Free Proposed Findings of Uncontroverted Fact - District Court of Federal Claims - federal

Case 1:07-cv-00355-NBF
2. CONTRACTOR AND ADDRESS

Document 24-3

Filed 07/30/2008

Page 1 of 20

ALL STAR IRON WORKS,
~ D~'SCRIPTI~)"N OF WORK

1
PROM Zll/0~
QUAN}ITYAND ' d~lT: ' UNIT

4'~ DISTI~ICTIsHEET ~--°[ z

7. REQUIRED COMPLETION DATE 10. JOB ORDER NO.

GA[Ek~AY OUTBOUND CANOPY-DESIGN
B': LOCATI~N .........

BROWNSVIL,LE~ TX
IIEM

THRU 4/30/00
CDNTRACT PRICE d AMOUNT e

11. E~_..~ATE NO.

TOTAL TO DATE ........ Q'GANI~ITY AND UNIT AMOUNT I

i

DESIGN WORK (BASE CANOPY) (REFER TO PLANS & SPECS.) !ALTERNATE BOOTH DESIGN ALTERNATE MISTIN6 SYSTEM

-

100%

17,668.80

65%

11,497.72

100% lO0%

6,400. O0 1,650.00

.4,160.00

1o%

165.0D

4

TECHNICAL LINES & SPARE ELECTRICAL LINES DESIGN (PENDING)

TOTAL EARNINGS |CLUDES MODIFICATION THRU: 12. PRESENTED FOR PAYMENT PAYEE PER

TOTAL CONTRACT ~ $ ...... ~4.A"

25,718.80 TO DATE

PREVIOUS DEDUCTIONS OTHER THAN RETAINED PERCENTAGE"" PREVIOUS RETAINED PERCENTAGE PREV IOUS PAYMENTS PREVIOUS EARNINGS (A+B-~C) ¯

...5-26-0Q

. PRES !DEN..T. ... ......
13. APPROVED FOR PAYMENT E. EARNIN'~B THIS PERIOD {TOTAL EARNINGS T.O DATE MINUS DI F. LESS RETAINED PERCENTAGE GI LESSDEDUCTION OTHER THAN RETAINED PERCENTAGE FOR

I CERTIFY that I have checked "the quantities covered by this bill or estimate; that the work ~vas actually perlormed; that the quantities are co:rect and consistent wilh all previous computations as actually checked; 1hat lhe quanf.ilies end amounts are wholly consldent with th~ requirements of the contract or other instrument involved.

SIGNATURE

TITLE

DATE

,.. RETA',N G ' REFUNDED
"= J. OTHER REFUNDS K~ TOTAL REFUNd; ~HIS PER L. AMOUNT DUE CON'[RACTOR (E-H+K| 1S. RECAP |TULATION: ..... TOTAL RETAINED PCTG. (B+F-I) S TOTAL PAID (C÷L) S

CO~C~IN~ OFFICER APPROVA_L_(Signai.ure| ENG i FORM 78 MAR 93

DATE

PREVIOUS EDITION OF TI4IS FORM IS O6SOLE~E

"(use REVERS--- S.~E FO~ DETAILED EXFL~I~TI©~ AND.O.-q ~EM~..~:'; .

Case 1:07-cv-00355-NBF

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Filed 07/30/2008

Page 2 of 20

APP 022

Case 1:07-cv-00355-NBF

Document 24-3

Filed 07/30/2008

Page 3 of 20
4.1DISTRICT

3. {;ONTR ACT

"83 , MERCEDES, TX7 8570 LOS TOMATES OUTBOUND
B. LDCAT# O~'4

TC-I-96-013

CANOPU DESIGN

BROWNSVILLE ,
ITEM

TEXAS

,#y ~~-<~ ~,,, .......u.,-r .......
U N IT ¯ PRICE

OONTR ACT

TOTAL TO DATE AMOUNT B UNI~T ~UNT

c

d

100% (REFER TO PLANS & SPECS.) ~TEBNATE BOOTH DESIGN (DESIGN) 3 4 5

19,900.00

100%

i;9. 900. O0

1oo%

6,B00,00

Ioo%
10o%

6,B00.00

~O~DWAY & DRAINAGE MODIFICATIONS
ALTERNATE MISTING SYSTEM(DESIGN)

zoo%
lOO% lOO%
TQTAL CONTRACT ~

~ ,~oo ,oo
1,650.0"0 7,240.00
!~37~390. 00

,ooo..oo
1,650.00 "~. 7~240.00 ~

¯
100%
TO DATE

PAYmeNT & PE~F0~ANCE BONDS

INCLUDES MODIFICATION THRU:

~. P~E~NTEO ~Oa P~YMENT

PREV1OUS DEDUCTIONS OTHER THAN RETAINED PERCENTAO~"" PREVrOUS RE/A IlN,E O,,, PERCENTAGE C. PREVIOUS PAYMENTS

- 0 28,642:~ 00 2B,641.00

OATEIEI- 0

7- 0 0

PRESIDENT
APPROVED TOR FAYN~ENT

D. PREVIOOS EARNINGS [A+B÷C] " E. EARNINGS THIS PERIOD IToTAL EAFININGFI TO DATE MINUS D' F. LE~ RE~AI~'EO PERCENTAGE ~. L{~ DEDUCTION ~EB THAN ..... RETAINED PER~EN~AGE FO~ I. RETAINAGE REFUNDED J, O~ER REFUNDS L. ~OUNT DUE C~T~ACTOR [E-~+K) TOTAL RETAINED PCTG. |B÷F-I| S TOTAL PAID IC+LI' $

8,748.00

SIGNATURE

TITLE

DATE

''[USE REVERS~ SIDE FOR DETAIL~ED EXFL ~,N,-~.TION .ANP"OR REMa.F~F'.

