CONSTRUCTION TEMPLATE: CONTRACTOR PROGRESS PAYM

APPLICATION FOR PAYMENT

TO OWNER PROJECT NAME

APPLICATION NUMBER

PERIOD ENDING

CONTRACT WORK

CONTRACT NUMBER

PREPARED BY

CONTRACTOR'S APPLICATION FOR PAYMENT

Refer to backup sheets attached for detailed breakdown

1 Original Contract Amount: $ 20,000.00

2 Net Changes to Contract: $ 600.00
3 Total Contract Amount: $ 20,600.00
4 Total Completed To Date: $ 15,000.00
5 Retainage:
a. 15% of Completed Work
Total Retainage: $ 2,250.00

6 Total Completed Less Retainage: $ 12,750.00

7 Less Previous Applications: $ 5,000.00

8 Current Payment Due: $ 7,750.00

9 Balance to Finish Including Retainage: $ 7,850.00

EXTRA WORK SUMMARY ADDITIONS DELETIONS

Changes From Previous Applications $ 1,000.00

Changes From This Application $ -
Total $ 1,000.00

Net Changes $ 600.00

CTOR PROGRESS PAYMENT

FOR PAYMENT
PROJECT NAME FROM CONTRACTOR

CONTRACTOR'S CERTIFICATION

The undersigned Contractor to the best of his knowledge, information and believe of the Work cover
Application for Payment has been completed in accordance with the Contract Documents, that all am
been paid to him for Work for which previous Certificates for Payment were issues and payments re
20,000.00 the Owner, and that current payment shown herein is now due.

600.00 CONTRACTOR DATE

20,600.00
15,000.00 STATE COUNTRY
Subscribed & sworn to before me
this day of
2,250.00
NOTARY PUBLIC NAME COMMISSION EXPIRATION
12,750.00

5,000.00 ENGINEER'S CERTIFICATE FOR PAYMENT

The Engineer hereby confirms that based on site observations & to the best of his/her knowledge, th
7,750.00 application accurately reflects the progression of work and that this work meets contract requiremen
enough to justify payment in the amount certified below:
 7,850.00 AMOUNT CERTIFIED

Provide explanation below or attached if amount certified does not match this application amount. In
DELETIONS & markups to agree with certified amount.

$ 400.00 ENGINEER DATE

$ -
$ 400.00 The Amount Certified is payable to the contractor listed above.

600.00
TIFICATION

tion and believe of the Work covered by this

he Contract Documents, that all amounts have
ment were issues and payments received from

COMMISSION EXPIRATION DATE

o the best of his/her knowledge, this payment

s work meets contract requirements sufficient
t match this application amount. Initial all figures
CONSTRUCTION TEMPLATE: CONTRACTOR PROGRESS PAYMENT

APPLICATION FOR PAYMENT

TO OWNER PROJECT NAME FROM CONTRACTOR

APPLICATION NUMBER

PERIOD ENDING

CONTRACT WORK

CONTRACT NUMBER

PREPARED BY

CONTRACTOR'S APPLICATION FOR PAYMENT CONTRACTOR'S CERTIFICATION

Refer to backup sheets attached for detailed breakdown The undersigned Contractor to the best of his knowledge, information and believe of the Work covered by this
Application for Payment has been completed in accordance with the Contract Documents, that all amounts have
been paid to him for Work for which previous Certificates for Payment were issues and payments received from
1 Original Contract Amount: $ - the Owner, and that current payment shown herein is now due.

2 Net Changes to Contract: $ 600.00 CONTRACTOR DATE

3 Total Contract Amount: $ 600.00
4 Total Completed To Date: $ - STATE COUNTRY
5 Retainage: Subscribed & sworn to before me
a. 0% of Completed Work this day of
Total Retainage: $ -
NOTARY PUBLIC NAME COMMISSION EXPIRATION DATE
6 Total Completed Less Retainage: $ -

7 Less Previous Applications: $ - ENGINEER'S CERTIFICATE FOR PAYMENT

The Engineer hereby confirms that based on site observations & to the best of his/her knowledge, this payment
8 Current Payment Due: $ - application accurately reflects the progression of work and that this work meets contract requirements sufficient
enough to justify payment in the amount certified below:

9 Balance to Finish Including Retainage: $ 600.00 AMOUNT CERTIFIED

Provide explanation below or attached if amount certified does not match this application amount. Initial all figures
EXTRA WORK SUMMARY ADDITIONS DELETIONS & markups to agree with certified amount.

Changes From Previous Applications $ 1,000.00 $ 400.00 ENGINEER DATE

Changes From This Application $ - $ -
Total $ 1,000.00 $ 400.00 The Amount Certified is payable to the contractor listed above.

Net Changes $ 600.00

CONSTRUCTION TEMPLATE: PROGRESS PAYMENT BACKUP

BID CONTRACTOR OR
TASK DESCRIPTION CONTRACT SUM
ITEM # SUBCONTRACTOR

EXCAVATION & EARTHWORK

1.001 Cut & Fill

1.002 Removal of Stone/Dirt
1.003 Trenching For Utility Hookups
1.004 Foundation Excavation
1.005 Foundation Footing Drains
1.006 Curtain Drains
1.007 Culverts
1.008 Swales
1.009 Retaining Walls
1.01 Ponds
1.011 Other Site Drainage
1.012 Backfill
1.013 Compaction
1.014 Top Soil
1.015 Finish Grading
1.016 Seeding/Sod

