grand Totals69,588.0o <br />... .�_ . ......... ... .0.00....69,588.00...� . ........ ........00 ' o '' <br />_......._.... ............ -....80.00 <br />_. ,588 00 I �� O.OD 69,588.00 t00.00% : 0.00 <br />