Case 1:07-cv-00355-NBF

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Page 4 of 20

b

DESIGN WORK (BASE CANOPY}

{REFXR TO PLANS & SPECS.) 6.0BO.00 1.567.50

2 3

ALTERNATE BOOTH DESIGN ~LTERNATE MISTING SYSTEM (DESIGN)

NCLUD~S MODIFICATION THRU: 12. PRESENTED FOR PAYMENT PER PREVIOUS PAYMENTS

TOTAL EP~RN TO DATE

00 8 - O 7 -0 0 PRES IDE~.T
13. ~PROVED FOR PAYMENT D. PREV IO -~IS EARNINGS E;EARNINGS THIS PERIOD iToTAL EARN;NG5 TO DATE-MINUS F. LESS ftETA.INEDPERCENTAGI~ .G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR con*ist~ with the r~!u;r~entt of the ~tr~t ~ other ins;rUment H. TOTAL DEDUCTIONS THIS PERIOD SIGNATURE

15,822-72
;-:-:-:-:,:<<<-.'..;.;-;<.:-.'<.;-; .>:-:<-:-:-.'-i ¯ :- :':':-:-: <-.'<- 5::::~:-:':-:-:-:-.'-:':~-.'-:->:i ::::::::::::::::::::::::::::::::::::::::::::::: , ~

TITLE

I. RETAINAGE REFUNDED J. OTHER .REFUNDS K. TOTAL REFUNDS THIs PERIOD L. AMOUNT DUE CONTRACTOR 15. R EC AP ITULAT IONTOTAL RETAINED PGTG. {B+~:-I| $

Case 1:07-cv-00355-NBF

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ii

APP 025

Case 1:07-cv-00355-NBF

Document 24-3

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J I. DATE

Page 6 of 20

PAYMENT ESTN%JATE -. CONI'R:ACTPERFORMANCE

~~o A~PR~S~
i. OESC

CONTRACT, NO.

~

TAR IR0~ ~0RKS,ZMC.P.0.BOXB3,~RCEDES,TX 78570
¯

TC-I-g6-013 "
TH IS F_~TII%{ .~ T~ TFi~U 09--[~--00

LOS ~NDIOS

.... :" ":;..~ .,.~--, "Z~, ~ ~,,~" ['[G" .~.~ ' "~ ,~ ~.~ " - ":'-.":,~'~.: ~.::,'q~'~ ,OUqBOUND CANOPY DESIGN ,_

L Lo~.T, ON
NO. ~ ~ DESCR IPTtON b

ZOOl]2.~o~e -to ~'b o S.EP
QUANTITY AND UNIT

¯ COaTRAC~ "

Toi~L TO O~TE "' ....
AMOUNT QUANTITY ANO UNIT !

Pm~C.E

u~If "

DESIGN WORE RASE (.BASE CANOPY) (~EFER TO PLANS & SP.EC-S.)
ALTERNATE BOOTH DESIGN (DESIGN)
ROADWAY & DRAINAGE MODIFICATIONS ,ALTERNATE MISTING SYSTEM (DESIGN)
FPAYMENT & PEI
1oo%
100%

19,900~00
6,800..00

100%
1oo% 10o%
100%

19,900.00

~oo~ ~oo~ ~oo~
~oo%

I,B00.00

1,800.00

,650.0o

7,~40.00

5,100.00
79.,500.00

:STRUCTURAL STEEL

¯

~.-,

lOO% 95% : 7~%

1,650.00 7,~40~00 4,545.00 57,240.00

I ,._, (t
~NCLUOE$ Moo)F~ATION L'I"~. RU: 12. PReSeNTED FOR PAYME~'T' ,
....

TOTA!. CONTRACT

S121,990.00

TO O ATE

; 1~
' , ' ,

s 99,475.00

14"A. PREVIOUS DEDUCTIONS OTHER THAN RETAINE0 PERCENTAGE ' "

pREVIOUS ;t ETA INED PERCENTAG E
PREVIOUS PAY&,I ~" NTS OAT E

37,3g0.00 ;
:::::::::::::::::::::::::::::::::::::::::
37.r390,00

-0-

09-15-00

?RESIDENT
13. APgJ:IOV£O FOR PAYM.=NT

O. PREVIOUS EARriINGS E. EARNII~GS THI.~ Fi~RIOD iTOTA'L E.ARNIN~S I'0 0AT'-~ %fliP, US 0]

z ~.~-:.':.'.:'-'.'.'.';:'I.Z-Z.'.T::,'.'.'.'::'~
{
" 0. -

,085.00

F, LE55 RETAIN==D PERCENTAGE
vi~J~ ~m~t~ion~ ~ ~tu~ ~ecked: that ~he ~uaadtles and amount~ are wholly ' ~'i L~$$ DEDUCTIO;~ 0T'H~a THA3I .......... RETAINED ~ERCENTAGE FOR

3,104.25~

H. TOTAL 0 :DUCTIOI~IS -r'.A iS P E~IOO !F ~G': ~:~:ii~:]~i~'~:~[."~:i~i:!:i:i[i:ili:i . 3, I 0 4. Z5 "" ..... B!,'.L'~! , ¯ . .'.','.,.,.,,-.;-., ~'.;'-'.'~-¢,, ,. . ,,. ,,:, TITLE DATE

..... ~_. '~.vIO'u~T 'D'U£ COt~TR &C~'OR [E-H-K.', ..... ~'-'~:-~-~K~'---~9>;--.~¢~!~:~.~--~`~`~-:~ :':':'-""':::':'"':'~ 58 r 980, 75' "

Case 1:07-cv-00355-NBF

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Filed 07/30/2008

Page 7 of 20

!9. PERIOD COVERED BY ~'H~ EST~&,IATE CO N TR

TOTAL TO DATE
A MOUN T UNIT ! AMOU N r

NO.
b

QUANTIFY AND UNIT ,.

UNIT PR IC.E '..

].oo%
100%
~iRO~WAY & DRAINAGE ~0DIFICATIONS

19,900.00

ioo%
lOO% 10o% 10o% 100% B5%

19,900.00
6,800.00"

ioo%
10o% 100%

STRUCTURAL STEEL

lOO% 1oo%

6 , B00 I,B00~00 1,650.00 7,240.00 5,400 ¯ 00 7fl,800.00

l, 800. O0

1,650.00 "

7,240.00

4,590.00 56,7~6.00

q~_N_CLUD~ MOOIFICATION THRU: i:Z. PRESENTED FOR f~AY/MEN~ ..........

