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PAY APPLICATION NO. 4 <br /> CONTRACT SUA 4IARY: <br /> 1 - Original contract amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 426,380.25 • <br /> 2 - Additions approved to date (Itemize) (Nos. 1 & 2 ) . . . . . . . . . . . . . . . . . . . . . . $ 40,616.00 <br /> 3 - Deductions approved to date (Itemize) (Nos. none . . . . . . . . . . . . . . . . . . . . . . $ -0- <br /> 4 - Revised contract amount to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 466,996.25 <br /> STATUS OF ACCOUNT: <br /> 5 - Contract amount to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 466,996.25 <br /> 6 - Value of completed work to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 419,509.14 <br /> 7 - Material stored on site (Attach Schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ NA <br /> 8 - Less 2 per cent retained . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,390.18 <br /> 9 - Total earned less retained amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 411,118.96 <br /> 10 - Total of estimates previously approved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 398,533.68 <br /> 11 - Amount due this estimate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12,585.28 <br /> CERTIFICATE OF CONTRACTOR: <br /> I (We) certify that all work for which this request <br /> payment is made has been completed in full, according <br /> the plans and specifications and terms of the contract <br /> documents. I (We) also certify that payment has been <br /> made for all just claims for labor, material and services in <br /> APPROVAL OF (ARCHITECT) (ENGINEER): connection with the work performed on all preceding <br /> estimates. <br /> The work of the project and this estimate have been <br /> examined and the amount shown is recommended for <br /> payment. MIDWEST ASPHALT CORPORATION <br /> Firm Name <br /> -2Z <br /> Signature <br /> GG S' nature <br /> Date Z''lli 7 <br /> Dater 9� <br />