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d� <br /> PAYMENT APPLICATION NO. 1 <br /> CONTRACT SUMMARY: <br /> 1 - Original contract amount ........... ....... ........ . . . . .. ...... .. .. .. .. .. . ..... . . . $570.547.33 <br /> 2 - Additions approved to date(Itemize)(Nos. none 1 .. .. . ... .... .. .. .. .. .. .. . .. ... . .. $ 0 <br /> 3 - Deductions approved to date(Itemize)(Nos. none ) .. . ........... .. .... .. . .. ... . .. $ 0 <br /> . 4 Revised contract amount to date .. . ... .. .. .. .. . .. ..... $570.547.33 <br /> STATUS OF ACCOUNT: <br /> 5 - Contract amount to date . . . . . ... . ... .. . . .. ... . .. . .. . . . . .. ... ... ... . . ... . . . ..... .. . $570.547.33 <br /> 6 - Value of completed work to date ........ . ...... . . ... ... ....... .. . . .. ...... . ..... .. . $349.947.51 <br /> 7 - Material stored on site(Attach Schedule) . .. .. .. . . . ... . .. . ... .. . . . . .. . . .... .. .. .... .. . $ NA <br /> 8 - Less 5 per cent retained . .. .. . . .. .. .. . . .. . .. .. . ..... . ... . . .... .. .. . ... . ... $ 17.497.38 <br /> 9 - Total earned less retained amount. .. .. .. . . ..... . . . .. . . . .. .. . ... ... . . ... . . .. . . . .. . . . . $332.450.13 <br /> 10 - Total of estimates previously approved . . . . ... . . . .. . . .. . .. .. .... . .. .. .. ... .. .. . .. . . .. $ 0 <br /> 11 - Amount due this estimate . .... ... .... . . . . . . . . . .. . . . . . ... ..... .. .. . .. .. . .. . . ... . . . . $332.450.13 <br /> APPROVAL OF FIELD SUPERVISOR CERTIFICATE OF CONTRACTOR: <br /> I(We)certify that all work for which this request for payment is <br /> made has been completed in full, according to the plans and <br /> Date specifications and terms of the contract documents. I (We)also <br /> certify that payment has been made for all just claims for labor, <br /> material and services in connection with the work performed on <br /> APPROVAL OF ENGINEER: all preceding estimates. <br /> The work of the project and this estimate have been <br /> examined and the amount shown is recommended for NORTHDALE CONSTRUCTION CO..INC. <br /> payment. Firm Name <br /> w _ <br /> Signature Signature <br /> Date (f r /Q.7 Date 7' Z-1-7 <br />