TOTAL CONTRACT ~ i14-A. PR EV1OUS DEOUCTION~ OTHER THAN R.=TAIN ED PERICEN'I'AGE" ' B. PREVIOUS RETAINEO PERCENTAGE C. PREVIOUSPAYMENTS D. PRE.V IO~S EARN IDIG3

i'121. 670.00

TOTAL EARN iN~ TO DATE

98,716.00

13, APPROVED FOR PAYMENT

E. EARNINGS THIS PERIOD {TOTAL EARNINGS TO DATE MINUS OI
F. LESS R-ETAII,~ED PERCENTAGE G.LE~S O~9UCTION OTHER THA.~ R=.TAINED PERCENTAGE FOR

SIGNATUR~

TITLE

DATE

~-IUSE ~EV~RS~ S10£ ---OR DET,.%[LEO 'EAP,'L;~N aT|O,',I &NO 0"~" R~'&Ax'

Case 1:07-cv-00355-NBF

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I t. DATE

Page 8 of 20 10/25/00 SHEET l___o~ l_!---

PAYMENT~ ESTIM;~T.E°U¯ C'ON:~RACT" PERFORMANCE For use of this form, see ER 37-2~10 and ER 37-345-10. CONTRACTOR AND ADDRESS

.~l.l 8tar Iron Works, Inc. PO Box83, Mercedes,TX ?85[70 ~ESCRIPT~ON OF WOR<

I

3. CONTRACT NO.

I

' I6. APPROPR~ATIbN AND PROJECT
I .CS-T-99-24749-6
CONTRACT UNIT PRICE d"e"

TC-T-96-013

Los Indios Outbound Canopy Design "
LOCATION ITEM NO. a

REOuIRE coMPLE 'oN. . .
10. JOB ORDER NO. [I 1. ESTIMATE NO. ~TOTAL TO DATE

9. PERIOD COVERED BY THIS ESTIMATE

FROM 09--16--00 THRU 10--15--00
DESCRIPTION QUANTITY AND UNIT o AMOUNTQUANTITY AND f AMOUNT

g

Design Work Base (Base Canopy) (Refer to Plans & Specs.) Alternate Booth Design (Design) Roadway & Drainage Modification~ Alternate Misting System(Design Bonds

19,900.'00
6,800.00 1,800.00 1,650.00 7,240.00
9,.20"0.00

1oo% lOO% lOO% zoo% lOO% lOO%

19r900.00

6,800.06 1,800.00 1,650.00 7~240,00 9,200.00

,I00.00 240.00 500.00 S151'430"00
OTHER THAN "AGE" B. PREVIOUS RETAINED PERCENTAGE " C. PREVIOUS PAYMENTS

100%

5, i00.00
20,240.00 6z~, 600. O0

100% 81% "

CLUDES ,YEE

TOTAL EARNINGS )-S 136,530.00 TO DATE

10/25/00

Presidez

D. PREVI~IUS EARNINGS (A+B+C) EARNINGS THIS PERIOD {TOTAL EARNINGS TO DATE MINUS D|

99,475.00

13. APPROVED FOR PAYMENT ;ERTIFY that I have Checked the quantities covered by this bill or estimate; that the was actually performed; that the quantities ~re co,'rect and consistent wi=h all procomputations as actually checked; that the quantities and amounts a~'e wholly nsistent with the requirements of the contract or other instrument involved.

,37,055.00

F. LESS RETAINED PERCENTAGE G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR " H. TOTAL DEDUCTIONS THIS PERIOD (F+G)

GNATURE

TITLE

DATE

I. RETAINAGE REFUNDED .
J. OTHER REFUNDS K. TOTAL REFUNDS THIS PERIOD

~

G oFFICER APPROVAL (_S.!.gnature) .~ FORM 93 1 MAR 78

DATE

L. AMOUNT DUE CONTRACTOR (E-H+K) 1,5. RECAPITULATION; TOTAL RETAINED PCTG. {B+I=-I) S TOTAL PAID {C+L} S

0 35,2U2.25

PREVIOUS EDITION OF TI41S FORM IS OBSOLETE

¯ "(USE REVERSE SIDE FOR OETAtLED EXPiLANAT|O'N AND-OR REMAR~ "

Case 1:07-cv-00355-NBF

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1. DATE

Page 9 of 20

PAYMENT ESTIMATE CONTRACT PERFORMANCE For use of Ihis. lorrn. ~ee ER 37-2-10 and ER 37-345-i0. TRACTOR AND ADDRESS 3, CONTRACT NO.

0/25/00
14" DISTRICT

SHEET lo[ ~

~ Tron Wor~s, Trim- l~O BO~
3RIPTION OF WORK ATION

8.3 Mercedes, TX

....... TO-',,, 1-96-013
6. APPROPRIATION AND PR. OJECT

CS-I-00-23988-9
PERIOD COVERED BY THIS ESTIMATE

[7. REQUIRED COMPEETION DAT'~ t I 10. JOB ORDER NOr tII. ESrIMATENO" TOTAL TO DATE AMOUNT

¯

hts

FR0,,M ,,, i0-I-00 THRU I0--i~.--00
tON .
QUaNTiTY At~O Ur~IT CONTI=IACT UNIT PRICE d

~
Mobilization
Kitchen Cabinets
o Paint Repairs

OUANT'TY AND
. AMOUNTe UNIT

100%

4,8Q0.00 66,020.05 2,200.00 4,8.00.00

10o%

4,800.00

lOO%
100%

~emou~. i i z at i on

lO0%

DES M~DIFIC~ION THRU: -"=< "~" 12. PRESENTED FOR PAYM'ENT I PER TOTAL CONTRACT

j

s 77,.820.05

TOTALEARNINGS~ TO DATE,,

4,800.00

14"A. PREVIOUS DEDUCTIONS OTHER THAN R ~:TAINED P,ERCEf~TAGE ~" B. PREVIOUS RETAINED PERCENTAGE C. PREVIOUS PAYMENTS

0 o

10/25/qo
13. APPROVED FOR PAYMENT "IFY that I have i::heckLL'd the quantitie~ covere"J by this bill or estimate; that the actually perlormed; that the quantitle$ are co:feet and c;3nsi$tent with all preomguta~ion$ as actually" checked; that the cIuanti:|~ and amounts are wholly with lhe r~!uir.".men:.~ DE the contract or other instrument'involv~d.

D. PREVI~3~S EARNINGs {A+B~-CI E.EARNINGS THIS PERIOD EARNINGS TO DATE MINUS F. LESS RETAINED PERCENTAGE " G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR H. TOTAL DEDUCTIONS THIS PERIOD IF+G) TITLE DATE I. RETAINAGE REFUNDED J. OTHER REFUNDS K. TOTAL REFUNDS THIS PERIOD L. AMouNT DUE CONTRACTOR {E-H-;-K) ! 5. RECAPITULATION: LrOTAL RETAINEDPCTG. {B4-F-I} S TOTAL PAID IC~-LI

4,800.00

DATE

FORM '93 1 MAR 78

pREVIOUS EDITION OF TI41S FORM IS OBSOLETE

.

..:{.U$~;R~.y.ER$I=.SIDE FOR DETAILED EXPLAN~ATION AND-DR REMAR~ ¯ .

