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AO t <br /> Page 5 of 6 <br /> ATTACHMENT A <br /> 1 . List of all subcontractors , laborers , materialmen and suppliers who have not been <br /> paid from the payment received from the last Pay Request and the reason why <br /> they were not paid ( attach additional pages as necessary) : <br /> 2 . List of all subcontractors , laborers , materialmen and suppliers for which a signed <br /> release of lien form ( partial or final as applicable) is not included with this Pay <br /> Request , together with an explanation as to why the release of lien form is not <br /> included ( attach additional pages as necessary) : <br /> 00622 - 5 00622 - Contractor's Application for Payment - 03- 10 rev . doc <br /> F :\Public Works\ENGINEERING DIVISION PROJECTS\0517-OSLO ROAD_ 43rd Ave to 58th Ave-Phase III\Admim\bid documents\00622 - Contractor's Application for <br /> Payment - 03- 10 <br /> rev.doc Rev. 05/01 <br />