NYC 9/11 Public Portal Document
Mayor's Office of Emergency Management
7 World Trade Center
1st, 7fh & 23rd Floors
CONTINUATION SHEET EQUIVALENT TO G703 PAGE 4 OF 4 PAGES
APPLICATION AND CERTIFICATE FOR PAYMENT, CONTAINING APPLICATION NO. 4
CONTRACTOR'S SIGNED CERTIFICATION IS ATTACHED DATE 3/26/99
AMB. JOB S57-5175
USE COLUMN I ON CONTRACTS WHERE VARIABLE RETAINAGE FOR LINE
ITEMS MAY ITEMS MAY APPLY.
A B C D E F G H I
ITEM DESCRIPTION OF SCHEDULED FROM THIS PERIOD MATERIALS TOTAL % G-C BALANCE TO RETAINAGE
COMPLETED
PREVIOUS
AND STORED
NO WORK VALUE APPLICATION TO DATE FINISH
Change Order #054 2,671.00 2,671.00 2,671.00 100%
Change Order #055 29/ 00 29,000.00 29,000.00 100%
Change Order #057 63,000.00 63,000.00 63.1SEE 00 100%
Change Order #058 5,506.00 5,506.00 5,506.00 100%
Change Order #059 10,948.00 10,948.00 10,948.00 100%
Change Order #060 8,114.00 8,114.00 8,114.00 100%
Change Order #061 2,400.00 2,400.00 2,400.00 100%
Change Order #062 9,679.00 9,679.00 9,679.00 100%
Change Order #063 1,912.00 1,912.00 1,912.00 100%
Change Order #064 6,500.00 6,500.00 6,500.00 100%
Change Order #065 22,721.00 22,721.00 22,721.00 100%
Change Order #066 14,800.00 14,800.00 14,800.00 100%
Change Order #067 2,894.00 2,894.00 2,894.00 100%
Change Order #069 672.00 672.00 672.00 100%
Change Order #070 6,114.00 6,114.00 6,114.00 100%
Change Order #071 4,579.00 4,579.00 4,579.00 100%
Change Order #075 4,874.00 4,874.00 4,874.00 100%
TOTALS 12,334,705.00 10,780,405.00 1,554,300.00 12,334,705.00
NYC-WTC_000172356
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