Case 1:07-cv-00355-NBF

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Page 10 of 20

PAYMENT ESTIMATE - CONTRACT PER'FORMANCE
For use oI this form, ~e ER 37-2-1{] and ER'37-345-I0. ¯ coNTRACTOR AND ADDRESS

Lll Star Iron Works Inc. P0 Box 83 Mercedes, TX
. DEScRIP.TION OF WORK

'elcom Dam Admin. Bldg. Roof Repairs
LOCATION 9. PERIOD COVERED Bh; THIS ESTIMATE

'aic6n Heights, TX
ITEM

FROM i0-I-00 THRU 10-15-00
QUANTITY AND UNIT c CONTRACT UNIT PB IC.E d AMOUNT e QUANTITY AND UNI'~ f AMOUNT

4,800o00
27,900,00 4,800.00

4,800.'00
27,900.00 4,800.00

100%

4,800.00

CLUDES MODIFICATION THRU: 12. PRESENTED FOR PAYMENT ,YEE PER

TOTAL CONTRACT ~ $

37,500.00

TOTAL EARNIN, GS TO DATE ~-

4, 800 - 00

14"A. PREVIOUS DEDUCTIONS OTHER THAN RETAINED PERCENTAGE." ~ B. PREVIOUS RETAINED PERCENTAGE C. PREVIOUS PAYMENTS

TITLE

10/25/00

Presi
13. APPROVED FOR PAYMENT

D. PREVIbUS EARNINGS {A+B~-C) E.EARNINGS THIS PERIOD (TOTAL EARNINGS TO DATE MINUS D) F. LESS RETAINED PERCENTAGE G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR , H~.TOTAL DEDUCTIONS THIS PERIOD {F+G}

.ERTIFY that I have checked the quantities covered by this bill or estimate; that the ,rk was actually performed; that the quantities are co.'rect and consistent with all pre~us computations as actually checked; that the quantities and amounts are wholly lsi~tent wlth lhe r~'.lUJ[ements of the contract or other instrument involved.
TITLE DATE

0

3NATURE

I. RETAINAGE REFUNDED J. OTHER REFUNDS K.TOTAL REFUNDS THIS PERIOD L. AMOUNT.DUE CONTRACTOR (E-H+K) 5. RECAPITULATION: TOTAL RETAINED PCTG. (B+F-I] $ TOTAL PAID (C'tLI S

0 4,560.00

IN.TR,~CTING oFFICER APPROVAL {Signature)
FORM 1 MAR 78

DATE

7

93

FAEVIOUS EDITION OF THIS FORM IS OBSOLETE

¯ "(USE REVERSE sIDE FOR DETAILED E×PI~AN,~TIQN AND-OR RE~,~F~

Case 1:07-cv-00355-NBF

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Page 11 of 20

LOS Tomates Outbound Canopy Design
8. LOCATION

:., ,~
|

! CS~I~99--2~7~-0 ."
CONTRACT PRIDE d

iI" 7. REQUIRED COMPLETION DA'T ~ ' "TO. JOB ORDER NO.

'9. PERIOD COVERED BY

I

I l. ESI'IMATE NO

Brownsvil i e, .Texas
NO.
a

ouA~TrrY ~o .....
'UNIT ~=

UN~

' AMOUNT , e ...... .

TOTAL TO DATE QUANTITY AN'D
UNIT AMOUNT g

i

Design Work (Base Canopy)
(Refer to plans & specs.) Alternate Booth Design Roadway & Drainage. Design Alternate Misting System (Design. Payment & Performance Bonds Mobilization

~9,900.0C

100
100%

19,900.00~

lbO~
lOO% lOO%
100%

6,800..0C
.~1,800.0C
11,650.0C

~o~

6,800.00
1,800.00
1,650.00

7,240.0C

i00%. 100%

7,240,00

Rebar
Structural Steel

"9,650.0[
5,400.0[
78,800=0[
100%

85%
TOTAL EAFININGS ,T,O,,,DAT,~,,~ . _ ~ s

9,050.00
g~90.O0

63.,040.0~

.......... ...... THRU:

130,.640,Q.['
~OTALCONTRACT--------}~
$ RETAINED PERCENTAGE

114,070.00

PRESENTED FOR PAYMENT

0/25100

~,~ --

'
¯~ ~

/ /

, ....... . ........
O. PREVIOUS EARNINGS {A~B~CI E. EAFININGS T~I~";EBtOD 'TOTAL EARNINGS TO DATE MINUS D, F. L-=SS RETAINED PERCENTAGE G. LE~S DEDUC'~ION OT~a THAN ~ETAINED PERCENTAGE FOR Ho TOTAL DEDUCTIONS THIS P-=RII:3~

13. APPROVED FOR PAYMENT CERTIFY that I have checked -~Se quantities covered by this bill ot estimaP; that the

SIGNATURE

TITLE

DATE

I. FIr'TAINAGE FI=~FUNDED ' " ~'.ToTAL REFUNDS T~'IS PERIOO L, AMOUNT OU£ CONTRACTOR I"3. R~.CAPiTuL'ATION : ............

'.. 7/2 RET 'I E +-,, ......

TOTAl PAID (C*Li S

Case 1:07-cv-00355-NBF

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Page 12 of 20

LOCATION

9. PERIOD COVERED BY THIS ESTIMATE

. JOB ORDER NO,

11 ESTIMATE NO.

Fal6on

FROM .] n!1 6!nn THRU
¯ DUANTi'TY AND UN IT l:: CONTRACT " UNIT PR ICE d" TOTAL TO DATE AMOUNT

oU'kNTiTY AND UNIT f

AMOUNT g

Mobilization
Roof Repairs 2.1 Materials

100% 100% 100% .100%

4,800.00 16,140.00 11,760.00

,100%

4,800;00 12,912.00

2.2 Labor

~SO%

3

Demobilization.

4,800.00

TOTAL EARNINGS

JiNCLUDES MODIFICATION THRU: ' 12. PRESENTED FOR' PA'YMENT PAYEE
PER

TOTAL CONTRACT 14"A. PREVIOUS DEDUCTIONS OTHER THAN ' RETAINED PERCENTAGE"" B. PREVIOUS RETAINED PERCENTAGE
PREVIOUS PAYMENTS

TODATE :

~ ~

17,_712.00...

