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SW0001-EM030728Coppcl. i'X 75iqg ~pplicatic,n Date FROM Green Scapmg 8917 Cardinal [,anc N Richland Hills JX '7618{I [-~IARcH I1 1(71' ~ x ICONTRACTOR ('ONTILACT FOR Rixerchasc Sidcx:a[k CONTRACTOR'S APPLICATION FOR PAYMENT ORIGINAl CONTRACT SUM Nc! chaJage by Change Ordcrs CONTRAOT SUM [O DAlE(Line 1 '['O I'AI, COMI'I,ETED & StORED TO DATE (Colutllil (~ on (J?II3 } RETAINAGE a 10 % of Colnplelcd Work (Column D + t on G703) b % ot Stored Malelial $ 135.737 0(/0 I ~5,737 ¢)0 108,012.50 I0,80125 S 0 00 $ 97.211.25 9 BALANCE TO FINISH. INCLUDING RETAINAGE (Linc 3 less l,me 6) $ ~25 s C $ 27.724 51~ CltANGE ORDER SUN~[ARY A )DITIONS DEDUC] IONS Folal changes app~o', ed CONTR. ACTOR Green Stalling ARCHITECT'S CERTIFICATE FOR PAYMENT comprising thc ~pplicafion, thc ArclmecI ccnU]cs [o fire O~ net thai Io thc ~st oF This Ccrtificale is nol negotiable The ,&MOUNT CERTIFIED is paxable onh to linc p~cjudice to an> rtghts of Ibc ()'.'.'ncr or Contraclor under ~his Contract (.'()N IRACT I'OR' Rix ercbase Sidewalk 51 EarlJt & [k,~ro;; 20,310 0f $ I -;.0fl0 O0 55,311)!)0 $20.31[/00 101) 0O'Y~ $00( $2.03100 2 St[I Fcncc 294 (1( $(100 0 00¥4 $294.0£ $0.00 I-3 Ha}' Bah Chcck Dam 300 0C $0 00 0 00% $300 0( I-5 ,1" (t,,~crctc S,dcwa~ S10,188 0(; $9.t~00 0~ S9,0()I} ()0 88 34¢ $1,198 (fl 1-6 Bamcr Fr~m Ramp S2.400 00 ";2,400.0( $2,40000 100 00'~ $(~ 0l $24~ 00 I-7 8' IIc~ ~tcd Sidcx~alk S101.88~ 00 5;50,942 5(J $2>,0(10.01 $75.94250 74 ~4~4 S25.942 5( $Z594 25 iGR_&~D TOTALS $135,73700 $66,302 50 $41,7100( S00(. $1083)1251 7957% $27,72456 $10.801.25