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<br /> �� TION AND CERT►�tCA�'� �aR PAYM�i��_--- ����; ��ocu����_r�r c�ioz_-- ��,,�.< <,.F �,� ' ��,��-,��
<br /> APP�t.�� �. .
<br /> I�1'I'LICi\TIO��� r�o: 1 Uislribution lo:
<br /> ,=--= f'ROJC(=1: i'�c�i_l.er Re��La,:��mc�uL [� O�'dN1:R
<br /> TO (U�vncr): CiCy of Uecatur
<br /> Nc�t 1.1i �1.�rc��Cmr�n C 1'���nt ��I.RIOC) V f:(��•1: i� Z. �-] l�RC.I IIiCC�.I
<br /> �I . 1'1_ar�i �„�•, l_� 3/�`�
<br /> i C:i.vic Cci;l.cr r, ,, i�- ' � ` '"�
<br /> � �``� �, Ti): L �•������� CI CONTh�\CIOI:
<br /> ])CC£1LU1- � .I..L.L1I101.-`, G7_�.=-' ��
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<br /> 1-1
<br /> �� ��mcr,�. l�,I�.C1��f�_Ci"� �;ss:�.7
<br /> A�i7LNT101�l:
<br /> II��:I.l. , ;;cl���ral l:z �� illileni.u��, r\rc.l�, i�.0i�11I���c�i" i _ �ri- I'I:c_��l.C:l h!i�.
<br /> 'L'1_5 5r.�ul:h 1•1�� i.n
<br /> O2_`�2�� �;.t;� c_.Oi!I Ri\(-.I (�:\I I.. ..l,�n��,�:'.,� �'� , �.�)`�`) __ -
<br /> D�.c�L u r , I:1.:l.i.n o_i.., ��.v 2/—,�Do� ------------------- -
<br /> ---- ------ ,�;���I��:.�li��n is in�iclr (cir I'��yint'nl, :iti ;lic>�:�n l�cic�::�, in Cc�nneClini� v;ilh Ilic C��ntr�ii'�
<br /> NTRACTOR'S A�'PLICA�X�ION [=C)��. 1'/�YM6_NT �_��„��,,,�.,���,�, si,����, nin i��,<<��„��„� c�u_,, �. ;,��.,�_i,���,
<br /> CO __ _------ ------- -I hc i�rE�;r�nl slalus o( �hc account (�� tl�is i:c�nlrict is �s �ullu4:-t:
<br /> ----------- ,- ] ,�� E 3.GO
<br /> CHANGE ORDER SUMMARY _______------ -- , --
<br /> c� _
<br /> — OltlGl�l�L CONTRnCI� SU�1 . . . . . . . . . . . . . . . . . . . . . . . �—
<br /> Changc C)rdcrs ap��rovcci l�DDI(IONS
<br /> DLDU(;710NS
<br /> in prcvinus months by . . . . . . . . . . . .5----- — -
<br /> Nct chai��� hy Ch�ng�� Ordcrs . . . . . . .
<br /> p�vncr
<br /> TOT,\l ----------- l`� ,��+3.�0
<br /> --- ------ -----
<br /> -----_� • . . . . . . S-= -
<br /> _ ----
<br /> CON�I�RACI SU��1 l�0 Dn 1. . . . . . . . . . . . . . . . . . .
<br /> A�)OiU�qci ��ii5 \liinl�i -
<br /> v�n,bc� t),�c np -- . . . . 518,516.00
<br /> --- �IUTAL CO�'v11'l.{:Y[D & STORLD 70 f)AiE . . . . . -
<br /> (Colunin G c>n G70:1) 1,851.60
<br /> RL-1 nW�GE _-10—�'� . . . . . . . . . . . .
<br /> . . . . . . . . . . . .5— ------
<br /> or lotil in Colui�in I un C�iO3 _16 664.40
<br /> - . . . . . . . . . . .� ' --- -
<br /> __,_ -- — "1O1��L [i\RNt=t� LLSS IZC:7nW�GE . . . . . . .
<br /> TOT��LS ---- -- ,
<br /> 1ct �hanp,c by Ch,nE;c Ordcrs __ -_ I.I:SS 1'REVIOUS CEK(IFIUTES FOR Pnl'MEN�T� . . ' . . . . 5---�- —
<br /> Thc undcrsigned ContraUor ccrtitic�ih�l lo thc bcst oi his kno�vl�clE;c,
<br /> infurmalion and bclic( thc \1�ork cuvcrcd by lhis Application (or
<br /> Pa�•ment l�as �ee� com�;le�ed in accord.i�ce ��•i�li �he Con�r�ct Docu- `,�6,G64.90
<br /> ments, lh.�t all �mounls hivt bcen paid b}' him (or Vdork (or which . . . . . . . . . . . . . r--- -- ---
<br /> C�)12R[:N�I f'��lYt��iENT [)UE . . . . . . . . ___
<br /> ��icvinus Ccrli(icales (or I',iymcnt ��•crc iss�cd ,nd p�ynunls rcc�'ivccl _ ,- -------�--
<br /> irom th�_ Owncr, and lh�t currrnl payn�enl sho�vn h��r�in is no�v du�t. Cc�ur;;' c�(:
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<br /> CONTf::\CT . It�'�. ��»•���� Pluint�i_n�;, lleatin�, � '
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<br /> `_;ul�sciihccl an�l s`vc�in ln I>c(oi�: inc U�i, �
<br /> � lvotary f'ul�lic:
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<br /> vaUons an�� il�c d.il�� ruin��ricm�; lhc al�ovc a��plicati��n, li:c Archilrcl � l` - --- ---
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<br /> �_crULrs ;o th�: C.)v;ncr ihat thc �\'orG: ha, pro};tcz�,cd Io ih�. ��uin� l'\'' -� ---- - - -- — , --- `
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<br /> i• ri;;!�ls ui ll��� Uwncr n� �:��nl�,r_lor ��nU�� ',,',��` �.-�;nir;� .t -- ---- -
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