-

:::::::::::::::::::::::::::::::::

DATE

D. PREVIOUS EARNINGS

1~I/30/00

.................... President
APPROVED FOR PAYMENT

E. EARNINGS THIS PERIOD (TOTAL EARNINGS TO DATE MINUS DI

il ERTIFY that I I~ave che=:ked the quantities covered by =his bill or es:im~e- that th4 work Was actually peHormed; that the ~antltles are ~:r~£ and consistent wi~h all pre'vlous :om~utati~n~ ~ ~ually :hacked; Ihar Ihe quantities and amounts are wholly constant with ~he r~uff~ents of the :ont~c~ or o~her inst~ment involved.

G. RETAINED PERCENTAGE .OR L=.~s DEDUCT,ON OT.ER
H. TOT~,L DEDUCTIONS THIS PERIOD (F 1." REV;I~AG'~ ..... R£FUND£D J. OTHER REFUNDS K. TOTAL REFUNDS THIS PER lOO L. AMOUNT DUE CONTBACTOB RECAPITULATION: '

sIGNATURE

TITLE

.DATE

CONTACTING OF ICER APPROVAL

,TO:FAL RET_AIN.E_D__P~CT_G. (B~+F-') S~

TOTAL ,PAID {C÷LI S

ENG I FORM 93 MAR 7S

Case 1:07-cv-00355-NBF All"Star Iron W6#ks,

Document 24-3

Filed 07/30/2008

Page 13 of 20
" 7. REQUIRED COMPLEi'ION DAT : ">._': ....... ::~...-,:. .,: -. .... : -, : ..'. 2_'3:~. 10. JOB ORDER NO.'' "!', ESTIMATE NO. TOTAL TO DAT~

e. APPHOPRIATION AND PROJECT .--.." ~-~;

B & M Out,bound

Can~p.y Design ..:. ,-::---~
¯ :.'.~'..-~ ; ~, ..

~.. LbCA.TION-- '
- ITEM

~. e~'~iO~,.COVEREO"~ T.,S EST,MA'~E
FRO,. 9/,~0/,,00
QUANTITY AND UN IT CONTRACT UNiT PR i.C.~

CS-I-'99'- 24748- 8

Brownsv~l-le, Texas

THRU 1 I/.15/00
AMOUNT e

NO:

...... 6UA~TITY AND ..........
UNIT !

d

AMOUNT g

100%

2

DESIGN WORK(Traffic Study)

lOO%

9 ii,000.00 8,568.00

65%
100%

12,935.00.
8,568.00.

..... ,==-MOOIlf= ICATION THRU: 12. PRESENTED FOR PAYMENT" 'AYEE

TOTAL CONTRACT

S27,568.00

" TOTAIL EARNINGs TO DATE , ~,

$21.,503.00 _

1 i 980, .'00

,ATE

"~/30/00

. Presiden~
13. APPROVED FOR PAYMENT

O. PREVIOUS EARNINGS (A+EI~C) E. EARNINGS, THIS PERIOD |TOTAL EARNINGS TQ DATE MINUS D] F. LESS RETAINED PERCENTAGE G. LESS DEDUCTION OTHER T~"AN RETAINED PERCENTAGE FOR H. TOTAL DEDUCTIONS THIS ~ERIOD {F+Gi

::::::::::>:-:.';.'.'.'.::-.v.-.:::- ¯.....,-, ~ :::;;;-" ........

98o.,oo

!9,523.00

CERTIFY that ! have checked the quantities cove~ed by this bill or es¢imate; that the fork was actually Flerf°rme¢l; that the quantities are I;;o:re~t and ¢ons|stent wlth all preious corriputa~ion~ as actually c~eck~l; that the quantities and amounts are wholly ~nsi~tent with the ¢equirement~ o! Ihe contract or other instrument involved. TITLE

"

IGNATURE

DA %=

!. R-=TAINAGE REFUNDED .... K. TOTAL REFUNDS THIS PERIOD

~FICER APPROVAL {Signature}

DATE

L. AMOUNT DUE CONTRACTOR 15. RECAPITULATION: TOTAL RETAINED PCTG.'{B+F-I}" S TOTAL PAID (C+LI S

FoRM 93 ENG ~ .MAR 7s

Case 1:07-cv-00355-NBF

Document 24-3

Filed 07/30/2008

Page 14 of 20

'' ....

."

3. CONTRACT NO.

4. DISTRICT -¯ 7. REQUIRED COMPL~_T, ION DA'f

Mercedes, TX78570

TC-I-96-013
' 6. ~PPROPRIAT|ON AND i=ROJ~CT -

"C8-I.99.2474:q~0
PERIOD C0VERED"~' THIS ESTIMATE "

"" "" : . ".i ":.'.;'~:':.-', .":

10. JOB ORDER NO. ' 1 I, ESTIMATE NO. TOTAL TO DAT~ QUANTITy AND AMouNT UNIT

~SOM ~0i16/00 ..... THOU 1!/!5/00.
CO~RACT UNIT ¯c PRIqE d AMOUNT e

19,900-00

IO'ON .... I~", 900. O0 100% 100% o-~

2

(Refer to plans & specs.) Alternate Booth Design

100%

Roadway & Drainage .Design
Al~ernate Misting System (Design] Paymen.t & Performance Bonds

lO0% lOO%
100% 100%

6,BO0.O0 1,800.00 1,650.00
7,240.00

6,800.00

I.,800.00
1,650.00
7,240-00

100% rm
100% ~

Mobilization

9,0~0.00

~7 8 9 ~0

Refer Structural Steel .Mech~n~c~l-~V/AC (Booth Only)

I Inspection Booth
i,
PER

~oo% zoo% 1o0% ~oo%
TOTAL CONTRACT

5,400.00 78,800.00
3,602.00 12,607.00

B5~
~0,%

9,050.00
4,590.00

25% ¯ ~

~ ~

63,040.00
90Q.00 10,806.00

....... T6TAL EiRN IN~S

~CLUOES MOD~IFICATigN THRU:

$ 146,84.9-9~

TOO,,ATE,,,,- ~ ,,,,

~;s125,776.50~

14"A. PREVIOUS DEDUCTIONS OTHER THAN RETAINED PERCENTAGE""

REV'Ous PA ' NTS , ,,
ATE / D. PREVIO~S EARNINGS {A+B+CI

~.~'3o/oo .... os~aen~ ..
13. APPROVED FOR PAYMENT
~I I[

ll4,OTO.nn
E. EARNINGS THI$'PEBIOD |TOTi~ ¯ EARNINGS TO DATE MINUS D) F. LESS RETAINED PERCENTAGE RETAINED FERCENTAGE FOR H. TOTAL DEDUCTIONS THIS PERIOD (F+G|

