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Home My WebLink AboutTerry Payment Applications & Certified Payroll Dvirka and Bartilucci CONSULTING ENGINEERS 330 Crossways Park Drive,Woodbury, New York, 11797-2015 516-364-9890 • 718-460-3634 Fax: 516-364-9045 e-mail: db-eng@worldnet.att.net August 7, 2003 Principals Nicholas J.Bartilucci,P.E. Jaynes Bunchuck Hent.Chlupsa,P.E. Town of Southold U E Executive Vice President ' Thomas F.Maher,P.E. Town Hall � wce Pm decd 53095 Main Road �' !' Robert T.Bums,P.E. Vice President P.O. Box 1179 Richard 1' Southold,NY 11971 TOWN OF SOUTHOLD Steven d nn,P.E. DEPT. OF SOLID WASTE Theodore S.Pytlar,Jr. Re: Southold Landfill Closure Vi-P°�°"t D&B 1314 Senior Associates Anthony o.Conetta,P.E. Dear Mr. Bunchuck: Dennis F.Koehler,P.E. Joseph H.Marturano Please find enclosed from Bob Terry, Payment Application No. 13 and a request John A.Mirando,P.E. th J.Pritchard,P.E. for additional monies over and above that contained in the payment application. I Kenneth Brian th v.,ht P.E. have reviewed the payment application and it is correct for the items for which M. payment is being requested. This payment application, in my opinion, could be "date' considered the final application. Joseph F.Baader Garrett M.Byrnes,P.E. The total project amount in the payment application is $5,343,752, which is Rudolph F.CannaRE. Joseph A.Fi annao,P.E. $127,385 (2.4%) over the contract amount of$5,216,367. Thomas P.Fox,RG Gerald Gould,C.P.G In addition to the amount in the payment application, it is my understanding that William D.Merklin,P.E. the installation of the replacement water supply well in the amount of $29,655 Michael Neuberger,P.E. will be paid with landfill closure bond monies for a total landfill closure Edward J.Reilly construction cost of$5,373,407. Charles J.Wachsmuth,P.E. Kenneth P.Wenz,Jr.,C.P.G Bob Terry's request for additional monies is the following: 1. Fence Repair $3,000 2. Extra Topsoil — 5,000 3. Extra Truck Hire 5,400 4. Trommel Hire 5,000 5. Insurance Extension 9,575 6. Delay Claim 52,544 7. Sand Pit Regrading 200,601 8. RCA on Cox Lane Temporary Road 5,110 A DIVISION OF WILLIAM F.COSULICH ASSOCIATES,P.C. Dvirka and Bartilucci CONSULTING ENGINEERS James Bunchuck Page Two Town of Southold August 7, 2003 Additional items which can be considered by the Town to enhance completion of the project should bond monies remain are the following: 1. Final Paving $23,000 2. Completion of Fencing Along McBride Property 6,000 3. Construction of Sound Barrier 60,000 4. Construction of New Road to Cox Lane 40,000 5. Signs and Painting of Lines on Asphalt Roads ? 6. Completion of Fencing Along Eastern Boundary 35,000 If you have any questions or require additional information, or would like to meet to discuss this letter, please do not hesitate to call me,please call me. Very truly you -� � ---- Thomas F. Maher, P.E. Vice President TFM/tam Enclosure 01314\TFM03(A)LTR-16.doc(R05) TERRY CONTRACTING & MATERIALS, INC. M WESI't+ AIN SIMW RIVERHEAD,MY 11901 (631)727-0170 August 7,2003 Thomas F.Maher, P.E. Dvirka and Bartilucci 330 Crossways Park Drive Woodbury,NY 11797-2015 RE: Southold Landfill Closure D&B 1314 Dear Mr.Maher: Enclosed please;find Payment Application Number 13. Please review the attached remaining balances due should the town choose to settle all claims at this time. We reserve our right to revise these amounts higher to reflect actual costs if necessary.I have included a brief description of our position on each of these items and I am willing to discuss anything in the spirit of settling claims. On the issue of Substantial Completion,we stand by our July 2,2003,request,as we still do not know if we will be asked to do more work. It may be that we have reached final completion if the town does not have any more money to spend. Thank you. Very truly yours. President Attachments ROTrm APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: TOWN OF SOUTHOLD Fwwr. APPLICATION: 13 Distribution to: 53095 Main Reed Southold Landfill Closure ( ]OWNER Southod.W 11971 PERIOD TO: 07/24/03 [ )ARCHITECT I I CONTRACTOR FROM:(OONFRACTOR)c YfA(ENGINEERS)r Tony Contracting&Materials,I nee Dwift&sartllucci PROJECT N0 2000 SW West Main Street 330 Crowmes Park Drive RWwhesd,NY 11901 Woodbury,Nan York 11797.2015 CONTRACT DATE: 01/31/01 0014 ACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Applicllion Is made for Payf at as shown b*w.in oonlne to withvw cm*w. Conlinuadon Shed,AIA Document G703,is dtaciiad. CHANGE ORDEti SUM MARY Changs Orders approved in ADDITIONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,21$,366.50 previous months by Owner Changs Orders 1 to 12 2. Net change by Change Orders $ 127,366.78 TOTAL $317,929.00 10.00 3. CONTRACT SUM TO DATE(Line 1 +2) $ 5,343,752.28 roved this Month 4. TOTAL COMPLETED&STORED TO DATE $5,343,752.28 tar Date Approved (Column G an G703) 19 6/1/03 5. RETAINAGE: a:,_5 hof Completed Work 5287,187.61 (Col umn D+E on G703) 190,543.22 b;.—% of Stored Material $ - Net Champ by ChanLe Orders 5127,385.78 $0.00 (Cal umn F on G703) The undersipmed Contra W c so ffis a*W to the bad ar ha C=kacWft knowledps, Total Retainage(Line 561+5b or Yrtamsaiionand beW t%e Wwk oaw%d byft Appiea m for Psyn int hu bam Total in Column I of G703 X7,187.61 oomplard In aooardw os wtlh the Contract Downwrds,that all arnourib haus been 6. TOTAL EARNED LESS RETAINAGE $5,076,564.67 paid by 1hs Contractor for Week 1br which prwlous Csrd4catw of Paymentwsn (Line 4 less Line 5 Total) hawd and payttwo nedved ham ft Owner,vA thet cum*pwflnwd show 7. LESS PREVIOUS CERTIFICATES FOR berain Is now due. PAYMENT(Line 6 from prior Certificate) $ 4,807,031.81 8. CURRENT PAYMENT DUE 3289,532.88 CONTRACTOR: 9. BALANCE TO FINISH,PLUS RETAINAGE $ 267,187.611 Line 3 less Line 6 Stated: EW V041c County cf: f30L Subscribed and shown to before h d�i; 7 day of -40C OST .200Z r Date: Notary Public; j91-k •- GC �'K.c. 104 Commissionex iris;3-/o?-61007 GINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ ardente with the Contract Documents,based on on-alta oboavations and the (Attach explanation If amount certi led differs from the amount applied for.) 11(Coompr'tsing the above spplieadon,to Engineer catlfies to Do owner that to the ENGINEER: best of the Enginsees laWadye,information and belief the Work hes progressed as bsdkatad,the quality of the Work is it aaeoMano,with On Contrail Downwrrb,,and BY: Data: the Contractor is entitled to pery ent of the AMOUNT CERTIFIED. CURRENT This;Csrlifltate Is notn&WAable. The AMOUNT CERTtFED is payable only tithe Contractor named hweii,laaance,pays wn!and ameptartaa of paymart wo wiii- out projudlos So arty rW tc of the Owner ac Contractor under this Contract NOTAAY PUBLIC STATEEOOFF VE Y*RK Na.01MCE0 ww carwad In Sia*Cointy '".Salm Fw0kQs(f3.0.20e,7 CONTINUATION SHEET AIA DOCUMENT 127011 PMW2WIt PAGE'S AIA Docesment 4702,APPLICATION AND CERTIFICATE FOR PAYMENT,contetnilg APPLICATION NUMBER: 13 Contractors signed Certification is attached. APPLICATION DATE: 07/24/03 In tabulations below,amounts an stated to the nearest dollar. PERIOD T0: 07/24/03 Use Column 1 an Contracts widen variable m Wnap for line Items may apply. ARCHITECT'S PROJECT NO: 20M A B C D E r G H I mai DESCRrrm Or WORK SG11ED1A1EE11 1rORIC COMPLETED MAT MLS TOTAL afi BALANCE RETAINAGE NO. YAWE FROM PREVMSTN6 PERIOD PRESENTLY COMPLU D (S q TO FINISH APPLICATION STORED AND STORED (C-W 0)i E) (NOTIN TO DATE oonq 0)+E+ 7 1 Moblwe6on 8 204ow.00 $21)s.0o1).0D 30.05 s0.W x".000.00 IOD% S s10,40D.0o 2 Mobil.,Uai t.OernoWiza im $ 10LOW-00 871.400.OD $30.800.00 $0.00 5102,00D.00 10D% S 55,10D.W 3 Olea ft and cnamno 5 100100 314640100 $3,61)1).5 SOM $18.00a0D 100% 5 5900.00 4 UAckseffied Excay.i4 Relandllll(per F01)-Smm S 421,42500 5421,425.00 $D.OD $0.00 5421,425.00 105% $ $21,071.25 5A Ranted&Ralorw0linTd 9urbdwrb&Fill 1 Surwy $ 13,627.60 $13.627.61) 50.00 $0.00 $13,671.65 100% 3 5681.38 58 Emewbon of Gas UbrAlun Ow"Trenches S 15,57CLM $15.57400 $1013 $0.00 $$5.576.w 100% S 5778.80 5C Remover&ReliandUra of buried Waste&Fie 2 S 9,001).00 59,00100 mm $0.00 $9,0010D 100% 3 - $491).00 50 Wade Excavation Area 2-C.O.4 $ 484395.0 348,996,00 $0.00 $0.00 $46,396.00 100% S $2.419.75 5E Wasile Excwmdon Are@ 3-0.0.4 $ 49,726.55 348,72OL55 3100 30.00 349,72655 100% S - $2.486.33 5F EXmAntlon Arse 4 S 2.676.10 1=11,10 3040 $0.00 52,67$.10 100% 3 - 3133.91 5G Waste Ewwwtion Ars@ 5 S M78 394.'#78 $0.00 WAG 5943.76 100% S - $47.19 6 Grsdirp Maft"Gerwal FII(ram Onsite Souroes $ 332,307.00 5332,307.01) $100 SD.00 $332,301.00 100% 3 - $16,615.35 7 Geotermle Type 1 S - 40-00 $0.00 50.00 $0.00 0% 3 - 30.00 8 Gas verrtin0 lay@rkm on Ike $ 171,901).00 8171,900.00 $0.00 $0.00 $171,900.00 100% S - S8,59500 9 W Mll textured HOPE Geamwnbrane $ 867,009.16 5867.009.16 $0.00 '0.00 $987.009.16 100% S - $44,3500.46 10 Lend811 Gas Vents $ 58.D1 5.00 568.01400 $0.00 $0.00 $56,018.00 1OD% S 52,90180 11 Geocompoeb $ 288,044.40 $288.044.40 $0.00 50.00 $288,044.40 100% $ 514,402.22 12 Barrlar Proledlon L.ayar hon One to Souoss S 300,615.00 3301),815.00 $0.00 $100 S300,615.OD 100% S 315,031)75 13A Vepdetive Growth Med UslW On"Ain Comp(F01) $ 200,674.00 $=074.OD (328,420.00) $0.00 $20.1,074.01) 100% $ 310,003.70 138 C: 'npeeeyTopsoiOff &WperF01) $ $100 $0.00 $100 30.000% $ $0.00 14 Erasion Control DWket S 360,868.69 53812868.89 ($16,339.11) $O.OD 5360,666.89 100% S $18,043.44 15 Erasion Control Fabric $ SOAM 00 560.000.00 $63D.00 $100 580.631OD foci% $ - $3,031.50 16 HydroseadirO S 69,264.40 869,264.40 (52,584.60) $10D 389,26440 100% S - $3,463.22 17 LINW93apke S 45,291.00 525,992.00 $19,299.00 $100 545,291.01) 100% S - $2,264.55 18 Rip Rap Stone FII,Gravel&Reno Mattress S 268,907.1) 5206,907.00 $000 $0.00 5266,907.00 100% $ - $13,345.35 19A &Foot H Wh Fetlolnp S 87,85550 $66.012.50 52.MW $0.00 $67.695.50 100% S - $3,392.78 198 12-Foot Nigh Fenanp S 11,62290 $f 1,622.90 8001) $0.00 $11,622.90 IW% $ - $561.15 190 Galtse S 1/,976.00 SO.00 $11,97400 $0.00 $11,976.00 100% $ 3588 85 20 Maintanance Road 6'Deep RCA S 1361)61)1) 513,608.00 (S4W.0D) $0.00 513,806.00 100% 3 UK 40 21 Maintenance Road 12'Deep RCA 3 61,915.00 $49,008.75 $12,906.25 50.00 561.915.00 100% Is 83095 T5 5 4097,276.28 $4,015,422.03 $34.102.54 50.00 $4,097,276.28 3 - 3204,863.81 IIA Document G70Z,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 23 Pacts a d 4 Contractor's sligfed Cartilication Is sUadmul. APPLICATION DATE 07/24/03 In tabulations below,annaunts are stated to the nearest dollar. PERIOD TO: 07/24/03 Use Column 1 on Contracts where variabis retainer for line items may apply. ARCHITECT'S PROJECT NO: 2000 A • C • E r 4 N 1 tTEJ11 DfsdNPlfOM Cr aro•tx tCItDLILED WON COE1P1>E7m RIAIRM S WFAL 11110. VALUE FRCP r11EVNM 1NIs PE HOD PRE•ENTLy CMFLEM x' mism4:E R[TAMIAGE {0 4 TDr1•ICH APPLICATION t7r0M ANDST0 (C-4) +q 0110 NI 10DAl1E DO• 4•Et 22 MainMcaysftoad $x=511.75 5202,227.75 %214.OD '0.00 SM.511.75 100% 3 - St0,925'SD 23 Gide RSH 374000.00 $13.850.x16 581.350.0 9400 578x000.00 100% 1 - 59,900.00 24A Abandon t3dskiro LmM Gas hl0nitortnp Wens 32.106.00 12,100.06 $000 9400 $2,100.90 t00% 3 - 5195.06 246 Nunn Lard Gu Mocitnift Wds 542.'360.06 S8,0M5.60 S34,934.4D 9400 342,Sum t00% 1 - SZ12LOO 25A Abandon B68MV Qoundomter Umtata Welk 522.64400 S?2,840.00 $0:00 10.00 822.64000 100% 1 - 11.132.00 2513 New GroumkVieriva Monitoring Walk VA200.00 10.00 125.200.06 Mm 825,20D.00 100% S - $1,280.00 25 Drain Pips IrVxk"Structures,Shctina Brains MH SK!128.00 8.5.528.00 10.6 $MOD 888,526.00 100% 9 3%27&40 fxal"Under dalvaAnchor Troeehee SK000.00 SBg000.00 $0.00 =m 38 .CM00 190% $ 33,000.00 IRPS .ter Suppy`Wd and Electrical Services 14.900.00 54,000.00 $0.00 MOD 54,000.00 im% $ 3200.00 29 Sken&Electrical&Telephone SWc* S02,000.00 Mom= $9.200.00 S0.