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CONTINUATION PAGE Page 2 of 2 <br /> PROJECT: IRC Discharge Outlet and Rlp R APPLICATION #: 3 <br /> Discharge Outlet & Rip Rap Spillway DATE OF APPLICATION: 11/14/2005 <br /> Payment Application containing Contractor's signature is attached. PERIOD THRU: 12/16/2005 <br /> PROJECT #s: <br /> A B C D E F G H I <br /> COMPLETED WORK STORED TOTAL PERCENT BALANCE <br /> # AMOUNT <br /> ITEM WORK DESCRIPTION SCHEDULED AMOUNT AMOUNT MATERIALS COMPLETED AND COMPLETE TO RETAINAGE <br /> PREVIOUS THIS PERIOD (NOT IN D OR E) STORED (G / C) COMPLETION (IF VARIABLE) <br /> PERIODS (D + E + F) (C-G) <br /> 1 Mobilization $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 1000% $0.00 <br /> 2 Furnish 7 Install 16" Pipe DIP & HD $12,650.00 $12,650.00 $0.00 $0.00 $12,650.00 100% $0.00 <br /> 3 Furnish & install all Fittings $13,585.00 $13,585.00 $0.00 $0.00 $13,585.00 100% $0.00 <br /> 4 Furnish & Install Fabriform Concret $6,500.00 $6,500.00 $0.00 $0.00 $6,500.00 100% $0.00 <br /> 5 Clearing Grubbing Removal of Muc $25,000.00 $25,000.00 $0.00 $0.00 $25,000.00 100% $0.00 <br /> 6 Grassing( Topsoil & Sod) $3,000.00 $0.00 $3,000.00 $0.00 $3,000.00 100% $0.00 <br /> 7 Record Drawinfgs, AsBuilt Survey $6,000.00 $6,000.00 $0.00 $0.00 $6,000.00 100% $0.00 <br /> 8 IRC Force Account $25,000.00 $0.00 $25,000.00 $0.00 $25,000.00 100% $0.00 <br /> 9 Add 90 Tee 2 16" GV 20' 16" DIP 4 $8,350.00 $8,350.00 $0.00 $0.00 $8,350.00 100% $0.00 <br /> TOTALS $115,085.00 $87,085.00 $28,000.00 $0.00 $115,085.00 100% $0.00 <br /> CONTINUATION PAGE FOR PAYMENT APPLICATION OSS, INC. DOCUMENT <br />