CERTIFY =hat I have checked lhe quantities covere~ by this bill or estimate: that the o~k w~s ~:tually performed; that the quantities are ~o;re~t and consistent with ~11 ous ~mputallanS ~ ~:ually checked; that the qu~nti~ies and amounts are wholly ,mlsten~ ~th Ihe requlr~ents of the contract or other inR~ument DATE

S GNATURE

~rlTLE

L RETAINAGE REFUNDED ..... K:ToTAL REFUNDS I'HIS FER 16'0 15. RECAF~ULATION: TOTAL RETAINED PCTG. JR+F-I)

NTR/

Case 1:07-cv-00355-NBF

Document 24-3

Filed 07/30/2008

Page 15 of 20

-" - : ::-'- ~i--~.~:t~Z.~". :::-:. ¯ ..,.-.,°: ¯ ¯ .. ..... : " ¯ ¯ 6. APPROPRIATION AND PROJECT : " ,"~ ¯ , 7. REQUIRED COMPLE'~I6N'{ g. PERIOD COVERED BY THIS ESTIMATE FROM!O,/1 6/00

~R-T,-9~,,--25600-1 - :. "
JOB ORDER NO.

LOCA.TiON ITEM NO.

THRU 11/15/00
CONTRACT UN IT AMOUNT

h I.

ESTIMATE N(

DESCR IPTION b

~NYi ~Y

UNc,T

TOTAL TO DATE QUANTITY AND UNIT AMOUNT ~ g

1

DESIGN WORK (BASE CANOPY)

lOO%
I00~

!?~668-80

100~

17,668.8
6,400,0 "1,650.0 8,586.0

2 3 4

(REFER TO PLANS & SPECS,) ALTERNATE BOOTH DESIGN
ALTERNATE MISTING SYSTEM DESIGN woEK (traffic study)

6,400 /1#650.00 8,568.00

lOO%
100% 100%

TOTAL EARNINGS FICATION THRU: 12. PRESENTED FOR PAYMENT

TOTAL CONTRACT

~ S 34.,..286°80 TO DATE

~ S34,286.80

14"A- . PREVIOUS. DEDUCTIONS OTHER THAN RETAINED PERCENTAGE"" B, PREVIOUS RETAINED PERCENTAGE " C. PREVIOUS PAYMENTS

24,432.86 '432,86 853-94

)ATE

11/30_]/00

O. PREVIOI~$ EARNINGS {A+B÷C|. E. EARNINGS THIS PERIOD {TOTAL EARNINGS TO DATE MINUS D| F. L=.SS RETAINED PERCENTAGE G. LESS DEDUCTION OTHER THAN . RETAINED PERCENTAGE FOR H. TOTAL DEDUCTIONS THIS PERIOD (F+G)

IGNATURE

I. R.=TAINAGE REFUNDED J. OTHER REFUNDS " K. TOTAL REFUNDS THIS PER IOD APPROVAL {Signature} L. AMOUNT DUE CONTRACTOR IE-H+KI RECAPITULATION: TOTAL RETAINED PCTG. (B+F-I) S TOTAL PArD {C~LI S

Case 1:07-cv-00355-NBF
¯

Document 24-3
;

Filed 07/30/2008

Page 16 of 20 12/26/00
I

PAYMENT ESI'IMAtE -. CONTRAC] PERFORMANCE
For use o! this lotto, se~ ER :37-~.lO,and ER 37-345-10.

t
TC-1-96-013

{!: DA]'E

1

¯

!SHEET .. _o[ 1

Mercedes TX 785~0
~CAT;ON

"

1 3.'CONTRACT NO. " .
/'8. APPROPRI,~TION AND PROJECT 7. REQUIRED COMPLETION DARE

|, CS'I-98-25600-I
.... [9. PEI~IOD' COVERED ]ElY ~HIS ESTIMATE FROM ~1/16/00 THRU i2/15/00 DESCRIPTION b. QUANTI~Y AND UNIT CONTRAC+ UNIT PRiqE d

!~
IO. JOB ORDER NO;

.,o
IT.l,

I

ESTIMATE NO.

5

AMOUNT e

TOTAL TO DATE QUANTITY AND UNIT AMOUNT f. g

DESIGN WORK (BASE CANOPY)

(REFER TO PLANS & SPECS.) ALTERNATE BOOTH DESIGN
ALTERNATE MIS~ING SYSTEM (DESIGN DESIGN WORK (TRAFFIC STUDY

lOO%
100%

17,668-80 6,400.00

lOO%
lOO% 100% ~oo% 100% 100%

17~668.80

6,400.00

lOO%

PAYMENT & PERFORMANCE BONDS

10o% 100%

1,650.00 8,568.00 7,680.00

650 ¯ 00 b

MOBILIZATION

lOO%

9,500°00

6B¢.. oo

o5oo
,'

~
TOTALEARNING~

;LUDES MODIFICATION THRU: 12. PRESENTED FOR PAYMENT

TOTAL CONTRAC1~ ~

>

S52,006.80
-0286. BO '

r,,,,,,~ . ..~

14"A. PREVIOUS DEDUCTIONS OTHER THAN RETAINED PERCENTAGE"" B. PREVIous RETAINED PERCENTAGE C. PREVIOUS PAYMENTS¯

:::::::::::::::::::::::::::::::::::::::: ¯ -;'-::,;:-:-:-'. : : .:;'.':~',',v

12/26/00
13: APPROVED FOR PAYMENT
ERTIFY tha~ I have checked the quantities covered IW this bill or" estimate; that the rk w-as ectually perlormed: that the quantities are co.'trust and consistent wish all pre,u~ computations as ~tually check~d; that the qUanlilies and'amounls are wholly ~sistent with the requi~on=s of the c0n~ract o[ o~her in, tureen{ involved. TITLE I~ATE

D. PREVIOUS EARNINGS E. EARNINGS THIS PERIOD {TOTAL EARNINGS TO DATE MINUS F. LESS RETAI~ED PERCENTAGE G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR H. TOTAL DEDUCTIONS THIS PERIOD (.F +G} RRF, _ n~

34,286.80

. 17,720.00

886.00

3NATURE

I. RETAINAGE REFUNDED J. OTHER REFUNDS K.TOTAL REFUNDS THIS PERIOD L. AMOUNT DUE CONTRACTOR {E-H+K.} RECAPITULATI.ON : TOTAL RETAINED

~°00

)NTRACTING oFFICER APPROVAL {S~gna{Ur~}

Case 1:07-cv-00355-NBF
'"
i~, cO~NTRACTOR AND ADDRESS

Document 24-3

Filed 07/30/2008

Page 17 of 20
I~/26/00

PAYMENT ESTIMATE - CONTRACT PERFORMANCE
Fr~r use of Ihls form, see ER 37-2-10 ~nd ER 37-345-10, " " S.'CONTRACT NO.

