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PLEASE REMIT TO : <br /> ESTIMATEM <br /> PERIOD ENDING : <br /> CONTRACTOR' S REQUEST FOR PAYMENT <br /> SCHEDULE OF CONTRACT CHANGE ORDERS <br /> TOTAL COST OF COST OF CHANGE <br /> ITEM ADDED BY ORDER ITEM <br /> NO , DATE DESCRIPTION CHANGE ORDER COMPLETED TO DATE <br /> TOTALS <br /> ANALYSIS OF ADJUSTED CONTRACT AMOUNT TO DATE : <br /> 1 . Original Contract Amount $ <br /> 2 . Additions To Contract + <br /> 3 . Adjusted Contract Amount To Date $ <br /> ANALYSIS OF WORK PERFORMED : <br /> 1 . Cost Of Original Contract Work To Date $ <br /> 2 . Extra Work Performed To Date + <br /> 3 . Total Cost of Work Performed To Date $ <br /> 4 . Material Stored + <br /> 5 . Total Cost of Work and Materials Stored $ <br /> 6 . Less 10 % Retainage - <br /> 7 . Net Amt Earned on Contract Work To Date $ <br /> 8 . Less : Amount Paid on Previous Estimates - <br /> Amount Owed On Previous Estimates - <br /> 9 . BALANCE DUE THIS ESTIMATE# $ <br /> PR- 1 <br />