FOUNDATION
2.001 Footings/Pads
2.002 Foundation walls/stem walls/grade beams
2.003 Piers
2.004 Slabs - Foundation, Basement, Garage
2.005 Steel Reinforcing
2.006 Anchor Bolts, Hold Downs
2.007 Bulkheads
2.008 Sub-Slab Vapor Barrier
2.009 Sump Pump
2.01 Crawlspace Vapor Barrier
2.011 Crawlspace Vents
2.012 Foundation Windows
2.013 Dam-proofing, Water-proofing
2.014 Foundation Drain Board
2.015 Slab insulation: Edge/Blow
2.016 Exterior Foundation Insulation
2.017 Exterior Insulation Coating/ Protection

OTHER MASONRY/PAVING
3.001 Patios
3.002 Exterior Stairs
3.003 Masonry Chimneys
3.004 Fireplaces/Hearths
3.005 Driveway
3.006 Walkways

ROUGH FRAMING
4.001 Sill & Seal
4.002 Steel/Wood Carrying Beam, Lolly Columns
4.003 Floor Framing
4.004 Exterior & Interior Walls, Rough Stairs
4.005 Sheathing, Subflooring
4.006 Roof Framing/Trusses
4.007 Sub fascia
4.008 Steel Framing Connectors
4.009 Nails, Screws, Fasteners
4.01 Prep for Plaster, Drywall
4.011 Rough Framing - Labor Only

EXTERIOR
5.001 Exterior Foam Sheathing
5.002 Weather Barrier (Tyvek, etc.)
5.003 Membrance & Flashing
5.004 Vinyl or Composite Siding
5.005 Wood Siding
5.006 Brick Veneer
5.007 Stone Veneer
5.008 Stucco
5.009 Fascia, Frieze, Corner Boards, Water Table
5.01 Soffit/Gable Vents
5.011 Window/Door Trim
5.012 Other Exterior Trim
5.013 Exterior Paint, Stain, Caulk
5.014 Exterior, labor-only

WINDOWS/EXTERIOR DOORS
6.001 Membrane & Flashing
6.002 Exterior doors, prehung
6.003 Exterior door slabs
6.004 Exterior door frames, sills
6.005 Sidelights, transoms
6.006 Locksets, knobs, door hardware
6.007 Patio doors: sliding or hinged
6.008 Windows
6.009 Garage Doors & Opener

PLUMBING
7.001 Drain/Waste/Vent
7.002 Water Supply Piping
7.003 Gas Piping
7.004 Water Treatment
7.005 Water Heater
7.006 Fixtures: Toilets, Tubs, Sinks, Showers
7.007 Faucets, Mixing Valves, Shower Heads
7.008 Disposal

ELECTRICAL
8.001 Service, Panel, Sub-Panels
8.002 Rough Wiring
8.003 Phone, Cable, Internet Wiring
8.004 Lighting Fixtures
8.005 Low-Voltage Fixtures/Transformers
8.006 Exterior Lighting
8.007 Devices: outlets, switches, dimmers
8.008 Lighting control system
8.009 Doorbell System
8.01 Smoke, CO2 Alarms
8.011 Intercom system
8.012 Security system
8.013 Home theater/Entertainment

HVAC
9.001 Furnace/Heat Pump
9.002 Central AC
9.003 Air Handler
9.004 Ductwork, Grilles, Registers
9.005 Air Filter
9.006 Boiler, Piping
9.007 Radiators
9.008 Whole-House Ventilation (HRV, ERV, Exhaust Only, Other)
9.009 HVAC Controls
9.01 Solar hot water

INSULATION & AIR-SEALING

10.001 Roof/Attic Insulation
10.002 Roof/Eave Baffles
10.003 Wall Cavity Insulation
10.004 Foam Board Insulation
10.005 Spray Foam Insulation
10.006 Basement Insulation
10.007 Crawlspace Insulation
10.008 Air Sealing
10.009 Energy Diagnostics (Blower Door, Infrared)

DRYWALL/PLASTER
11.001 Walls
11.002 Ceilings, Soffits
11.003 Decorative Plaster
11.004 Drywall Labor Only

INTERIOR FINISH
12.001 Interior Doors, prehung
12.002 Interior Door slabs
12.003 Interior Door frames, thresholds
12.004 Door knobs, hardware
12.005 Chair Rail, Other
12.006 Wainscotting, Paneling
12.007 Built-in Shelving, Cabinets
12.008 Closet Shelving, Hardware
12.009 Stairs, Railings, Newels
12.01 Interior Painting, Staining
12.011 Wood Flooring
12.012 Carpeting
12.013 Resilient/Vinyl Flooring
12.014 Other Flooring
12.015 Acoustical, Metal, Decorative Ceilings
12.016 Interior Carpentry Labor Only

KITCHEN & BATH

13.001 Kitchen Cabinets
13.002 Bath Cabinets
13.003 Cabinet Pulls, Hardware
13.004 Countertop, Backsplash
13.005 Ceramic Tile, Stone
13.006 Raised Tub Platform
13.007 Tub Enclosure
13.008 Shower enclosure/doors
13.009 Medicine Cabinets
13.01 Mirrors
13.011 Towel hangers, toilet paper holders, accessories
13.012 K&B Labor Only

PORCHES & DECKS

14.001 Open Porch
14.002 Screen Porch
14.003 Wood or Composite Deck
14.004 Fencing

APPLIANCES
15.001 Refrigerator
15.002 Range, Cooktop
15.003 Microwave
15.004 Range Hood
15.005 Dishwasher
15.006 Washer/Dryer
WORK COMPLETE CONTRACTOR'S AMOUNT
AMOUNT VALUED REASON FOR DIFFERENCE
(%) CLAIM PAYABLE

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TOTAL $ -