(1) 592,000.00 100% $ 54,600.00 3D Send fkftp $0.00 10.00 $0.00 $0.00 3000 0% S $0.00 31 32 Ted Plmrro 110,600.00 410.800.W $0.00 $0.01) 910,80000 106% S 33 WMs inport 354.385.00 184.985.00 $0.00 Saw 564.385.00 10D% S - $3.219.25 34 Sawnft 17-un Malwilf3bra%r Qw Tmuta a 140,000.0 S11m 119000.00 $0.00 so.mo.00 100% $ - $2,000.00 35 Sovadloa of Grseopat Pond Material $11m $D.W $0.00 $0.00 SO.OD 0% S - 59.00 36 Sowthenatern Drairiep Dhwalon Syeten 3216.354.00 3214351.00 5000 $0.00 1218.354.00 107% S - S10,917.70 37 Handing of C8 D Nelarieis-C:AT 321 337300 8975.00 30.00 50.00 5371g.00 100% $ - $1 B.75 38 Conso4datim of rneareened compost in SP-CAT 322 S2,15QU0 321156.00 $0.00 $0.00 $2.156.00 100% S - 1t07.80 36 0macid2fica of wwreened mopost In BP-CAT 980 $2.985.63 $2.98183 30.00 $0.00 12.985.63 100% S - $14&28 40 Consdidedon of macreened compost in BP-CAT 07 $2.9MOD S2,Q&m 30.00 50.00 $?.925.00 100% S - S141.25 41 GmAirg of Essbem HIM-CAT D7 $11,02200 511,025.00 1400 $0.00 S1i,02Sx00 100% 3 - $65125 42 Saperals Loom taProduction orVGU-Cut D6 S4W.m 940400 8400 $0.00 3400.00 t00% 3 520;m 43 Separate LoomforproductionofVGM-Cat 322 385825 1888.25 MIX) $0.00 5856.25 100% 3 33261 44 Screerft of Unsaeened Compost-Tmar aW 725 $15,675.00 $15.675.00 moo $0.00 $156473,00 100% 1 5783.75 45 emVoraryAsphalt Apron 32,835.00 32,835.00 $000 Sam 92 mem 100% S $141.75 r49 Surdwgs for Bsdr Vinyt Faming; 39.005.00 83.995.00 90.0D 5400 53,995.00 100% S $199.75 Teadnp of17-acre Sand for Gas Venting&BPL $12,970.00 $12,670.00 $0.00 10.00 312,970.00 19D% S 3848.50 48 Enlaryernent.&Censtrucdoa Charas Recharge Basin 3 $84,687.14 364.687.14 $D.m $am 864,®67.14 100% $ - $3.233.36 Segmerrtad tnrtalla8oa of Geornembrarr for 1T-acre Road 148,479.80 S31,761.69 $16.718.11 9D m 348,479.80 100% S - S2,423.99 50 Additional Surveying 558,943.90 08.90.90 50.00 50.90 956,243.90 100% $ - $2,947.20 51 Gas Mipralm Control Trench EAsneion Scafalbuaa Area $8,698.00 $8;868.00 $0.00 $D.m 58,898.00 1009$ $ - $434.90 52 Liner Irmtallstion Around Eastern Drainage System C.B.1 $1,300.78 St•9DO.TB $0.00 $000 $1,300.78 10D% $ - $65.04 53 Final Greft of Rsol%@ gp 8 to 2 $4,800.OD $46800.00 (Sb00.00) $0.00 $4.800.110 100% S - $240.00 54 Transition AmGradin9 $8,800.0 $8,000.00 3800.00 50.00 $6,800.00 t00% S 5440.00 55 Rebeatlon ox Makdau m Road Alarg IMIcBrids Property $7.2000D $7,20400 ($800.00) $0.00 57.20400 100% 5 $380.00 Extra Gas Migration Co*d Trench Ve ft&Turbines $D.m $0.00 $0.00 MIX) 1400 0% 3 30.00 56 Elimionfion of Waterproo8rrp Manholes along SAI drainage Syntax (32.100.00) $0.00 (52,100.00) $0.00 132,10400) 0% 1 ($105.M 37 ftni rtoa of Trudy Stand (5706.00) 3000 (570400) $0.00 (3700.00) 0% 8 58 d C udon uriex for eroNon Contra$Blaniett (38.221.50) 30.00 (58.221.50) 30.00 (18,22t.SOq 0% S - %35L� (3311.08) 50 Baetn and Pipe by 3csis SBn894 00 80.00 98,85400 $0.00 88,660.00 100% S - $342.50 9 - Sam s 36.00 $1.16677473 39a5i868.74 5191,91801 $400 31,188,774.75 S - 350,438.74 w _ N Z4 - o � � y ev = N rr, o � m ZL a �+ mw :. -. jlSa et ig Ul � � sssg $ s ggggg � sssBSgsgggs � s8s $ gggsg =i A `c3 � � � �38LlSi� lS (9I9 � �48 �3iis" mo U 88888888 $ 888888888gS � 88s888 ; g s 8ggg $ gg $ 88ggggggggs $ � 8ggggg u sssssgssassssssssssswssssg $ � � �� qoqq aeQQgqGGgqpp QQ $$ Q �j K K K i�R �R % ' Q� �ip� �3 N r/ M N K N N N N N M M www V ob (q q y M y �p q qyy N N_ m O v � d GGO O O p C G¢ fps CP 6 O C 0 0 0 ,C bO p�p m� p j lq� p�� U Southold Landfill Closure Construction Costs not included in Payment Application 13 I. Fence airs in south east comer Approximately: $3,000.00 2. Topsoil Screened in sandpit but not used because scope was reduced by town due to budgeting concerns. Based on survey$5/cy Approximately: $5,000.00 3. Extra Truck hire for the limited time when we were hauling on the same road as the public through the landfill to the 17-acre site. We have only asked for three(3) days. This issue was addressed in a letter to you on 10-24-02 and a copy is enclosed for your review. We reserve the right to increase this number substantially, Total $5,400.00 4. iommel hire: The town under the contract was to provide screeDw compost and sand to produce the Vegetative Growth Medium(topsoil). When the town ran out of compost,we suggested using wood chips and fill;from the borrow pit instead. We already had planned to use a screening plant to blend the materials.The amount claimed covers a two-month period that we used the woodchip material to make topsoil. I have enclosed a quote from Powerscreen to rent an 830 Trommel for$12, 000.00 per month.. They do not stock this machine because it is too large to have much demand for it. The 830 Trommel is the largest tromrnel manufactured. I feel our claim for$5,000.00 is very reasonable as it allowed the project to move ahead without purchasing compost, Total $5,000.00 5. Insurance Extension. this charge reflects our cost to extend coverage on the project due to delays beyond our control. Some of this time includes the 125 days added in Change Order I because of LIPA'S delay in removing their power lines through the site. Total $9,575.00 6. DOgy Claim: this charge is only for delays beyond our control not for all the time beyond the original completion date.All this charge is for delays in 2002. We have only asked for utility, trailer and our construction superintendent costs to be recovered without a markup. We have not requested any,Home Office overhead or equipment/labor related charges which normally would be part of any delay claim. We recognize sorne ineffiencies and delays were our own. We reserve our right to amend this amount. Total $52,544.35 7. Sand Pit Regrading: Contract Survey indicates 66,867 CY @$3/cy Total $200,601.00 8. RCA on Coag Lane EntranceTem2gM Road and Pad: RCA left in Place 13,800 sq ft at V deep to be billed at$10/CY materials only. 511 CY @$10/CY Total $5,110.00 TERRY CTRACTING & MATERI INC . V0 WEST MAIN STREET RIVERHEAD , NY 11901 (6 3 1 ) 727 - 0170 FAX _ (631 ) 727 - 0410 October 24, 2002 Thomas F. Maher, P.E. Dvirka and Bartilucci 330 Crossways Park Drive Woodbury, NY 11797-2015 Re: Southold Landfill Closure D&B No. 1314 Dear Mr. Maher: This letter is to provide a record of cost and delays due to continued operation by the Town of Southold within the Contract Limits. As you are aware, continuous access to the Contract area has been provided to Southold Town as necessary for the waste collection center to continue full operation. This has caused waste collection center equipment and Southold Town Highway Department vehicles to operate ,in the direct path of our hauling trucks during BPL transport. The hauling trucks are often forced to travel directly behind slow moving town pay loaders and town trucks or pull aside to allow these vehicles to pass. In addition, the general public has been directed to dispose of their waste in very close proximity to these trucks. As a result, the hauling trucks have been forced to slow down and, at times, come to a complete stop to allow for the safe passage of the general public. In an effort to compensate for this delay and bring production to where it needs to be, a third hauling truck has been placed in operation. We are again working in a situation not specified by the contract documents. As such, we ask that adequate time and costs be added to the contract to compensate for this situation. The contractor requests the following: 1. For each day of BPL transportation, 0.5 days be added to the Contract Time. 2. The cost of $1800.00 per day for operation of the third hauling truck be added to the Contract. Please recognize that this situation is due only to the town's insistence on continuing its full operation during our working hours and within the contract limits. Also, please recognize that any hindrance to the travel speed of the trucks has had a direct effect on the necessary costs and time to complete the work. Please contact me with any questions or comments. Thank you, r Timothy . Howell cc: James Bunchuck Frank DeVita Igor Sikiric 10/24/2002 Paw I of 1 Jul 30 03 03: 45p PC*CREEK 6341658 l.. 1 PEGSON aan+cnmmo:.m PIWERSCRE N NY INC. 36 RHE COURT, MEDFORD, NY 11763 (6311924-2700, fox: (631) 92A-1638 June 27,2 3 Terry Bre then Contracting 840 West Main Street Riverhead,NY 11901 Attn: Bol o Terry hear Mr. rerry, Thank yo j for your recent inquiry on POWERSCREEN Rentals. We currently rent our POWERS CREEN 830 TROMMEL for approximately $12,000.00 per month depending on the nu riber of months you plan to rent. If we can of any further assistance please do not hesitate to call. We hope you find our prices petitive and favor us with your business. Sincerely Donal M llally SALES""SERVICE"""RENTALS sensing: long Island.NYC b the Hudson Valley o�osuFFot,��oG if JAMES BUNCHUCK =� �� P.O.Box 962 SOLID WASTE COORDINATOR y Cutchogue, New York 11935-0962 0-0 • ! Tel: (631) 734-7685 dol � Sao Fax: (631) 734-7976 SOUTHOLD TOWN SOLID WASTE DISTRICT September 26, 2001 MEMORANDUM TO: Linda Cooper FROM: C)hm Bunchuck SUBJECT: FOIL Request Attached, as per your request, are copies of the certified payroll records for the billings to date from Terry Contracting and Materials, Inc. pursuant to the landfill capping project. They cover work done from June 4—September 2, 2001. Please let me know if I can be of further assistance. 1 , Datee I, ROBERT G. TERRY do hereby state: (1 ) That I pay or supervise the payment of t persons employe by TERRY CONTRACTING & MATERIALS INC. on th that the payroll co ting on the day of and ending th Y all persons employe on said pro t have be n pa t e full weekly wages earned, that no rebates have been or will .be made either directly or indirectly to or on behalf of said TERRY .CONTRACTING & MAT&IAILS, INC.. