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Page 5 of 5 <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 - Contractor's Application for Payment - 03-10 rev <br />00622-5 <br />F:1Public W"sIENGINEERING DIVISION PROJECTS\1305-CR 512 Resurf(SCOP)_Myrtle St to 125th StlAdmimlbid documentsWlaster Contract Documents\00622 - Contractors <br />Application for Payment - 03-10 rev.doc Rev. 05101 <br />