I

~. DATE

1 1 SHEET __a[

~ AlL. Star Iron Works, Inc.-P.0. Box 83 Mercedes, TX TC-I~96-013 6. APPROPRIATION AND PROJECT s. DESCRIPTIO~ OF We~k'. .......... 0S-I-00-2398B-9 Falcon heights HOusing Repalrs&
9. PERIOD COVERED B~"THlS ESTIMATE .......

...... i 7. REQUIRED Co~'PL'~TiO{4 D~T E 10. JOB ORDEi~ NO. 11. ~IMAT'E NO';

FROMI0/I 6/00 THRU 12/15/00
ITEM

2
TOTAL ~O DATE ..... QUANTIT~ AND ' ........ UNIT AMOUNT g

NO.

DESCRIPTION b

'

CONTRAC'~ OOANTI~f'""~ND .... " UNIT UNIT PRIC.E c

AMOUNT

100%.

4,800.00
66,020-05

4~B00.00

2

Kitchen Cabinets
} int Repairs
Demobilization

>3

lOO% lOO% 100%

29,709.00.
~'"' .: 3. "?

2,2oo.oo

o
.......................~ ~,~ ~ ~ ~.[~~

.,o

-

4, BOO" O0

.

t'-3

;~ ~ ' '3"'~:/~.
~:~ ' t.~-.~ ~ "~-~,~';~ ~ ~, ~ ~: INCLUDES MODI =ICATION THRU: 12. PRESENTED FORpER PAYMENT 14rA" TOTAL EARNINGS ~ TOTAl. CONTRACT ~ S77 t 820 - 05 TO DATE °OTHER" THAN RETAINEDPREVIOUS DEDUCTIONSp~RCENTAGE

~s34,509. DO

Ti~L~ 7~/-. v -- /

D. PREVIOUS EARNINGS IA~'B÷C}

work w~ actually ; )erformed; that the ~an{ities ~re co. r~l and consistent wl{h'all provioUS c~mputat~ons as ~:lu~lly checked; that lhe qua~litJee and amounts are wholly :onsisten{ wlth the ~equi{ements ol the contract or other instrument involved. DATE

" F. LESS RSTAINED PERCENTAGE

sIGNATURE

TITLE

CONTiR.~CTING OFFICER APPROVAL (SignatureI

1:5. RECAPITULATION: TOTAL RETAINED PCT~:.

-'",,.,./4--"

Case 1:07-cv-00355-NBF

Document 24-3
" "

Filed 07/30/2008

Page 18 of 20
I
[4, DISTRICT i ~. REQUIRED COMPLETION bATh

PAYMENT ESIIMATE -- CONTRACT PERFORMANCE
For usa of th~s Iornl. see ER 37-2-1D and ER 37-345-10.

Iron Works, Inc~-P~O. BOx 83
5. DESCFIlPTION OF WO'~K ..... ;'' "

Mercedes, TX

¯ ~ C~NTRACT NO.

, II:DATE 12/27/00'

I

1

1

TC-I-96-013 CS-I-00-23554-9

B~' APPR0'I;'hlATION AND PROJECT

Falcom am Admin. Bldg. FaleDn eights, Texas

Roof Repairs

~ LdcAT'ON

9. PERIOD O~ERED BY THIS ESTIMATE

11./16/0.0 THRU 12/15/00
CONTRACT QUANTITY AND UN IT

OESGR IPTION b

.... bNiT
PRIC.E
AMOUNT

d

TOTAL TO DATE OU~N~ITY AND UNI~ AMOUNT ~f -g .:.

¯Mobilization of Repairs
2.1 Materials 2.2 Labor mobilization

100%

4,800.00
16,140.00 IL~760.00

I00~

4,800.00
O0 oo

10o%

90%

lOO%
100%

90%

~.;.800.00

INCLUDES MObil :_ICATION THRU: .......... 1,,.~. PRESENTED FOR PAYMENT ......14"AI PREVIOUS DEDucTioNS OTHER THAN ~AYEE PER B.'PREVIOUS RETAINED PERCENTAGE

TOTAL CONTRACT ~ S37" 500. O0

~29 ,"~I 0. O0

R TA,NED ERCENTAGE'"

~',:,-":O:.7-: ' "":"~>;':-:-3: ; Z ;

C, PREV:iOUS PAYMENTS

12~ Z7/00

President
~3. APPROVED FOR PAYMENT

¯ D. PREVIOUS EARNINGS (A+B~CI E.EARNINGS THiS PERIOD (TOTAL EARNINGS TO DATE MINUS D} F. LESS RETAINED PERCENTAGE G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR H. TOTAL DEDUCTION~J THIS'PERIOD (F+G!

17,712.00

12,198.00

I cERTIFY that ! I" ave check.=d the quantities covered by this bill or estim,ate; that the work was actually I: erlormed; that the quantities a~a {:~;rL, ct and consistent with all previous ~,omputatlona as actually checked; that the quantities and amounts are wholly conslsIent whh the requirements o# the contracl or ozher instrument involved. TITLE DATE

;IGNATURE

. I. ,RETA1NAG. E REFUNDED J. OTHER REFUNDS K. TOTAL RE~'UNDS THIS PERIOD " -- 0-:::::::::::::::::::::::::::::::::::::::::::::::::::::: .......... TOTAL P~ID {C-~LI -~ L. AMOUNT DUE CQNTRACTOR 15. R ~CAPh'ULA~IpN : ~ TOTAL RETAINED PCTG. (B .'-F-I}

CO~A CTi N~6--6 FI~ ICE R'"APPRO V A L {Signa,ure}

Case 1:07-cv-00355-NBF
2. coMTF~ACTOF1 AND ADDRESS ~N OF WORK

Document 24-3

Filed 07/30/2008
3. ~ONTRACT NO,

Page 19 of 20
DISTRICT REQUIRED COMPLETION DA 10. JO'B ORDER NO. [ 1 I. ES IIMAz~E NO. TOTAL TO DATE QUANTITY AND UN IT ANiOUNT [ g

For use o! ~,hi~ form. see ER 37-2.10 and ER 37-34S-I0.

