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Contractor's Application for PaymentOwner's Project No.:Engineer's Project No.:Agency's Project No.:1 From09/01/25to 09/30/25A C D E F F1 F2 G H I J K LItem Quantity UnitsUnit Price($)Value of Bid Item(C X E)($)Quantity Previous EstimateValue Previous EstimateEstimated Quantity Incorporated in the WorkValue of Work Completed to Date(E X G)($)1 139,770.00 SY 1.68 234,813.60 - 139,770.00 234,813.60 234,813.60 100% - 2 8.00 EA 250.00 2,000.00 - 8.00 2,000.00 2,000.00 100% - 236,813.60$ -$ 236,813.60$ -$ 236,813.60$ 100% -$ BASE BID TOTALBITUMINOUS SEAL COAT WITH 1/8" DRESSER TRAP ROCK PROTECT EXISTING THERMOPLASTIC PAVEMENT MARKING DescriptionWork CompletedMaterials Currently Stored (not in G)($)Contract Information Previous Estimate09/30/25BBASE BID% of Value of Item (J / F)(%)Balance to Finish (F - J)($)Work Completed and Materials Stored to Date (H + I)($)Bid Item No.Application Date:Application Period:Application No.:Engineer:Contractor:Project:Contract:Progress Estimate - Unit Price WorkCity of Lake ElmoBolton & Menk, Inc.Pearson Bros., Inc.2025 Seal Coat ProjectOwner:25X.137950137950Unit PriceEJCDC C-620 Contractor's Application for Payment(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.12 of 14