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PAYMENT APPLICATION NO. 5 (FINIAL) <br /> CVrCT SUMMARY: <br /> 1 - Original contract amount . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . $ 659.709.90 <br /> 2 - Additions approved to date(Itemize)(Nos. C.O. 1 &2 1 . . . . . . . . . . . . . . . . . . . . . . $ 5.219.77 <br /> 3 - Deductions approved to date(Itemize) (Nos. none 1 $ 0 <br /> 4 - Revised contract amount to date . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . $ 664.929.67 <br /> STATUS OF ACCOUNT: <br /> 5 - Contract amount to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 664.929.67 <br /> 6 - Value of completed work to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 639.659.17 <br /> 7 - Material stored on site(Attach Schedule) . . . . .I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ NA <br /> 8 - Less 0 per cent retained . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 <br /> 9 - Total earned less retained amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 639.659.17 <br /> 10 - Total of estimates previously approved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 574.686.27 <br /> 11 - Amount due this estimate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 64.972.90 <br /> APPROVAL OF FIELD SUPERVISOR CERTIFICATE OF CONTRACTOR: <br /> I (We) certify that all work for which this request for payment <br /> is made has been completed in full, according to the plans and <br /> Date specifications and terms of the contract documents. I (We) <br /> also certify that payment has been made for all just claims for <br /> labor, material and services in connection with the work <br /> APPROVAL OF ENGINEER: performed on all preceding estimates. <br /> The work of the project and this estimate have been <br /> examined and the amount shown is recommended for MIDWEST ASPHALT CORPORATION <br /> payment. Firm Name <br /> Signature Signature <br /> Date Date <br /> • <br />