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other ,khan permissible deductions as defined in Article 6, Section 193 of the New York State Labor Law, and described below.. (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;t.hat the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates- contained in any wage determination incorporated into the contract; that the classsifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed, in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor. (4) That:-- (a) hat-(a) WHERE FRINGE BENEFITS ARE; PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly' wage rates paid to each laborer or mechanic listed in the above referenced payroll., payments of fringe benefits as listed in. the contract have been *or will be made to appropriate programs for the benefit of such. employees, except as noted ±n section 4 (c) below_ (b) WHERE FRINGE BENEFITS ARE PA= IN CASE Each laborer or mechanic listed im the above referenced payrol.L has been paid, as indicated on. the pay=ell, an amount not less than. the sum of the applicabla basic hourly wage rate plus the amount of the requi red fringe benefits as Zisted i-m the contract,- except as rioted in Section. 4 (c) below- (c) EXCEPTIONS' EXCEPTIOIP (CRAFT) EXPLANATION Remarks J Name & Title Signature ROBERT G._ TERRY PRESIDENT CONTRACTOR'S PAYROLL STATEMENT IAME OF CONTRACTOR[ J OR SUMWRACTOR[ J ADDRESS ERRY CONTRACTING i MATERIALS.INC. 840 W.MAIN STREET RIVERHEAD.N.Y.11901 WYROLL 4 - FOR WEEK ENDING PROJECT AND LOCATION 12 SEPT.2,2001 SOUTHOLD LANDFILL CLOSURE (1) ($ (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET SAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES ;OCTAL SECURITY NUMBER W/HOLWlG CLASSIFICATION OR 8/27 8/28 8/29 8/30 8/31 9/1 9/2 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID )F EMPLOYEE EXEMP'FaNS S.T. HOURS WORKED EACH DAY JEARNED TAX TAX DEDUCTIONS FOR WEEK AICHAEL N.JONES >p 0 JASTQ*NY 11942 DOZER 8 8 8 5 7 36 30.95 1114.20 CKR 3277 )90-68.2853 0 EXCAVATOR S 3 1 4 33.28 133.12 95.42 264.44 68.62 0.60 429.08 818.24 ANDREW M.FLEMING .1 BEATRICE STREET 0 >HIRLEY.NEW YORK 11967 CK113275 )69.68.1419 3 DRIVER S 8 8 7 8 8 39 29.41 1146.99 87.74 130.75 57.14 0.60 276.23 670.76 tOBERT TERRY i7 FOSTER AVENUE 0 - iAMPTON BAYS,NEW YORK 11946 CKS 3274 )71.28.9247 4 EXCAVATOR S 8 8 7 8 8 39 33.28 1297.92 99.29 156.45 66.16 0.60 322.50 975.42 IASON E.HAND '.0.BOX 393 0 iAMPTON BAYS.NEW YORK 11946 CK*3276 118.645404 3 DRIVER S 8 8 7 8 31 29.41 911.71 69.75 97.00 39.04 0.60 206.39 705.32 1 RICHARD T.TERRY 28 OLD TRAIL ROAD 0 NATE Y 11976 CK.0 3270 D79- 31 EXCAVATOR S 8 8 8 - 24 33.28 798.72 61.10 101.20 37.23 0.60 200.13 598.59 j SEAN TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NEW YORK 11946 DRIVER 2.5 2.5 29.411 73.53 CIC#3278 05076.6251 S ROLLER S 4 4 4 4 2.5 1 18.5 29.78 550.93 47.77 79.67 24.64 0.60 152.68 471.78 p S O S 0 S .Date I, ROBERT TERRY do hereby state: (1 ) That I pay or supervise the payment of t persons by TERRY CONTRACTING & MATERIALS INC. on the 1W,—Lozq-k� that the payroleo A*) day of he day 'f and ending all persons employed on said pro a ha a been paid a full weekly wages earned, that no rebs s have been or will .be made either directly or indirectly to. or on behalf of said TERRY CONTRACTING & MATERIALS INC.. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any . person,other than permissible -deductions as defined in Article 6, Section 193 of the New York State Labor Law, and described below., (Z) That any paYr0 s ° erw se under t s contras qu resed to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classsifications set forth therein for each Laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor. (4) That-- (a) hat:z(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced pay=oll, payments of fringe benefits as listed in. the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4 (c) below_ WHERE RE rRINGE BENEFITS ARE PAID = CASE Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4 (c) below.. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Remarks 14ame & Title Signature ROBERT G. TERRY PRESIDENT CONTRACTORS PAYROLL STATEMENT ,AME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS ERRY CONTRACTING k MATERIALS.INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 AYROLL A FOR WEEK ENDING PROJECT AND LOCATION 10 August 19,2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET TAME,ADDRESS AND NO.OF WORK O.T. F81131 N TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES OCTAL SECURITY NUMBER W/MOLDING CLASSIFICATION OR 8/14 8/15 8/16 8/17 8/18 8/19 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID F EMPLOYEE EXEMPTIONS IST. HOURS WORKED EACH DAY JEARNED TAX TAX DEDUCTIONS FOR WEEK IICHAEL N.JONES .0.SIM DOZER 0/T 0 1 1 61.9 61.90 AST QNY 11942 DOZER 4 8 8 8 28 30.95 866.60 CKX 3188 90.68-2853 0 EXCAVATOR S 4 8 12 33.28 399.36 101.58 288.60 74.14 0.60 464.92 862.94 HRISTOPHER ZITO 3 REVILO AVENUE O HIRLEY,NY 11967 DOZER 0/T1 1 61.90 61.90 CKs 3186 08.64.2931 2 DOZER 5 I 8 8 8 8 1 32 30.95 990.40 80.50 122.51 51.97 0.60 255.58 796.72 NDREW M.FLEMING I BEATRICE STREET 0 HIRLEY,NEW YORK 11967 DRIVER 0/T 1 1 44.12 44.12 CK.*3190 69.68.1419 3 DRIVER S 8 8 8 B 8 40 29.41 1176.40 93.37 150.61 62.17 0.60 306.75 913.77 OBERT TERRY 7 FOSTER AVENUE 0 AMPTON BAYS,NEW YORK 11946 EXCAVATOR O/T 1 1 66.56 66.56 CK m 3189 71.289247 4 EXCAVATOR S 8 8 8 8 8 40 33.28 1331.20 106.93 183.40 73.00 0.60 363.93 1033.83 NIBALA.DIAZ 069 WEST MAIN STREET 0 IVERH EW YORK 11901 DRIVER 0/T 1 1 44.12 44.12 CK.R 3182 26.88 5 DRIVER S 8 al 8 24 29.41 705.84 57.37 52.06 27.30 D.60 137.33 612.63 ASON E.HAND .0.BOX 393 0 AMPTON BAYS,NEW YORK 11946 CK.•3192 1864.5404 1 DRIVER S al 81 29.41 470.56 35.99 21.11 10.26 0.60 67.96 402.60 (CHARD T.TERRY S OLD TRAIL ROAD 0 ATERMILL.NY 11976 CRs 3162 79.64.8741 1 DOZER S 8 8 16 30.95 495.20 37.88 S5.67 16.75 0.60 110.90 384.30 EAN TERRY 7 FOSTER AVENUE 0 AMPTON BUYS.NEW YORK 11946 CK.o 3191 50.76-6251 5 ROLLER S 3.5 3.5 3.5 3.5 3.5 17.5 29.78 521.15 39.87 62.16 17.72 .0.60 120.35 400.80 0 5 jDat Y ROB G. TERRY do hereby state: (1 ) That I pay or supervise the payment of th persons loyed ((�� by TERRY CONTRACTING & MATERIALS INC. on the that the payroll commencing o th day of and ending th�� day all persons employed on said jrFZjct ave been paid the full weekly wages earned, that no rebates have been or will .be made either directly or indirectly to or on behalf of said TERRY CONTRACTING & MATERIALS, INC. from the full weekly wages earned by any person and that no deductions have been made either directly or indireceifrm he full eearned ynArticle person,other than Pr ssbledeductionsasdefinedi 6, Section 193 of the New York State Labor Law, and described below. (2) That any .payrolls otherwise under this contract required to be submitted for the above period are correct and complete that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classsifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor. (4) That: (h WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FONDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic, listed in the above referenced payroll, payments of fringe benefits as listed in. the contract have been or will. be made to appropriate programs for the benefit of such employees, except as noted in section 4 (c) below_ (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as Listed in the contract, except as noted in Section 4 (c) below.. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Remarks Name & Title Signature ROBERT G. TERRY PRESIDENT CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ) ADDRESS TERRY CONTRACTING 6 MATERIALS.INC. 840 W.MAIN STREET RIVERHEAD.N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 11 August 26.2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (g) (g) DEDUCTIONS NET NAME ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 8120 8/21 1 8/22 8/23 8/24 8/25 8/26 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EASTQUOGUE.NY 11942 Cult 3205 090.68.2853 0 DOZER S 8 8 8 8 8 1 40 30.95 1238.00 94.71 261.64 67.98 0.60 424.93 813.07 A .FLEMING 11 ICE STREET 0 SHIRLEY.NEW YORK 11967 CK.it 3208 069.68-1419 3 DRIVER S 8 8 8 8 8 40 29.41 1176.40 90.00 138.70 59.15 0.60 288.45 ROBERTTERRY 57 FOSTER AVENUE 0 HAMPTON BAYS.NEW YORK 11946 CK.0 3207 071.28.9247 4 EXCAVATOR S 8 8 8 24 33.28 798.72 61.10 67.74 31.96 0.60 161.40 637.32 JASON E HAND P.O.BOX 393 0 HAMPTON BAYS.NEW YORK 11946 CK-a 3206 118-64.5404 1 DRIVER S B 8 6 8 8 40 29.41 1176.40 90.00 168.46 57.17 0.60 316.23 860.17 RICHARD T.TERRY 28 OLD TRAIL ROAD 0 WATERMILL.NY 11976 CK-ft 3210 . 079.64.8744 1 EXCAVATOR S 8 8 8 24 33.28 798.72 61.10 101.20 37.23 0.60 200.13 598.59 SEAN TERRY 5718 AVENUE 0 HA BAYS.NEW YORK 11946 CK-0 3209 050.76-6251 5 ROLLER S 3.5 3.5 3.5 3.5 3.5 17.5 29.78 521.15 39.87 62.16 17.72 0.60 120.35 400.80 0 S O S 0 _ S Date ::rnQ ,I� ROBERT G. TERRY do hereby state: (1 ) That I pay or supervise the payment of tt�� persons e ploy dt ' by TERRY CONTRACTING & MATERIALS INC. on -theme that the payroll c mmencing on he Y'.a da o a � and ending th 'N1 day of persons ersons employed on said proj e t have b en pa d the full Weekly wages earned, that no rebates have been or will "be made either directly or indirectly to or on behalf of said TERRY CONTRACTING & MATER'ZALS, INC. from the full weekly wage earned by any person and that no deductions have been made either directly or indirece�ssifrm the full ble deductionseasearned definedyinnArticle person,other ,than P 6, Section 193 of the New York State Labor Law, and described below_ (Z) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that . the classsifications set forth therein for each laborer or mechanic conform with the work he performed.. (3) That any apprentices employed in the above period are duly- registered ulyregistered is a bona fide apprenticeship program reg=stered with the New York State Department of Labor. (4) -That. (ha. Wigg ERINCE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRBMS Za addition to the u basic horly wage rates paid to each laborer or mechanic listed in: the above referenced pa-y= ., payments of hinge benefits as listed in. the contract have been or will be made. to appropriate programs for the benefit of such employees, except: as noted to section. 4 (c) below_ (b) WgEgE FRINC-E' BENE=S' ARE PAID IN CASE Each Iabo aid, asr. indicated om the payroll, aamount referenced pay== T has been g a rate not less than. the sum, of the applicable basic hourwage g Plus the amount of the required fringe benefits as Listed is the contract,_ except as noted in Section 4 (c) below.. (c) EXCEPTIONS EXCEPTION (CF-UT) EXPLANATION' Remarks Name & Title. Signature ROBERT' G. TERRY FRESIDENT CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ 7 OR SUBCONTRACTOR[ J ADDRESS TERRY CONTRACTING 6 MATERIALS.INC. 840W.MAIN STREET RIVERHEAD.N.Y.11901 PAYROLL w FOR WEEK ENDING PROJECT AND LOCATION 13 SEPT.9,2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE . GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 9/3 9/4 9/5 9/6 9/7 9/8 9/9 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS IS.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES LABOR DAY 8 8 22.00 176.00 CK#3351 ERROR COR. LABOR DAY 8.95 71.60 5.48 3.10 0.00 0.35 8.94 62.66 P.O. EXCAVATOR 0 2 8 10 33.28 332.8D EAST UE.NY 11942 EXCAVATOR 0/T 1 1 66.56 66.56 CKA 3318 090.68.2853 0 DOZER S 3 8 8 19 30.95 588.05 89.00 240.25 62.87 060 392.72 770.69 ANDREW M.FLEMING CK.f13352 11 BEATRICE STREET ERROR COR LABOR DAY 0 11.41 91.28 6.981 0 0 0.46 7.44 83.84 SHIRLEY,NEW YORK 11967 LABOR DAY 8 8 18.00 144.00(SEE CHECK•3323) CIC•3321 069.68.1419 3 DRIVER S 4 4 8 29.41 23528 18.OD 0.00 1.35 0.60 19.95 215.33 ROBERT TERRY ERROR COR. LA80R DAY13.28 106.24 8.13 0 0 0.53 8.66 97.58 57 FOSTER AVENUE LABOR DAY 0 8 8 20.00 160.00 CK.