ALL STAR IRON WORKS, INC. P.O. BOX 83 MERCEDES , TX 78570

TC-I-96-01 3
6. APPROPRIATION AND PROJECT

~ALCON D___~M AD,MIN.
8". LocATION

BLD~-. RoqF REPAIRS
_.

CS~I-00-23554-9
9. PERIOD COVERED BY THIS ESTIMATE FROM THRU01/15/01

. FALC,,ON~T_~m.q ..
ITEM NO.
a

m~A~

I~/16/00

CONTRACT DESCRIPTION b

QUANTIT~ AND
UNIT c

UNI~
PRIGE d AMOUNT

2

MOBILIZATION ROOF REPAIRS 2.1 MATERIALS 2.2 LABOR. DEMOBILIZATION

100% 100% 100%

4,800.00

lOO%

.4,800 .00,

lO0%

16,14000 11,760.00 4,800.00

100%
100%

16,140 .0o
11,760 .oo 4,800 .00

100%

IN.__CLUDES MODIFICATION THRU: 12. PRESENTED FOR PAYMENT =AYEE PER . .

TOTAL CONTRACT --'---'---)" S 37,500.0
14"A. PREVIOUS DEDUCTIONS OTHER THAN RETAINED P.ERCENTAGE" " S. PREVIOUS RETAINED PERCENTAGE "C/PREVIOUS PAYMENTS

TOTA:L EARN INGS TO DATE

> s37,500 .00

)ATE 01/24/01

~{TITLE//"

I"

.

D. PREVIOUS EARNINGS (A+B÷C} E. EARNINGS THIS PERIOD ,{TOTAL EARNINGS TO DATE MINUS D} F. LESS RETAINED PERCENTAGE G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR H. TOTAL DEDUCTIONS THIS PERIOD IF+G}

I PRESIDENT
13. APPROVED FOR PAYMENT t CERTIFY that I have checked the quantities covered by this bill or estimate; that [he. work was actually partormed; [hat the'quantities are ~o;rec[ and consistent v~kh al! previous computations as ~[ually checked; thin the quandde%and amoums ~re wholly consistent with ~he requirements ol the contract or o~her ms~fu~en6 mvoLved. ¯ .. .¯

29,300.10

SIGNATURE

TITLE

"~'"-'

DATE

I.r'RETAINAGE REFUNDED J. OTNER REFUNDS K. TOTAL REFUNDS THIS PERIOD

CONTFIACTING OFFICER APPROVAL {Signature)

DATE

'1 L. AMOUNT DUE CONTRACTOR 15. RECAPITULATION: TOTAL RETAINED PCTG.'(B÷F-I} S

FOR~J ENG ~ MAR 78 ~3

PRE,VIOUS ED T ON OF: THIS FORM IS OBSOLETE

¯ "{USE REVERSE SIDE FOR DET~,ILED EXPL.~,N~'TION AND-OR REMA~:

Case 1:07-cv-00355-NBF

Document 24-3

Filed 07/30/2008
3. CONTRACT NO. -

Page 20 of 20
01/24/01 . tSHEET ~..L_o, ~ 4. a~SiRiCT

For use o! this IotaL ~ea ER 37-2-10 and ER 3"/.345-10.

2. CONTm~CTO~ A~D ADDRESS ALL STAR IRON WORKS, .]'NO.

P.O. BOX 83

MERCEDES, TX78570

~C-I-96-013
6. APPROPRIATION AND PROJECT

5. OESCR'~PT~O-~-OF WOR~< ..............

, 7. REQUIRED COMPLETION' Oi',,

FALCON ~_TGHT~. HOU.S_TNG REPAIRS
#~ LOCATION

CS'I-00'23988-9
9. PERI'0D ~OVER~D ~Y THIS ESTIIVlATE ....... ' 10."'JO8 ORDER NO. ! l |.' ES'rlMA]~E' NO.

FALCON HEI.GHTS, TEXAS .......
ITEM NO. DESCRIPTION b

3 ~ROMI 2/,I 6/0 0 ....... T~,'~,, 01 / 15/01
QUANTITY AND UNIT CONTRACT UNIT PRICE d AMOUNT TOTAL TO DATE QUANTITY AND ;UNIT AMOUNT

a

1 2 3 4

i MOBILIZAT.ION IKITCHEN CABINETS PAINT REPAIRS DEMOBILIZATION

10o%
100%

~o0%

.100%

4~800~;00 66,020.05 2,200.00 4,800.00

100%
55%

4,800.00
36,311 -00
500.00

TOTAL EARNINGS INCLUDES MODIF:ICATION THRU: 12. PRESENTEC)FOR PAYMENT PER ~AYEE TOTAL CONTRACT ~ $ "7 ?, 8

20¯05

TO DA~E ..... .

>- s

41,611.00

i 14"A. PREVIOUS DEDUCTIONS OTHER THAN RETAINED PERCENTAGE" B. PREVIOUS RETAINED PERCENTAGE

:., .v.-.v,..-.........r.:-'-v.',"

c. PREV,OUS PAYMEN'~ .......
01/24/01
............

PW ~..q TDENT
13. APPROVED FOR PAYMENT

,,

D. PREVIOUS EARNINGS {A+B÷C) E. EARNINGS THIS PERIOD (TOTAL EARNINGS TO DATE MINUS D} LESS RE[AINED PERCENTAGE G. LESS DEDUCTION OTHER THAN RETAINED PERCENTAGE FOR H. TOTAL DEDUCTIONS THIS PERIOD - ,.-.~.-,~,,,.......-...-.-...-..,.,-,~

CERTIFY tl~a~ I have checked the quantities covered by this bill or estimate; lhat Work was actually t~erforrned; that ~he quanti~ies are ¢o.'rect and consistent whh all p~avious computatlon~ as actually checked; that lhe quantities and amounts are wholly consistenl wi~h Iha requite.ments of the contract or other instrument involved.

¯ ,'.'.-. ......."-',v,',,.'.~.-..'-:.'.'-'.'.v

7, I 01 . 5

SIGNATURE

TITLE

DATE

I. RETAINAGE REFUNDED J. OTHER REFUNDS K. TOTAL REFUNDS THIS PERIOD L. AMOUNT DUE coNTRAcTOR

CON,2-;~ACTI NG: O--~ F I~ 1/ ISigna][ura}

DATE TOTAL RETAINEDPCTG. IB~-F-I) S TOTA~LPAID IC÷L}S

FORM MAR 78

PREVIOUS EDITION OF TIllS FORM IS.OBSOLETE

"'[USE REVERSE SIDE FOR DETAILED EXPL-~NATION