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To(OWNER): City of Waterloo Project: CITY OF WATERLOO/RATH Application No: 1
715 Mulberry Street Invoice No: 09-10009
Waterloo,IA 5073 Period To: 1/31/2009
From: DW Zinser Company,Inc. Via(Architect):
1775 Commercial Drive Architect's
PO Box 398 Project No: 08-427
Walford,IA 52351 Invoice Date: 2/2/2009
Contract Date:
1. ORIGINAL CONTRACT SUM $ 120,000.00
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS 2. Net change by Change Orders $ 0.00
3. CONTRACT SUM TO DATE(Line 1 +/-2) $ 120,000.00
Approved previous months 0.00 0.00 4. TOTAL COMPLETED&STORED TO DATE $ 48,750.00
Approved this month 0.00 0.00 5. RETAINAGE $ 2,437.50
6. TOTAL EARNED LESS RETAINAGE $ 46,312.50
TOTALS 0.00 0.00 (Line 4 less Line 5)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 0.00
Net change by change orders 0.00 (Line 6 from prior Certificate)
8. SALES TAX $ 0.00
9. CURRENT PAYMENT DUE $ 46,312.50
10. BALANCE TO FINISH,PLUS RETAINAGE $ 73,687.50
(Line 3 less Line 6)
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE TO RETAINAGE
NO. VALUE PRESENTLY COMPLETED G/ FINISH(C-G)
FROM PREV. STORED AND STORED C
APPLICATION THIS PERIOD (Not in D or TO DATE
(D+E) E) (D+E+F)
1 93 Vinton Street 9,500.00 0.00 4,750.00 0.00 4,750.00 50 4,750.00 237.50
2 97 Vinton Street 110,000.00 0.00 44,000.00 0.00 44,000.00 40 66,000.00 2,200.00
3 Salvage Brick Ornaments 500.00 0.00 0.00 0.00 0.00 0 500.00 0.00
Totals 120,000.00 0.00 48,750.00 0.00 48,750.00 41 71,250.00 2,437.50
1