#3353 HAMPTON BAYS.NEW YORK 11946 EXCAVATOR 4 8 8 8 28 33.28 931.84 CK#3320 071.28-9247 4 EXCAVATPR O/T S 1 1 66.56 66.56 88.62 121.69 56.60 0.60 267.51 890.89 JASON E.HAND ERROR COR. LABOR DAY 15.41 123.28 9.43 0 0 0.6 10.03 113.25 P.O.BOX 393 LABOR DAY 0 8 8 14.00 112.00 CK-0 3354 HAMPTON BAYS,NEW YORK 11946 DRIVER 4 4 8 8 24 29.41 705.84 CK-0 33.24 118.64.5404 1 LABORER S 0.5 4 4.5 25.38 114.21 71.30 102.49 40.14 0.60 214.83 717.22 SEAN TERRY ERROR COR. LABOR DAY 17.78 62.23 4.76 0 0 0.31 5.07 57.16 LABOR DAY 3.5 3.5 12.00 42.00 CK.•3355 57 FOS AVENUE ROLLER 0 1 2.5 3.5 29.78 10423 HAMf YS.NEW YORK 11946 LABORER 0.5 0.5 25.38 12.69 _ CK-A 3325 050.78 1 1 DRIVER S B 8 16 29.411 470.56 48.16 81.03 24.98 0.60 154.77 474.71 0 S 0 S 0 S O S Date I, ROGER G. TERRY do hereby state: (1 ) That I pay or supervise the payment of th persons ployed by TERRY CONTRACTING & MATERIALS INC. on the �� that the payroll ceating on he h day of and ending the�7 day of all persons employed on said prof e t ha a been paid t e full weekly wages earned, that no rebs s have been or will .be made either directly or indirectly to or on behalf of said TERRY CONTRACTING & MATER`IALS, INC. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Article 6, Section 193 of the New York State Labor Law, and described below. (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classsifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor. (4) That-. (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in. the contract have been -or will be. made to appropriate programs for the benefit of such employees, except as noted in section 4 (c) below_ (b) WHERE FRINGE BENEFITS ARE PAID IN' CASH Each laborer or mechanic listed in the above referenced payroll. has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as Listed in the contract, except as noted in Section 4 (c) below.. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Remarks Dame & Title S ignature ROBERT G. TERRY PRESIDENT CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ J OR SUBCONTRACTOR[ J ADDRESS TERRY CONTRACTING&MATERIALS.INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL s FOR WEEK ENDING PROJECT AND LOCATION 9 August 12,2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO,OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 8/6 8/7 8/8 8/9 8/10 8/11 8/12 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY I EARNED I TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 0 EAST QUOGUE,NY 11942 DOZER 8 8 8 8 32 30.95 990.40 CKs 3117 090-68.2853 0 EXCAVATOR S 8 8 33.28 266.24 96.13 267.23 69.26 0.60 433.22 823.42 CHR R ZITO 93 R AVENUE 0 SHIRLEY.HY 11967 DOZER O/T 1 1 61.90 61.90 CK*3127 108-64.2931 2 DOZER S 8 8 8 8 8 40 30.95 1238.00 99.44 187.101 68.93 0.6D 356.07 943.83 ANDREW M.FLEMING 11 BEATRICE STREET 0 0 SHIRLEY,NEW YORK 11967 0 CILO 3123 069.68.1419 3 DRIVER S 5.5 8 8 8 1 29.5 29.41 867.60 66.37 86.44 38.00 0.60 191.411 676.19 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NEW YORK 11946 CK#3129 07128.9247 4 EXCAVATOR S 8 8 8 8 8 40 33.28 1331.20 101.83 165.43 68.44 0.60 336.30 994.90 ANIBAL A DIAZ 1069 WEST MAIN STREET 0 RIVERHEAD,NEW YORK 11901 CKe 3122 126.8&2636 5 DRIVER S 8 8 8 8 8 - 40 29.41 1176.40 90.00 116.031 56.52 0.601 263.15 913.25 ISABEL BIINEGAS 106 ON STREET 0 RIVE NY 11901 DRIVER 8 3.5 11.5 29.41 336.22 CKS 3125 078.80.9325 4 LABORER S 2.51 2.5 25.38 63.45 30.72 8.18 7.38 0.60 46.86 354.79 RICHARD T.TERRY 28 OLD TRAIL ROAD 0 WATERMILL,NY 11976 DOZER 7.5 4 11.5 30.95 355.93 CKR 3118 079.64.8744 1 EXCAVATOR S 4 4 33.28 133.12 37.41 54.75 16.39 0.60 109.15 379.90 JAY A.POREMBA - 49 PELLETREAU STREET 0 SOUTHAMPTON,NY 11968 CK.R 3120 070.64.2222 5 LABORER S 2.5 2.5 25.38 63.45 4.851 0.00 0.00 0.32 5.17 58.28 O S Date QDdA I, ROBER TERRY do hereby state: (1 ) That I pay or supervise the payment of the persons`em lop yed, by TERRY CONTRACTING & MATERIALS INC. on that the payroll commencing og he +h day of and ending the yL. all persons employed" on said proje t a e been paid the full weekly wages. earned, that no rebs s have been or will .be made either directly or indirectly to or on behalf of said TERRY CONTRACTING I MATERIALS, INC.. from the full weekly wages earned by any person and that no deductions have been made either directly he indirectly he full deductionseasearned definedyinnArticle person,other than permissible 6, Section 193 of the New York State Labor Law, and described below. (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classsifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in. the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in section 4 (c) below (b) ARE FRINGE BENEF=S ARE PAID IN CASH" Each Laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4 (c) be-low.. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Remarks Name & Title Signature ROBERT G. TERRY PRESIDENT CONTRACTORS PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR ) ADDRESS TERRY CONTRACTING i MATERIALS.INC. 840 W.MAIN STREET RIVERHEAD.N.Y.11901 PAYROLL 0 FORWEEK ENDING PROJECT AND LOCATION 8 . August 5,2001 - SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO.OF WORK O.T. MON TUE WED THU F)11 SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 7/30 7/31 8/1 8/2 8/3 8/4 8/5 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS IS.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOK 191 0 0 EAST JF-NY 11942 DOZER O/T 0.5 0.5 61.90 30.95 CK.o 3092 090 0 DOZER S 8 B 8 B 8 40 30.95 1238.00 97.07 270.93 70.10 0.60 438.70 830.25 CHRISTOPHER ZITO 93 REVILO AVENUE O 0 SHIRLEY.NY 11967 DOZER O/T 1 1 61.90 61.90 CK.s 3098 108-64-2931 2 DOZER S 8 8 8 8 32 30.95 990.40 80.50 122.51 51.97 0.60 255.58 796.72 ANDREW M.FLEMING 11 BEATRICE STREET 0 0 SHIRLEY.NEW YORK 11957 O CK.A 3089 059-68.1419 3 DRIVER S 8 8 8 8 32 29.41 941.12 72.00 97.47 43.03 0.60 213.10 728.02 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NEW YORK 11946 CK.a 3091 071-28-9247 4 EXCAVATOR S 8 8 8 8 8 40 33.28 1331.20 101.83 165.43 68441 0.60 336.30 994.90 ANISALA.DIAZ - 1069 WEST MAIN STREET 0 RIVERHEAD.NEW YORK 11901 DRIVER O/T 0.5 0.5 44.12 22.06 CK.#3088 126.88• 5 DRIVER S 8 8 8 B 8 40 29.41 1176.40 91.68 119.34 58.03 0.60 269.65 928.81 ISAOMGAS 1069 . N STREET 0 RIVERHEAD.NY 11901 CK.x 3093 078.80-9325 4 DRIVER S 7.5 7.5 29.41 220.58 16.88 0.00 0.00 0.60 17.48 203.10 0 S 0 S t 0 S 41 Date�U I,, ROBERT G. TERRY do hereby state: (1 ) That I pay or supervise the payment of th per ns p oyed i /� by TERRY CONTRACTING b MATERIALS INC. on the I that the payroll commencing on the day of ` and ending the day of all persons employe said project have been paid the full weekly 'wages earned, that no rebates have been or wi 11 .be made either directly or indirectly to or on behalf of said TERRY -CONTRACTING & MATEtTALS, INC.. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other ,than permissible deductions as defined in Article 6, Section 193 of the New. York State Labor Law, and described below.. (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage raters contained ia any wage determination forth�therein fororated othe each laboreztorthat the classsifica mechanic conform with the work he performed. (3) That any apprencss employed. in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor.. (4) That: (a) WSERE FRINGE BENEE'TTS ARE: PAID TO APPROVED PLANS, FUN Sr OR PROGRAMS Im additi_on to the basic hourly wage rates paid to each. laborer or mechanic Listed in. the above. referenced pe-yro4 payments of fringe benefits as listed in, the contract have been .or wiu be made to app=opri ate programs for the benefit of such- employees, uchemployees, except as noted in section. 4: (c) below (b) WHERZ gRINGE• BEM S' ARES PAIDIN CAST Each laborer oz. mechanic listed Lm the above referenced payroI.T has been paid,. as indicated on: the payroll, an amount not less than.. the: sum of. the applicabla basic hourly wage rate plus the amount of the required fringe benefits as Listed is the contract, except as noted: in Section_ 4 (c) below- (C) EXCEPTIONS' EXC=pTION (CRAFT) EXPLANATSON' Remarks Name & Title Signature ROBERT G. TERRY PRESIDENT CONTRACTOR'S PAYROLL STATEMENT I IAI j° .` -')II T PA.,T"f:( i OR SUR!!^17I I"Af TOP.( ) ADDRESS TEPP,CXINI RACTING L.MATERIALS,INC 840 W.MAIN STREET RIVERHEAD,NY 11901 PAYPOLI I FOR WEEK ENDING PROJECT AND LOCATION 7 July 29.2001 SOUTHOLD LANDFILL CLOSURE (1) l2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET CAME.ADDRESSAND NO OF WORK. OT MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIA;SECURITY NUMBER W/HOLDING CLASSIFICATION OR 7/23 7/24 7/25 7/26 7/27 7/2812H7/29 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID 0=EMP_O,EE EXEMPTIONS IS.T. HOURS WORKED EACH OA IEARNED I TAX TAX DEDUCTIONS FOR WEEK MICHA=_;.N JONES P O BCr 191 0 0 EAST QUOGUE NY 11942 0 CK.#3054 ogoilm DOZER S 8 8 8 8 8 40 30.95 1238.00 94.71 261.64 67.98 0.60 424.93 813.0' PICAW TERRY 28 OLC TRAIL ROAD O 0 WATEPNI!LL.NY 11976 0 CK#3036 0%964 8744 0 DRIVER S 8 8 29.41 235.28 18.00 16.69 3.66 0.60 38.95 19633 ANDREW M FLEMING 11 BEATRICE STREET 0 0 SHIRLEY.NEW YORK 11967 - 0 CK#3052 069681419 3 DRIVER S 8 81 8 81 8 40 29.41 1176,401 90.00 138.7 59.15 0.60 288.45 88795 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS.NEW YORK 11946 CK#3053 071"289247 4 EXCAVATOR S 8 8 8 8 8 40 33.28 1331"20 101.83 165.43 68.44 0.60 336.30 994.90 ANIBAL A DIAZ 1069 WEST MAIN STREET 0 RIVERHEAD.NEW YORK 11901 LABORER 7 7 25.38 177.66 CK#3044 126"8&2636 5 DRIVER S 8 8 8 8 32 29.41 941.12 85.58 107.38 52.57 0.60 246.13 B7265 0 S 0 S 0 S 0 S I, RO.BERT__G. TORY do hereby state: (1) That I pay or supervise the payment of the- ers s em I�jy by TERRY CONTRA ed , or supe MATERIALS INC. on -the that the payroll comn mecing on the da of and ending theerja day of all persons employed on said project ve been paid the full all persons earned, that no rebates have been or will .be made weeeither directly or indirectly to or on behalf of said TERRY OpNTggCTING & MATE�t`ZALS INC. from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other ,than permissible deductions as defined in Article 6, Section 193 of the New York State Labor Law, and described below (2) That any payrolls otherwise under this contract required to be sur bmitted for the above period are correct and complete,-that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classsificatiw s set forth therhe ein for each laborer or mechanic conform (3) That any apprents.ces employed enti eshithe arocramegistered erduly registered in a bona fide app P P With the Nev York State Department of Labor.. (4) That (a) WEMRZ FRINGE BENE'F'ITS ARE PA2D TO APPROVEIl PLANS, EIINDS r QR. PROMMIS' Ia addits-oa to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced pay=o11, payments of fringe benefits as listed i n: the contract have been .or wi1L be made to appropriate Prog=ams- for the benefit of such employees, except as noted to section. 