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- VILLAGE WALK APARTMENTS
<br /> SUBCONTRACT AGREEMENT#16.131.0015
<br /> EXHIBIT G • SUBCONTRACTOR'S APPLICATION FOR PAYMENT
<br /> Subcontractor. :CWG:Rocfit��&:Eictedors. Application Number.
<br /> Address: 218�Hatrqsb�n Avenue: Biliing Per'wd To: -
<br /> _.. . ,
<br /> __._ ;
<br /> Salnt Louls,.M0,63139 ....... ,
<br /> Application for payment is made as shown in the scheduled of values below in connection with the above described subcontract.
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<br /> Pg';# °(. � � �'�"�� � •,f'K. ���� h-�:"�ro.._ ;;� "°`� y� �,� '��:',�a,�`z,�,�?�`°,�'°A;,��'°��=-
<br /> .s,, ni °d v '�� ,:�'1lt�::i..'�f.tittR,rkt�� s:- �i'ric�a ;.Pievi �;�'T�i�Ps�i:;
<br /> ... G� . . .. .. �. .. �, � .. .--. f, .
<br /> i � R&R-RnofSheating{up fn 10%)(Fxcludes Building F . " 5F : $ . 1:00 $. 4;�6A0 ` '
<br /> er Ca Ex 4,396.00 '
<br /> .
<br /> 2 8 R8�R=Asphait'Shingles=Arcf�itech�ra�30Yr.wle 15# _ __ - SQ , -- 97:458.OQ _ , .
<br /> Felt ExrludesBuild'n F 439.D0 222.00 , �
<br /> 3 " S 'UP9tade to#30 Felt_ -_ _ ' -0.00 _CS : $ "d:00 $ 1;712.00
<br /> _.. :.._ - + _._. _.. .... .... . _.. ...... ..
<br /> 4 -8' Continuous Rkige Vent=Shingle OGer- - Q.00-"- tS � 0.00" = ' 0.00 '
<br /> ._Included Excludes Build' F .__
<br /> Original Contract Sum S 103,566.00
<br /> Nef Change by Change Order $
<br /> Contrect Sum Date $.
<br /> Total Completed and Stored to D�te $
<br /> Retainage: 10% $
<br /> Total Earned Less Retainage $ ..
<br /> . _..
<br /> Less Previous Certificates for Payment $ ... _.....
<br /> Current Payment Due $
<br /> Balance to Finisti Pius Retainage $
<br /> CERTIFICATION AND WAIYER
<br /> The undersigned certfiss and vuarrants that the work performed to date is free from defects,that the materia�and equipment iumished are
<br /> of good quality and new,and that the work iumished wnforms to the requirements of the Subcontract The undersigned further oertifies and
<br /> warrants that the remaining work under the Subcontract Agreement will be timely performed in accordance with the time schedule or limits as
<br /> may be established,from time to time,by Formula Construction Group,LLC.
<br /> The under�igned does het�by waive,relinquish,and refease any and all c}aims,whether knoum or unknown,against Formula Construction
<br /> Group,LLC and its bonding companies,and the Ouvner,for labor,services,material,and equipment fumished to or forthe benefit of Formula
<br /> Construction Group,LLC or the canstruction project through the Billing Period,for which this application is submi#ted,as set forth above,or
<br /> the date of execution below,whichever is later("Current Date"). The undersigned alsa certifies and warrants that all of its suboontracto�s,
<br /> suppliers,mechanics,materialmen,and laborers,within S�bcontractor's d�ain of contracts,have been paid and satistied in full for labor,
<br /> seroices,material,and equipment fumished as of the Current Date.
<br /> The undersigned acla�owledges and agrees that this certification and waiver is an independer�covenant and shall operate and be effedive
<br /> wiih respect to all labor and seroices provided and materials and equipment fumished by,through,or on behalf of the undersigned under the
<br /> Subwntract Agreement or any supplemental contract or contracts,whether oral or written,for extra or additional work,and for any furlher
<br /> labor or services provided or materials or equipment furnished at any time with respect to the consUucfion project.
<br /> Swom and subscr�ed before me
<br /> This day of ,.20
<br /> Notary Public: � Subcontractor or Supplier � -
<br /> By: _ .
<br /> My Commission Expires:: Title:.
<br /> Subcontract FL EX Contractor's Initials:
<br /> Rev. 11/15 Subcontractor's Initials:
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