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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />PROJECT CONTRUCTION CHECKLIST <br />Project No. <br />117-031 R <br />NTP <br />3/26/2019 <br />Project Name <br />Water Works North Pumping Station Well Replacement <br />Sub. Comp. <br />11/21/2019 <br />Contractor <br />Peerless Midwest, Inc. <br />Final Comp. <br />12/21/2019 <br />Inspector <br />JJE <br />Today's Date <br />11/7/2019 <br />PAY APPLICATIONS & CHANGE ORDERS CHART <br />Pay App <br />C-(-wkw� — EVA <br />bi l 000 00 <br />$200,000 00 <br />/2019� 7/1/2019 <br />9/1 /2019 11 /1 /2019 <br />PAYMENT APPLICATION <br />SUMMARY <br />End Date <br />Total <br />Deductions <br />Sub Total <br />Prev. Pmts <br />Amount <br />Prev Pmt Error <br />1 <br />7/12/19 <br />$117.207.86 <br />$5,860.39 <br />$111,347.47 <br />$0.00 <br />$111,347.47 <br />- <br />2 <br />9/11/19 <br />$250,551.07 <br />$12,527.55 <br />$238,023.52 <br />$111,347.47 <br />$126,676.05 <br />3 <br />10/21/19 <br />$516 932.57 <br />$25,846.63 <br />$491,085.94 <br />$238,023.52 <br />$253,062.43 <br />4 <br />5 <br />6 <br />7' <br />8 <br />9 <br />10 <br />11 <br />12 <br />S <br />- <br />- <br />- <br />- <br />$238 023.52 <br />$491I085.95 <br />CHANGE <br />ORDER SUMMARY <br />Date Pry. Contract Change Amt. <br />New Contract Chan a %o Total % Added Days <br />1 6/18/2019 $532,763.00 $9,462.72 <br />$542,225.72 1.78% 1.78% 0 <br />2 <br />8/28/19 <br />$542,225.72 <br />$1,345.00 <br />$543,570.72 <br />0.25% <br />2.03% <br />0 <br />3 <br />11/7/19 <br />$543,570.72 <br />$3,988.00 <br />$547,558.72 <br />0.73% <br />2.78% <br />0 <br />4 <br />5 <br />S <br />- <br />-1 <br />$14,795.7, <br />- <br />- <br />2.78% <br />12/21/2019 <br />POST -CONSTRUCTION DOCUMENT CHECKLIST <br />Items Notes Date Rec'D <br />1 <br />Final Pay Application <br />2 <br />Project Completion Affidavit <br />3 <br />Final Waiver of Lien <br />4 <br />5 <br />6 <br />Final Change Order <br />Complet e Certified Payrolls <br />As -Built Documents <br />7 <br />Testing Reports <br />8 <br />Warranty Information <br />.m_ Signature: Date: t (31 I—q I <br />