4 (c) below.- (b) elow(b) WEMtr FRINGE' BENIT=S7 ARL PAID IDT CAST Each laborer or- se�� ted. oa the payrcll�an amount payzolZ has been gaz.d,. rate not: Less than the sum of the eaPf�rcin�ge le benefits�as ?-iwa�d stein' plus the amount o£ the requir the contract, except as noted in: Section 4 (c) below (c) EXCEPTIONS` EXCEPT20s' (CRAFT) EXPLANATION Remarks Name & Title _ Signature ROBERT G. TERRY PRESI'DE'NT CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR( ] OR SUBCONTRACTOR[ J ADDRESS TERRY CONTRACTING 6 MATERIALS.INC: 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL* - FOR WEEK ENDING PROJECT AND LOCATION 6 July 22.2001 SOUTHOLD LANDFILL CLOSURE (1) -(2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO OF WORK OT MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 7/16 7/17 7/18 7/19 7/20 7/21 7/22 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEBPTIONS Is T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P 0 BOX 191 LABORER 0/T O 2.5 2.5 38.07 95.18 EAST QUOGUE.NY 11942 EXCAVATOR O/T 1 1 66.56 66.56 CK.#2981 090AMES53 0 EXCAVATOR S 8 8 8 4 8 36 33.28 1198.08 104.03 298.19 76.32 0.60 479.14 88068 - C HER ZITO 93 REVILO AVENUE O 0 SHIRLEY.NY 11967 0 CK-S 3D04 10864-2931 4 DOZER S 8 8 8 24 30.95 742.80 56.82 76081 30.77 0.60 164.27 578.53 ANDREW M.FLEMING 11 BEATRICE STREET 0 0 SHIRLEY.NEW YORK 11967 0 CK-n 3015 069.681419 3 DRIVER S 7 8 8 23 29.41 676.43 51.75 57.76 24.90 0.60 135.01 541.42 ROBERTTERRY 57 FOSTER AVENUE 0 HAMPTON BAYS.NEW YORK 11946 CK.#3014 07128.9247 4 EXCAVATOR S 8 8 33.28 266.24 20.37 .0 0 0.60 20.97 245.27 ANIBAL A.DIAZ 1 D69 WEST MAIN STREET 0 RIVERHEAD.NEW YORK 11901 CK.S 2998 126882636 5 DRIVER S 8 8 8 24 29.41 705.84 53.99 45.44 24.28 0.60 124.31 581.53 i ISAB NEGA5 ] AW STREET O RIVE EAD.NEW YORK 11901 CK.R 2996 078809325 4 LABORER S 1 3 3 25.38 76.14 5.82 0.00 0.00 0.38 6.20 69.94 RICHARD T.TERRY 28 OLD TRAIL ROAD 0 WATERMILL NEW YORK 11976 CK.a 2982 079-648744 2 DRIVER 5 4.5 4.5 29.41 132.35 10.13 1.25 0.00 0.60 11.98 12037 JUAN C COLLAZOS PO BOX 2786 LABORER O/T 0 3.5 35 38.07 133.25 SOUTHAMPTON.NEW YORK 11969 LABORER 0.5 05 25.38 12.69 CG.a 3002 084643878 4 DOZER S 6 6 30.95 185.70 25.37 0.00 4.44 0.60 30 41 301.23 0 S Date�Vl,u I, ROBERT G. TERRY do hereby state: (1 ) That I pay or supervise the payment of th persons a ploye by TERRY CONTRACTING & MATERIALS INC. on the t 1 , that the payroll commencing on the day o and ending the a_ _ day of all persons employed on said project ave been paid the full week ly •wages earned, that no rebates have been or will .be made either directly or indirectly to or on behalf of said TERRY -CONTRA CTING & MATEkIALS, INC. from the full weekly wages earned by any person and that no deductions have been made either directly or indirecdeductionsasdefinedinArticle eeyany person,other ,than permissible 6, Section 193 of the New. York State Labor Law, and described below_ (2) That any pays s o erw se unZle= tftlz conSa"ct re Gd to be submitted for the above period are correct and camplete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates. contained is any wage determination incorporated into the cant=-act; that the classsifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed: in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor.. (4) That:: (a) W=Z FRINGE BENEF=S ARE: RAM TO APPROVED- PLANS, FUNDS, OR. PROGRAMS r addition, to the basic hourly- wage. rates paid to each. laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in. the contract have been or will be made to appmprfata programs for the benefit of such. employees, except as noted to section 4 (c) below_ (b) WHERE SCE' BENE=S ARE PA= IN CASE i Each Iabo=er ar mechanic Listed in. the above referenced payroll has beem paid,. as indicated on the: payroll, an amount not less than the sum of the. applicable: basic hourly wage rate plan the amount of the required fringe benefits as listed is the contract, except as noted in Section, 4 (c) below r (c) EXCEPTZOHS EXCEPTSOtq (CRAFT) EXPLANATION Remarks Name & Title Signature. ROBERT G. TERRY PRESIDENT CONTRACTORS PAYROLL STATEMENT J-` NAME OF CON TRACTOR( ) OR SUBCONTRACTOR( ) ADDRESS TERRY CON IRACTING 8.MATERIALS.INC 840W.MAIN STREET RIVERHEAD,N.Y.11901 PAYPOIL x FOR WEEK ENDING PROJECT AND LOCATION 5 July 15.2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 7/9 7/10 7/11 7/12 7/13 7/14 7/15 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS IS T. HOURS WORKED EACH DAY IEARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P 0 BOX 191 0 EAST QUOGUE.NY 11942 CK x 2940 090682853 0 EXCAVATOR S 8 8 8 8 8 40 33.28M1331-20 101.83 289.60 7436 060 46639 864.81 TOPHER ZITO VILOAVENUE O 0 SHIRLEY.NY 11967 DRIVER 8 6.5 8 8 30.5 2941 CK x 2964 108-642931 4 LABORER S 1.5 1.5 25.38 71.53 104.93 43.94 0.60 221.00 714 08 ANDREW M FLEMING 11 BEATRICE STREET 0 0 SHIRLEY.NEW YORK 11967 0 CK.x 2938 06968.1419 3 DRIVER S 2.75 8 81 8 al 1 34.75 29.41 1022.00 78.18 109.6 48.57 0.60 23695 78505 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS.NEW YORK 11946 CK x 2980 07128-9247 4 EXCAVATOR S 8 8 8 24 33.28 798.72 61.10 67.74 0 0.60 12944 669 28 0 S O S O S 0 S 0 S tj .Date:M11SA I, ROBERT G. TERRY do hereby state: (1) That I pay .or supervise the payment of the. ersons em loye t' by TERRY CONTRACTING & MATERIALS INC. on the that the payroll cc encing on th day of and ending the 5- day of all persons employed on said prof act ave been paid the full veekly 'wages earned, that no rebates have been or will .be made either directly or indirectly to or on behalf of said TERRY CroNTRACTING MAT&JALS, INC. from the full weekly wages earned by any person and that no tions full wavesbeen earnedab either directly or indirectly g y person,other .than permissible deductions as defined in Article 6, Section 193 of the New. York State Labor Law, and described below (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the waQe rates for laborers or mechanics contained herein are not less than the applicable wage rates- contained in any wage determination incorporated n-5setforth therein. forothe each labo�reartor�at the classsif mechanic conform with the work he performed. (3) That any apprentices employed. in the above period are duly registered in, a bona fide apprenticeship program registered with the New York State Department of Labor.. (4) That: (a) WEZRZ ERINCE BENEFITS ARE: PAS TO APPROVED PLANS, E'UNDS, OR PROGRAMS Ia addition to the basic hourly- wage rates pah id tc each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in. the contract have been or wi.1T be made to approp=iate prog=ams for the benefit of such ,pjoyees, except as noted in section 4 (c) below_ (b) ABX:S ERING;r BENEF=TS• ARE` PA=- IN CASE Each Izbcm= or, mechanic listed Lm the above referenced payroll has been paid,. as indicated. on. the payroll, an amount not less than the sum of the applicable basis hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as Anted is Section. 4 (c) below.. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Remarks Name & Title Signature ROBERT G. TERRY PRES=ENT CONTRACTORS PAYROLL STATEMENT NAME OF CONTRACTOR( ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS.INC, 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 4 July 8.2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO.OF WORK OT MON TUE WED THU FRI SATSUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 7/2 7/3 7/4 7!5 7/6 7/7 7/8 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID ?F EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK. MICHAEL N.JONES P O-BOX 191 0 EAST QUOGUE.NY 11942 HOLIDAY 8 8 30.95 247.60 CK.a 2910 -682853 0 DOZER 5 6.5 8 8 8 30.5 30.95 943.98F 91.16 247.85 64.80 0.60 40441 787.1' HERZITOwP OAVENUE 0 0 SHIRLEY.NY 11967 DOZER 5.5 5.5 30.95 170.23 CK.#2915 108-64.2931 4 LABORER S 0.5 1 0.5 25.38 12.69 13.99 0.00 0.03 0.60 1462 168.30 0 0 0 S 0 0 S 0 0 S O S 0 S 0 S 0 S Date��`u I ROBERT G. TERRY do hereby state: (1) That I pay or supervise the payment of th persons employ d by TERRY CONTRACTING & MATERIALS I C. on the . % 1 that the payroll commencing an the day of _ and ending the Sday of all pers=ons employed on said projectve eery paid the full tave weekly wages earned, that no rebates been or will .be made either directly or indirectly to or on behalf of said TERRY .CONTRACTING Si MATEJZTALS, INC.. from the full weekly wages earned by any person and that no deductions have been made either directly other , he full es arned any Article person,other ,khan P 6, Section 193 of the New York State Labor Law, and described below_ (2) That any payrolls otherwise under this contract req u i red to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not Less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classsificatioas set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with the New York State Department of Labor.. (4) That-- (a.) yMRE gRINCE BENEFITS ARE PAIM T-0 APPROVED. PLANS, MMS, OR. PROGRAMS' Ia addition to the basic hourly wage rates paid to each. laborer or mechanic Listed in. the above referenced pa-y=11" payments of fringe benefits as listed i.n, the cont=act have been or will be made to appropriate programs for the benefit of such employees,_ except as noted in section- 4 (c) below.- (b) WHERE gBTNCE BENEFITS ARE' PAID =N" CASE. Each laborer ar- mechanic listed im the above referenced pay=I.T has been paid, as indicated on- the payro=ll, an amount not Less than. the sum of the applicable: basic hourly wage rate plus the amount of the req u i red fringe benefits as listed is the contract, except as noted. in Section. 4 (e) below (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION Remarks Dame &. Title. Signature ROBERT G. TERRY PRESIDENT- CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR( j OR SUBCONTRACTOR[ j ADDRESS TERRY CONTRACTING&MATERIALS.INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 3 JULY 1.2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/25 6/26 6/27 6/28 6/29 6/30 7/1 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOGUE.NY 11942 CK.n 2865 Q%MW853 0 DOZER S 1 5.5 3 8.5 30.95 263.08 20.12 31.82 5.16 0.60 57.70 205.38 0 0 0 S 0 0 0 0 S O 0 S 0 0 S O S 0 S O S O S Date I ROBERT G. TERRY do hereby state: (1) That I pay or supervise the payment of the persons em loyed by CTING b MATERIALS INC. on the � �t gat a P+LY a +� eacrirey► Ora a 4dy o and ending thday of Aa all persons employed on said pr53ect have been paid the full weekly 'wages earned, that no rebates have been or will .be made either directly or indirectly to or on behalf of said TERRY .CONTRgCTiTG & MAT&IALS, INC. from the full weekly wages earned by any person and that no deductions have been made either directly or indirece�ssiblrom edeductionswages ased fineded yany in Article person,other ,J han P 6, Section 193 of the New. York State Labor Law, and described below- (2) That any payrollsquireotherwise under this contract red to be snhm. tted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates- contained in any wage determination incorporated into the contract; that the classsifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered }I with the New York State Department of Labor. i (4) That: (a) WHERE FRINGE BENEFITS ARE: PAID TO APPROVED PLANS, FONDSr i OR PROGRAMS'AMZa additi.oa to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payro11., payments of fringe benefits as listed in. the contract have been. or will. be made to apProP�te programs for the benefit of such employees, except as noted i.a section. 