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PAY ESTIMATE NO. I
TO ,ci janct.c) I ec.indI1 leers CDBG NO.
(Contractor) J
EXPENSE CODE
ADDRESS ¶ O 3 Ricker SF
DATE OF BILL II'61'0(9
a r-I 0 (A- • S u b o,3
INVOICE NO. I lP S I
OWNER C'
ADDRESS 1 i S i� k�rl Ave_
CONTRACT DATE (9— -0 U
SUMMARY OF PAY ESTIMATE
ORIGINAL CONTRACT SUM $ It SOU
CHANGE ORDER NUMBERS $ II( c..
TOTAL CONSTRUCTION COST $ l 49,0O.
LESS AMOUNT PREVIOUSLY PAID $ Ob OCR
BALANCE STILL IN CONTRACT $ 1+ A( Q .
PAYMENT REQUESTED $ I , g0C) • —
LESS 10% RETAINED $ 0- 00
TOTAL DUE CONTRACTOR THIS ESTIMATE
I have made a progress inspection of the property being rehabilitated at the above address.
The construction work for which payment has been requested has been satisfactorily
completed in accordance with the construction contract.
DATE REHABILITATION SPECIALIST
APPROVED F PAYMENT I�" 1
DAT COMMUNITY DEVELOPMENT DIRECTOR
OR DESIGNEE