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SUBCONTRACT AGREEMENT#16.130.0015
<br /> PRQJECT#16.930.0�
<br /> EXHIBIT G - SUBCQNTRACT4R'S APPLIGATION FOR PAYMENT
<br /> Subcontractor: . .CWC Roofin�_B.E�cteriors Application Number:
<br /> Address: ` 2985 Hamp#an Avenue - _ Billing Period To: � .
<br /> � 5aint Louis, _. . .
<br /> M0 63139.................... . ........ ......._. ... ,..... _.... .
<br /> Application for payment is made as shown in the scheduled of values belaw in connection with the above described subcantrad.
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<br /> 1 , $ .R&R=' ofing5heatlrig"{u�i'lo�iQ°/� . 5F � 4:4 � 5;344AQ : �
<br /> � 5,310.00 :
<br /> 2 8 :R&`R'-Asphelt Shingles-Archihectural 30 Yr.w130# 9Q 271.q0 ` � 11T;882.W
<br /> :FeR(ExGudes 8uild'ng 531.Q0_ .
<br /> 3 - 8 Contlnuaus Rldge Venf-5hingia-Ch+erSfyte(inclu�dj OAD SF 5 0:00� $ 8.d0'
<br /> Original Contract Sum � 123,192.00........ ..
<br /> Nef Change by Change Order $ „
<br /> Contrac#Sum Dat� $
<br /> Total Completed and Stored to D�te $
<br /> Re#ainage: 90°lc $ .
<br />� Total Earned Less Retainage $__ `
<br /> Less Previous Ce�i�icates fpr Payment $
<br /> Current Payment Due _$
<br /> Balance to Finish Plus Retainaga $
<br /> CERTIFICATION AND WAIVER
<br /> The undersigned certi�ies and vuarrants that the wark performed to dafe is free frorn defec#s,that fhe materia(s and equipment fumished are
<br /> of good quality and new,end that#he work fumished cor�arms to the requirements of the Subcontract The undersigned furiher certifies and
<br /> wa�rants that fhe r�maining w�rk under the Subconiract A�reement wi11 be timely per#ormed in accordance with the time schedule or limi�s as
<br /> may be established,from time to time,by Farrnula Construction Group,LLC.
<br /> The undersigned does heceby waive,relinquish,and�e3ease any and a�daims,whe#her known ar unknown,against Formula Canstruction
<br /> Group,LLC and its bonding companies,and t�e Owner,for labor,services,material,and equipment fumished to or forthe benefit of Farmula
<br /> Construction Group,LLC or the caasUuc6on praject Ihrough it�e 8iiling Period,for which this applica�on is submitted,as�t farth above,or
<br /> the date of execution below,whichever is later("Curnent Date"}. The undersigned also certifies and warranks that all of its subcontractors,
<br /> suppliers,mechanics,materialmen,and laborers,within Subcontractor's chain of cantracts,have been paid and saUsfied in ful!fnr labor,
<br /> senrices,matenal,and eqaipment furnished as of the Cur�nt Date.
<br /> The undersigned acknowledges and agrees thai this certificatian and waivar is an independent covenant and shaU aperate and be elfective
<br /> wifh respect fo a11 Iabar a�d senr�ces provided and maEerials ar�equipm�n#fumished by,#hraugh,or an bef�alF af the undersigned under the
<br /> Subconh�act�q�ement or any supplemental contract or contracts,whether oral ar wri�en,for extra or additional work,and for any further
<br /> ', labor or ssrvices provided ar materlats or equipme»t iurnishc�at any#ime with respect to the c�nstrt�ctian project.
<br /> Swom and subscr�red befar�me i
<br /> � This day of ;20 I
<br /> ', Notary Public: �� . �_ Subcoritraotor or Supplier �ry� _ ._. _�. ,
<br /> � By:
<br /> �
<br /> My Gommission Expires: Title:;
<br /> ' Subcor�tract�L EX Contractor's Initials:
<br /> Rev. 11115 � Subcantracta�'s lnitials:.
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