4 (c) below.- (b) WHERE ERINC-E BENE=S' A2Z PA=' Ilr CASA Bach Iabo=er or mechanc'ilisted in-. the above referenced pay=olL has been paid,. as indicated on- the payroll, an amount not Less than- the sum of the applicable: basic hourly 9a te plus the amount of the required fringe benefits as Listed is the contract_ except as noted La. Section. 4 (c) below.. (c) EXCISP'TIONfi' i EXCEMOET (CWT) EXPLANAT=OIT Remarks J Name Title signature ROBERT G. TERRY PRESIDENT CONTRACTOR'S PAYROLL STATEMENT IAM£OF CONTRACTOR( ] OR SUBCONTRACTOR( ] ADDRESS ERRY CONTRACTING L MATERIALS.INC 840W MAIN STREET RIVERHEAD•40Y.11901 "AYROLL r FOR WEEK ENDING PROJECT AND LOCATION 2 June 24,2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET r4AME.ADDRESS AND NO.OF WORK OT MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS. WITH WAGES ;OCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/18 6/19 6/20 6/21 6/22 6/23 6/24 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID )F EMPLOYEE EXEMPTIONS IS.T. HOURS WORKED EACH DAV IEARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES "0 80X 191 0 'AST QUOGUE,NY 11942 CK.e 2817 )90&8 0 EXCAVATOR S 7 8 7.5 22.5 33.28 748JD 57.29 130.27 34.47 0.60 222.63 526.17 0 0 0 S 0 0 0 0 S 0 O S 0 0 S O S 0 S O S 0 S Date�Urr1G� I ROBERT G. TERRY do hereby state: (1) That I pay or supervise the payment of th persons `e{n lA oyed� ^ ` ' by TERRY CONTRACTING & MATERIALS INC. on the T► that the payroll commencing on t e _day of and ending the I• day of all persons employed on said project ane been paid the full weekly *wages earned, that no rebates have been or will .be made either directly or indirectly to or on behalf of said TERRY CONTRACTING & MATEjgTALS, INC_ from the full weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other ,than permissible deductions as defined in Article 6, Section 193 of the New York State Labor Law, and described below.. (Z) That any payrolls otherwise under this contract required to be submitted for the above period are correct and camplete;that the wage rates for laborers or mechanics contained herein are not less than the applicable wage rates contained is any wage determination incorporated into the contract; that the classsifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentiCe5 employed is the above period are duly registered in a bona fide apprenticeship program registered with the New York state Department of Labor. (4) That: (a) WHERE ERING£ BENEFITS ARE PAID TO APPROVED; PLANS, FUN Sr OR. PROGRAMS ra addition to the basic hou=ly` wage rates paid to each. laborer or mechaai I'Sted in benefits astlis-tedvin. the�Geced contract ha e f been payments of fring Cr will be made to appropriate programs for the benefit of such employees, except as noted in section. 4 (c) below_ (b) WSERZ ERINCg BENEF=S ARE: PA= IN CASE' Each laborer or mechanic Listed in. the above referenced payroll. has been paid, as indicated on. the. pay= U, as amount not Zess than the sunm of the- applicable basic hourly wage rate ptas the amount of the required fringe benefits as Listed in the contract,- except as acted in Section. 4 (c) bellow.. (c) EXCEPT=N-T ESCEPT=Off (CRAFT) EXPLANATSON` Remarks ✓ Name A Title S 7. natu=e ROBERT G_ TERRY PRESIIIEIQT CONTRACTORS PAYROLL STATEMENT NAME OF CONTRACTOR[ ) OR SUBCONTRACTOR( ) ADDRESS TERRY CONTRACTING 3 MATERIALS.INC 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL K FOR WEEK ENDING PROJECT AND LOCATION 2 June 17.2001 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/11 6/12 6/13 6/14 6/15 6/16 6/17 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY I EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER L.ZITO 93 REVILO AVENUE 0 SHIRLEY.NY 11967 CK.4 2789 10 -2931 3 EXCAVATOR S 7 7 33.28 232.96 17.82 0.00 2.03 0.60 2045. 212.51 0 0 0 S 0 0 0 0 S 0 0 S 0 0 S 0 S 0 S 0 5 0 * S I, ROBERT_ G. TERRY do hereby state: (1) That I pay or supervise the payment of the ers ns e�Plo, Yea �� ,l by TERRY CONTRACTING MATERIALS IN on the C7 4�7J TJ that the payroll commencing on the i day of and ending the �.. day of all persons employed on said project have been paid the full all persons earned, that no rebates have been or will .be made weeeither directly or indirectly to or on behalf of said TERRY INC. from the full edwiearned COrRCTING S by any Personandthatnodeductionshavebeenmaeether directly or indirectly from the full wages earned by any j person,other than permissible deductions as defined in Article 6, Section 193 of the New York State Labor Law, and described below. (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained herein are not less �� peeoetcc � n ed in any wage. determinn �cozoradintthe ontract; that the classsifications set forth therein. for each laborer or mechanic conformL with the work he performed. (3) That any apprentices employed in the above period are duly registered inn a bona fide apprenticeship program registered with the New York State Department of Labor.. (4) That: CE BENEFITS ARE; PAID TO APPROVED. PLANS, FQNDS r (a) WEERH ERIN- OR. PROGRAMS T-M addi-tion to the basic hourly- wage rates paid to each laborer or mechanic listed in the above referenced gay=L, of fringe benefits as Listed in. the contract have been payments or will- payments ill o made, to appropriate programs- for the benefit of such employees,- accept as noted to section. 4 (c) below.. (b) pgERE ERINGE^ BENEF'LTS ARE PAID' IN CASH g� laborer or mechanic above refer Listed in. the enced payroll. has been ;aid, as indicatecl on. the gay=all, as amount aot Less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed is the contract, except as noted in. Section. 4 (c) below.. (.c) EXCEPTIQNS EgczPTZ01Q (CRAFT) EXPLANATION' Remarks Dame & Title Signature ROBERT G_ TERRY PRESIDENT CONTRACTORS PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS.INC. 840W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL r FOR WEEK ENDING PROJECT AND LOCATION I June 10,2001 SOUTHOLD LANDFILL CLOSURE (1). (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON- TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION. OR 6/4 6/5 6/6 6/7 6/8 6/9 6/10 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER 1.ZITO 93 REVILO AVENUE 0 SNIRLEY.NY 11967 DOZER 4.5 4.5 9 30.60 275.40 CK r 2743 -64^931 -3 EXCAVATOR S 7 7 32.35 226.45 38.39 39.94 14.88 0.60 93-81 408 04 O 0 0 S 0 0 0 0 S 0 0 is 0 0 S S 0 S F1 I I I -0 I I S 1 0 S APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: T TOWN OF SOUTHOLD PROJECT APPLICATION: 15 Distribution to: 53095 Main Road Southold Landfill Closure I ]OWNER Southold.NY 11971 PERIOD TO: 0911'03 [ I ARCHITECT I ICONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 640 West Main Street 330 Crossways Park Drive Riverhead,NY 1 1901 Woodbury,New York 11797-2015 CONTRACT DATE: 01,31,01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 previous months by Owner Change Orders 1 to 12 2. Net change by Change Orders $ 127,385.78 TOTAL $317,939.00 $0.00 3. CONTRACT SUM TO DATE (Line 1 + 2 ► $ 5,343,752.28 Aapro,,Led this Month 4. TOTAL COMPLETED & STORED TO DATE $ 5,343,752.28 N Date Approved (Column G on G703) 3 6/1!2003 ($190,543.22) 5. RETAINAGE: a:—O-%_of Completed Work $ (Col umn D + E on G703) $0.00 b:_0_% of Stored Material $ Net Change by Change Orders $127,395.78 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage (Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ 5,343,752.28 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT (Line 6 from prior Certificate) $ 5,293,752.28 8. CURRENT PAYMENT DUE $ 50,000.00 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ - / (Line 3 less Line 6) 9 State of: A/a.,_l yam/7 County of: _ { Subscribed and show before me this {((b da o Sp �. �x)„�200,j By: � ✓1 e Date: C Notary Public: (jJ�Q My Commissio xpires; no 7 INEER'S CERTIFICA R PAYMENT AMOUNT CERTIFIED $ �� o v� rdance with the Contract Documents,based on on-site observations and the (Attach exxPk ion if amount certifieddiffersfrom t e amount applied for.) data mprising the above application,the Engineer certifies to the owner that to the ENG R j ClJ Cvr ti c>CCit.t'�ez best of the Engineers knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: - Date: )YJ the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This Certy to is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-t2-20 _ CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 15 Contractor's signed Certification is attached. APPLICATION DATE: 09/16/05 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D + E) (NOT IN TO DATE DOR E) (D + E+ F) Pre-Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208.000.00 100% $ $0.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $102,000.00 $0.00 $0.00 $102.000.00 100% $ $0.00 3 Clearing and Grubbing $ 18,000.00 $18,000.00 $0.00 $0.00 $18.000.00 100% $ $0.00 4 Unclassified Excay.&Relandfill(per FOl)-Survey $ 421,425.00 $421.425.00 $0.00 $0.00 $421.425.00 100% $ $0.00 5A Removal&Relandfllling of Burled Waste&Fill 1-Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13.627.60 100% $ $0.00 5B Excavation of Gas Migration Control Trenches S 15.576.00 $15,576.00 $0.00 $0.00 $15.576.00 100% $ $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9.000.00 $0.00 $0.00 $9,000.00 100% $ $0.00 5D Waste Excavation Area 2-C.O.4 $ 48.395.00 $48.395.00 $0.00 $0.00 $48.395.00 100% $ $0.00 5E Waste Excavation Area 3-C.O.4 $ 49,726.55 $49,726.55 $0.00 $0.00 $49.726.55 100% $ $0.00 5F Waste Excavation Area 4 $ 2,678.10 $2.678.10 $0.00 $0.00 $2.678.10 100% $ $0.00 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $0.00 6 Grading Material General Fill from Onsite Sources $ 332,307.00 $332.307.00 $0.00 $0.00 $332.307.00 100% $ $0.00 7 Geotextile Type 1 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 8 Gas venting layer from on site $ 171.900.00 $171,900.00 $0.00 $0.00 $171,900.00 100% $ $0.00 9 60 Mil textured HDPE Geomembrane $ 887,009.16 $887,009.16 $0.00 $0.00 $887.009.16 100% $ $0.00 10 Landfill Gas Vents $ 58.016.00 $58.016.00 $0.00 $0.00 $58.016.00 100% $ $0.00 11 Geocomposite $ 288.044.40 $288,044.40 $0.00 $0.00 $288.044.40 100% $ $0.00 12 Barrier Protection Layer from Onsite Sources $ 300,615.00 $300.615.00 $0.00 $0.00 $300.615.00 100% $ $0.00 13A Vegetative Growth Med Using On Site Comp(FO1) $ 200.074.00 $200,074.00 $0.00 $0.00 $200.074.00 100% $ $0.00 0 Contingency Topsoil Off Site(per FO 1) $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 Erosion Control Blanket $ 360.868.89 $360.868.89 $0.00 $0.00 $360,868.89 100% $ $0.00 15 Erosion Control Fabric $ 60.630.00 $60,630.00 $0.00 $0.00 $60.630.00 100% $ $0.00 16 Hydroseeding $ 69.264.40 $69.264.40 $0.00 $0.00 $69,264.40 100% $ $000 17 Landscaping $ 45.291.00 $45,291.00 $0.00 $0.00 $45.291.00 100% $ $0.00 18 Rip Rap Stone Fill.Gravel& Reno Mattress $ 266.907.00 $266.907.00 $0.00 $0.00 $266.907.00 100% $ $0.00 19A 6-Foot High Fencing $ 67.855.50 $67.855.50 50.00 $0.00 $67.855.50 100% $ - $0.00 'I 19B 12-Foot High Fencing $ 11.622.90 $11,622.90 50.00 $0.00 $11.622.90 100% $ - $0.00 19C Gates S 11,976.00 $11.976.00 $0.00 $0.00 $11.976.00 100% $ $0.00 20 Maintenance Road 6"Deep RCA $ 13.608.00 $13.608.00 $0.00 $0.00 $13.608.00 100% $ 50.00 21 Maintenance Road 12"Deep RCA $ 61.915.00 $61.915.00 50.00 $0.00 $61,915.00 100% $ $0.00 $ 4,097.276.28 $4.097.276.28 $0.00 $0.00 $4.097.276.28 $ $0.00 AIA Documefit G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 15 Contractor's Signed Certification is attached. APPLICATION DATE: 09/16/05 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D + E) (NOT IN TO DATE D OR E) (D + E + F) 22 Main Access Road 177650 $206.511.75 $206.511.75 $0.00 $0.00 $206,511.75 100% $ $0.00 23 Guide Rail $78.000.00 $78.000.00 $0.00 $0.00 $78.000.00 100% $ $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $2.100.00 $2.100.00 $0.00 $0.00 $2.100.00 100% $ $0.00 24B New Landfill Gas Monitoring Wells $42,560.00 $42.560.00 $0.00 $0.00 $42,560.00 100% $ $0.00 25A Abandon Existing Groundwater Monitoring Wells $22.640.00 $22.640.00 $0.00 $0.00 $22.640.00 100% $ $0.00 258 New Groundwatering Monitoring Wells $25.200.00 $25.200.00 $0.00 $0.00 $25,200.00 100% $ $0.00 26 Drain Pipe In/Outlet Structures,Stilling Basins MH $65.528.00 $65,528.00 $0.00 $0.00 $65,528.00 100% $ $0.00 • Swale Under Drains Anchor Trenches $60.000.00 $60,000.00 $0.00 $0.00 $60.000.00 100% $ $0.00 Water Supply Well and Electrical Services $4.000.00 $4,000.00 $0.00 $0.00 $4,000.00 100% $ $0.00 29 Siren&Electrical&Telephone Service. $92.000.00 $92,000.00 $0.00 $0.00 $92,000.00 100% $ $0.00 30 Sand Pit Regrading $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 31 $0.00 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10.800.00 100% $ $0.00 33 Waste Import $64.385.00 $64,385.00 $0.00 $0.00 $64.385.00 100% $ $0.00 34 Screening 17-acre Material/stone for Gas Trenches $40.000.00 $40.000.00 $0.00 $0.00 $40.000.00 100% $ $0.00 35 Spreading of Greenport Pond Material $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 36 Southeastern Drainage Diversion System $218.354.00 $218.354.00 $0.00 $0.00 $218.354.00 100% $ $0.00 37 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ $0.00 38 Consolidation of unscreened compost in BP-CAT 322 $2,156.00 $2.156.00 $0.00 $0.00 $2.156.00 100% $ $0,00 39 Comsoildation of unscreened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2.965.63 100% $ $0.00 40 Consolidation of unscreened compost in BP-CAT D7 $2.925.00 $2.925.00 $0.00 $0.00 $2,925.00 100% $ $0.00 41 Grading of Eastern Hill-CAT D7 $11.025.00 $11.025.00 $0.00 $0.00 $11.025.00 100% $ $0.00 42 Separate Loam for Production of VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $0.00 43 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ $0.00 44 Screening of Unscreened Compost-Trommel 725 $15.675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ - $0.00 46 Temporary Asphalt Apron $2.835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ - $0.00 46 Surcharge for Black Vinyl Fencing $3.995.00 $3,995.00 $0.00 $0.00 $3,995.00 100% $ $0.00 • Testing of 17-acre Sand for Gas Venting&BPL $12,970.00 $12.970.00 $0.00 $0.00 $12,970.00 100% $0.00 Enlargement&Construction Changes to Recharge Basin 3 $64.667.14 $64.667.14 $0.00 $0.00 $64.667.14 100% $0.00 49 Segmented Installation of Geomembrane for 17-acre-Road $48,479.80 $48.479.80 $0.00 $0.00 $48.479.80 100% $0.00 50 Additional Surveying $58,943.90 $58.943.90 $0.00 $0.00 $58.943.90 100% $0.00 51 Gas Migration Control Trench Extension-Scale House $8.698.00 $8.698.00 $0.00 $0.00 $8,698.00 100% $0.00 52 Liner Installation Around Eastern Drainage System Catch B $1.300.78 $1.300.78 $0.00 $0.00 $1,300.78 100% $0.00 53 Final Grading of Recharge Basins 1&2 $4,800.00 $4.800.00 $0.00 $0.00 $4,800.00 100% $ $0.00 54 Transition Area Grading $8.800.00 $8,800.00 $0.00 $0.00 $8.800.00 100% $0.00 55 Relocation of Maintenance Raod Along McBride Property $7,200.00 $7,200.00 $0.00 $0.00 $7.200.00 100% $0.00 Extra Gas Migration Control Trench Vents and Turbines $0.00 $0.00 $0.00 $0.00 $0.00 0% $0,00 56 Elimination of Waterproffing Manholes-SW Drainage syste ('52,100.00) (52,100.00) $0.00 $0.00 ($2,100.00) 0% $0.00 57 Elimination of Truck Stand ($700.00) ($70000) $0.00 $0.00 ($700.00) 0% $0.00 58 Substitution of Curlex for Erosion Control Blanket ($6,221-50) (56,221.50) $0.00 $0.00 ($6,221.50) 0% $0.00 59 Catch Basin and Pipe by Scale $6.850.00 1 $6.850.00 1 1 $0.00 $0.00 1 $6.850.00 100% $0.00 $1,188.774.75 $1.188.774.75 1 1 $0.00 $0.00 1 $1.188.774.75 $ $0.00 $5,286,051.03 $5.286.051.03 $0.00 $0.00 $ 1 $0.00 $0.00 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 15 Contractor's signed Certification is attached. APPLICATION DATE: 9/16/2005 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 9/11/2003 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H 1 ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D + E) (NOT IN TO DATE D OR E) (D + E + F) 60 RCA for Borrow Pit Turnaround $14.720.00 $14.720.00 $0.00 $0.00 $14,720.00 100% $0.00 $0.00 61 Paving Center Access Road $25.200.00 $25,200.00 $0.00 $0.00 $25.200.00 100% $0.00 $0.00 62 Wildflower Seed $1,300.00 $1.300.00 $0.00 $0.00 $1.300.00 100% $0.00 $0.00 63 Extra Rebar in Headwalls $1.716.00 $1.716.00 $0.00 $0.00 $1.716.00 100% $0.00 $0.00 64 Paving Extra for Segmented Installation $3.250.00 $3,250.00 $0.00 $0.00 $3.250.00 100% $0.00 $0.00 65 Split Rail Fence Southern Boundary of Cap $6.221.50 $6,221.50 $0.00 $0.00 $6.221.50 100% $0.00 $0.00 66 Temporary Fencing $5.293.75 $5,293.75 $0.00 $0.00 $5.293.75 100% $0.00 $0.00 • $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $000 $0.00 $0.00 $000 $0.00 $0.00 $57.701.25 $57,701.25 $0.00 $0.00 $57.701.25 $0.00 $0.00 $ 5,343,752.28 $5.343.752.28 0.00 0.00 £5.343.752.28 S0_00 $0_00 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: TOWN OF SOUTHOLD PROJECT_ APPLICATION: 15 Distribution to: 53095 Main Road Southold Landfill Closure I (OWNER Southold.NY 11971 PERIOD TO: 09,1 1-03 [ 1 ARCHITECT I ICONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 1 1901 Woodbury,New York 11797-2015 CONTRACT DATE: 01,31,01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 previous months by Owner Change Orders 1 to 12 2. Net change by Change Orders $ 127,385.78 TOTAL $317,939.00 $0.00 3. CONTRACT SUM TO DATE (Line 1 + 2 ) $ 5,343,752.28 Approved this Month 4. TOTAL COMPLETED & STORED TO DATE $ 5,343,752.28 Date Approved (Column G on G703) 3 6/1/2003 ($180,543.22) 5. RETAINAGE: a: 0_%_of Completed Work $ (Col umn D + E on G703) $0.00 b:_0_% of Stored Material $ Net Change by Change Orders $127,395.78 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage (Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ 5,343,752.28 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT (Line 6 from prior Certificate) $ 5,293,752.28 8. CURRENT PAYMENT DUE $ 50,000.00 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ - (Line 3 less Line 6) State of: &U dunk County,of: S0 f bL Subscribed and shown�pto before me thi /� day of rJ 20 � By: Date: ib Notary Public: C 01�a. �, 626i'-Z My Commission pires; U ULGINEER'S CERTIFIC OR PAYMENT AMOUNT CERTIFIED $ 15—e:! ncryU 11111111111111111111111�rdance with the Contract Documents,based on on-site observations and the (Attach explan ' n if amount certified differs from a amount appUed for.) d comprising the above application,the Engineer certifies to the owner that to the ENG :< best of the Engineer's knowledge,information and belief the Work has progressed as i indicated,the quality of the Work is in accordance with the Contract Documents,and By: 1�-� Date: lO -' `-e2 j the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This CerYicate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County 3 Commission Expires 0342.20„V 7 ' v CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 15 Contractor's signed Certification is attached. APPLICATION DATE: 09/16/05 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED IC-G) (D + E) (NOT IN TO DATE D OR E) (D + E + F) Pre-Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208.000,00 100% $ $0.00 2 Mobil.,Maint.Demobilization $ 102.000.00 $102,000.00 $0.00 $0.00 $102.000.00 100% $ $0.00 3 Clearing and Grubbing $ 18,000.00 $18,000.00 $0.00 $0.00 $18.000.00 100% $ $0.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 421,425.00 $421.425.00 $0.00 $0.00 $421.425.00 100% $ $0.00 5A Removal&Relandfilling Of Burled Waste&FIII 1-Survey $ 13.627.60 $13,627.60 $0.00 $0.00 $13.627.60 100% $ $0.00 58 Excavation of Gas Migration Control Trenches $ 15,576.00 $15,576.00 $0.00 $0.00 $15.576.00 100% $ $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9.000.00 $9,000.00 $0.00 $0.00 $9.000.00 100% $ $0.00 5D Waste Excavation Area 2-C.0.4 $ 48,395.00 $48,395.00 $0.00 $0.00 $48.395.00 100% $ $0.00 5E Waste Excavation Area 3-C,0.4 $ 49.726.55 $49,726.55 $0.00 $0.00 549.726.55 100% $ $0.00 5F Waste Excavation Area 4 $ 2.678.10 $2.678.10 $0.00 $0.00 $2.678.10 100% $ $0.00 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $0.00 6 Grading Material General Fill from Onsite Sources $ 332.307.00 $332,307.00 $0.00 $0.00 $332.307.00 100% $ $0.00 7 Geotextile Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 8 Gas venting layer from on site $ 171,900.00 $171,900.00 $0.00 $0.00 $171,900.00 100% $ $0.00 9 60 Mil textured HDPE Geomembrane $ 887.009.16 $887,009.16 $0.00 $0.00 $887.009.16 100% $ $0.00 10 Landfill Gas Vents $ 58.016.00 $58.016.00 $0.00 $0.00 $58.016.00 100% $ $0.00 11 Geocomposite $ 288.044.40 $288,044.40 $0.00 $0.00 $288.044.40 100% $ $0.00 12 Barrier Protection Layer from Onsite Sources $ 300.615.00 $300.615.00 $0.00 $0.00 $300.615.00 100% $ 50.00 13A Vegetative Growth Med Using On Site Comp(FO1) $ 200.074.00 $200,074.00 $0.00 $0.00 $200.074.00 100% $ $0.00 10Contingency Topsoil Off Site(per 1`01) $ $0.00 $0.00 $0.00 $0.00 0% $ 50.00 1 Erosion Control Blanket $ 360.868.89 $360.868.89 $0.00 $0.00 $360.868.89 100% $ $0.00 15 Erosion Control Fabric $ 60.630.00 $60.630.00 $0.00 $0.00 $60.630.00 100% $ $0.00 16 Hydroseeding $ 69.264.40 $69.264.40 $0.00 $0.00 $69.264.40 100% $ $0.00 17 Landscaping $ 45.291.00 $45.291.00 $0.00 $0.00 $45,291.00 100% $ $0,00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 266.907.00 $266.907.00 $0.00 $0.00 $266.907.00 100% $ $0.00 19A 6-Foot High Fencing $ 67.855.50 $67,855.50 $0.00 $0.00 $67,855.50 100% $ - $0.00 19B 12-Foot High Fencing $ 11.622.90 $11.622.90 $0.00 $0.00 $11.622.90 100% $ - $0.00 19C Gates $ 11,976.00 $11.976.00 $0.00 $0.00 $11.976.00 100% $ $0.00 20 Maintenance Road 6"Deep RCA $ 13,608.00 $13.608.00 $0.00 $0.00 $13.608.00 100% $ $0.00 [:T tenance Road 12"Deep RCA $ 61.915.00 $61,915.00 $0.00 $0.00 $61.915.00 100% $ $0.00 $ 4.097.276.28 $4,097.276.28 $0.00 $0.00 $4.097.276.28 1 $ - $0.00 AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 15 Contractor's signed Certification is attached. APPLICATION DATE: 09/16/05 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D + E) (NOT IN TO DATE D OR E) (D + E + F) 22 Main Access Road 177650 $206.511.75 $206.511.75 $0.00 $0.00 $206.511.75 100% $ $0.00 23 Guide Rail $78.000.00 $78.000.00 $0.00 $0.00 $78.000.00 100% $ $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $2,100.00 $2.100.00 $0.00 $0.00 $2.100.00 100% $ $0.00 248 New Landfill Gas Monitoring Wells $42,560.00 $42.560.00 $0.00 $0.00 $42.560.00 100% $ $0.00 25A Abandon Existing Groundwater Monitoring Wells $22.640.00 $22,640.00 $0.00 $0.00 $22.640.00 100% $ $0.00 25B New Groundwatering Monitoring Wells $25.200.00 $25,200.00 $0.00 50.00 $25,200.00 100% $ $0.00 26 Drain Pipe In/Outlet Structures,Stilling Basins MH $65.528.00 $65.528.00 $0.00 $0.00 $65,528.00 100% $ $0.00 iSwale Under Drains Anchor Trenches $60.000.00 $60.000.00 $0.00 $0.00 $60.000.00 100% $ $0.00 Water Supply Well and Electrical Services $4.000.00 $4.000.00 $0.00 $0.00 $4.000.00 100% $ $0.00 29 Siren&Electrical&Telephone Service. $92.000.00 $92.000.00 $0.00 $0.00 $92,000.00 100% $ $0.00 30 Sand Pit Regrading $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 31 $0.00 32 Test Pitting $10,800.00 $10.800.00 $0.00 $0.00 $10.800.00 100% $ $0.00 33 Waste Import $64.385.00 $64.385.00 $0.00 $0.00 $64.385.00 100% $ $0.00 34 Screening 17-acre Materlal/Stone for Gas Trenches $40.000.00 $40.000.00 $0.00 $0.00 $40.000.00 100% $ $0.00 35 Spreading of Greenport Pond Material $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 36 Southeastern Drainage Diversion System $218.354.00 $218.354.00 $0.00 $0.00 $218,354.00 100% $ $0.00 37 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ $0.00 38 Consolidation of unscreened compost in BP-CAT 322 $2.156.00 $2,156.00 $0.00 $0.00 $2.156.00 100% $ $0.00 39 Comsoildation of unscreened compost in BP-CAT 980 $2.965.63 $2,965.63 $0.00 $0.00 $2.965.63 100% $ $0.00 40 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2.925.00 $0.00 $0.00 $2,925.00 100% $ $0.00 41 Grading of Eastern Hill-CAT D7 $11.025.00 $11.025.00 $0.00 $0.00 $11.025.00 100% $ $0.00 42 Separate Loam for Production of VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $0.00 43 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ - $0.00 44 Screening of Unscreened Compost-Trommel 725 $15.675.00 $15.675.00 $0.00 $0.00 515.675.00 100% $ - $0.00 45 Temporary Asphalt Apron $2,835.00 $2.835.00 $0.00 $0.00 $2.635.00 100% $ - $0.00 46 Surcharge for Black Vinyl Fencing $3.995.00 $3.995.00 $0.00 $0.00 $3.995.00 100% $ $0.00 • Testing of 17-acre Sand for Gas Venting&BPL $12.970.00 $12.970.00 $0.00 $0.00 $12.970.00 100% $0.00 Enlargement&Construction Changes to Recharge Basin 3 $64.667.14 $64.667.14 $0.00 $0.00 $64.667.14 100% $0.00 49 Segmented Installation of Geomembrane for 17-acre-Road $48,479.80 $48.479.80 $0.00 $0.00 $48.479.80 100% $0.00 50 Additional Surveying $58,943.90 $58.943.90 $0.00 $0.00 $58.943.90 100% $0.00 51 Gas Migration Control Trench Extension-Scale House $8.698.00 $8.698.00 $0.00 $0.00 $8.698.00 100% $0.00 52 Liner Installation Around Eastern Drainage System Catch B $1.300.78 $1.300.78 $0.00 $0.00 $1.300.78 100% $0.00 53 Final Grading of Recharge Basins 1&2 $4.800.00 $4.800.00 $0.00 $0.00 $4.800.00 100% $ $0.00 54 Transition Area Grading $8.800.00 $8.800.00 $0.00 $0.00 $8.800.00 100% $0.00 55 Relocation of Maintenance Raod Along McBride Property $7.200.00 $7.200.00 $0.00 $0.00 $7.200.00 100% $0.00 Extra Gas Migration Control Trench Vents and Turbines $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 56 Elimination of Waterproffing Manholes-SW Drainage syste ($2,100.00) (52,100.01)) $0.00 $0.00 t$2,100.00) 0% $0.00 57 Elimination of Truck Stand ($70im)(1) ($70000) $0.00 $0.00 ($700.00) 0% $0.00 58 Substitution of Curlex for Erosion Control Blanket (S6,221.50) ($6,221.50) $0.00 $0.00 ($6,221,50) 0% $0.00 59 Catch Basin and Pipe by Scale 1 $6.850.00 1 $6.850.00 1 $0.00 $0.00 56.850.00 100% 1 $0.00 $1.188.774.75 $1.188.774.75 $0.00 $0.00 $1.188.774.75 $ - 50.00 $5,286.051.03 $5,286.051.03 $0.00 $0.00 $5.286.051.03 1 $0.00 $0.00 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 15 Contractor's signed Certification is attached. APPLICATION DATE: 9/16/2005 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 9/11/2003 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED IC-G) (D + E) (NOT IN TO DATE D OR E) (D + E + F) 60 RCA for Borrow Pit Turnaround $14,720.00 $14,720.00 $0.00 $0.00 $14,720.00 100% $0.00 $0.00 61 Paving Center Access Road $25.200.00 $25,200.00 $0.00 $0.00 $25,200.00 100% $0.00 $0.00 62 Wildflower Seed $1.300.00 $1,300.00 $0.00 $0.00 $1.300.00 100% $0.00 $0.00 63 Extra Rebar in Headwalls $1.716.00 $1,716.00 $0.00 $0.00 $1.716.00 100% $0.00 $0.00 64 Paving Extra for Segmented Installation $3,250.00 $3,250.00 $0.00 $0.00 $3.250.00 100% $0.00 $0.00 65 Split Rail Fence Southern Boundary of Cap $6.221.50 $6,221.50 $0.00 $0.00 $6,221.50 100% $0.00 $0.00 66 Temporary Fencing $5,293.75 $5.293.75 $0.00 $0.00 $5.293.75 100% $0.00 $0.00 $000 $0.00 $0.00 $0.00 $0.00 $000 $0.00 $0.00 $000 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $57,701.25 $57,701.25 $0.00 $0.00 $57.701.25 $0.00 $0.00 $ 5,343,752.28 55.343,752.28 0.00 $0.00 $5,343.752.28 0.00 $0_00 'L16A i 1 VIV A14L) %.GIS 1 1r 1\.A 1 m r VK r'A I IVILI-41 AIA UUCUMtN I U/U;d NAUt UNt Uh 4 VAUhb ' TOWN OF SOUTHOLD PROJECT: APPLICATION: 14 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 09/11/03 [ ]ARCHITECT .. [ ]CONTRACTOR (CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 tACT FOR: JTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,In connection with the Contract. Continuation Sheet,AIA Document G703,is attached. iE ORDER SUMMARY s Orders approved in ADDITIONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 u months by Owner Change Orders 1 to 12 2. Net change by Change Orders $ 127,385.78 TOTAL $317929.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 +2) $ 5,343,752.28 ad this Month 4. TOTAL COMPLETED&STORED TO DATE $5,343,752.28 r Date Approved (Column G on G703) 13 6/1/03 5. RETAINAGE; a:_0_%,—of Completed Work $0.00 (Col umn D+ E on G703) ($190,543.22) b:—% of Stored Material $ - range by Change Orders $127,385.78 $0.00 (COI umn F on G703) Tdersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+5b or ation and belief the Work covered by the Application for Payment has been Total in Column I of G703 $0.00 sted In accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $5,343,752.28 ythe Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) I and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR is now due. PAYMENT(Line 6 from prior Certificate) $ 5,076,564.67 8. CURRENT PAYMENT DUE $267,187.61 TRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ 0.00 Line 3 less Line 6 State of: County of: Q —1 Subscribed an shown beforo a this^, _ / day o 2003 0 Date: ! /y o:3 Notary Public: M Commissio expi • :INEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 4i M17161/4 ordance with the Contract Documents,based on on-site observations and the (Attach explanation If amount certified differs from the amount applied for.) TT omprising the above application,the Engineer certifies to the owner that to the ENGINF,.ER: f the Engineer's knowledge,information and belief the Work has progressed as /� f�� l ted,the quality of the Work Is in accordance with the Contract Documents,and .2y— �/' Date: .Y�s/ !? mtractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only tgqhe Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE STATE OF NEW YORK *G•`r, �tc,,c %b! NOTARY�t oL01MCGO56936 Certified in&dtdk Countyc„�.... GGr .20 Commission Expires 03.12 -.L 0 ITINUATION SHEET AIA DOCUMENT G703 PAGE 2OF3 PAGES ;ument G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 14 tor's signed Certification is attached. APPLICATION DATE: 09/11/03 ations below,amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 umn 1 on Contracts where variable retainage for line Items may apply. ARCHITECT'S PROJECT NO: 2000 B C D E F G H I DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C"G) (D+E) (NOT IN TO DATE DORE) (D+E+F Pre-Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ $0.00 Mobil.,Maim.Demobilization $ 102,000.00 $102,000.00 $0.00 $0.00 $102,000.00 100% $ $0.00 Clearing and Grubbing $ 18,000.00 $18,000.00 $0.00 $0.00 $18,000.00 100% $ $0.00 Unclassified Excay.&Relandfill(per FOI)Survey $ 421,425.00 $421,425.00 $0.00 $0.00 $421,425.00 100% $ $0.00 Removal&Reland80ing of Buried Waste&Pill 1-Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ $0.00 Excavation of Gas Migration Control Trenches $ 15,576.00 $15,576.00 $0.00 $0.00 $15,578.00 100% $ $0.00 Removal&RelandfilAng of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ $0.00 Waste Excavation Area 2-C.0.4 $ 48,395.00 $48,395.00 $0.00 $0.00 $48,395.00 100% $ $0.00 Waste Excavation Area 3-C.0.4 $ 49,726.55 $49,726.55 $0.00 $0.00 $49,726.55 100% $ $0.00 Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ $0.00 Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $0.00 Grading Material General FBI from Onsite Sources $ 332,307.00 $332,307.00 $0.00 $0.00 $332,307.00 100% $ $0.00 Geotextile Type 1 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 Gas venting layer from on site $ 171,900.00 $171,900.00 $0.00 $0.00 $171,900.00 100% $ $0.00 60 Mil textured HDPE Geomembrane $ 887,009.16 $887,009.16 $0.00 $0.00 $887,009.16 100% $ $0.00 Landfill Gas Vents $ 58,016.00 $58,016.00 $0.00 $0.00 $58,016.00 100% $ $0.00 Geocomposite $ 288,044.40 $288,044.40 $0.00 $0.00 $288,044.40 100% $ $0.00 Barrier Protection Layer from Onsite Sources $ 300,815.00 $300,615.00 $0,00 $0.00 $300,615.00 100% $ $0.00 Vegetative Growth Med Using On Site Comp(FO1) $ 200,074.00 $200,074.00 $0.00 $0.00 $200,074.00 100% $ $0.00 Contingency Topsoil Off Ske(per F01) $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 Erosion Control Blanket $ 360,868.89 $360,868.89 $0.00 $0.00 $360,868.89 100% $ $0.00 Erosion Control Fabric $ 60,630.00 $60,630.00 $0.00 $0.00 $60,630.00 100% $ $0.00 Hydroseeding $ 69,264.40 $69,264.40 $0.00 $0.00 569,264.40 100% $ $0.00 Landscaping $ 45,291.00 $45,291.00 $0.00 $0.00 $45,291.00 100% $ $0.00 Rip Rap Stone Fill,Gravel& Reno Mattress $ 266,907.00 $266,907.00 $0.00 $0.00 $266,907.00 100% $ $0.00 6-Foot High Fencing $ 67,855.50 $67,855.50 $0.00 $0.00 $67,855.50 100% $ $0.00 12-Foot High Fencing $ 11,622.90 $11,622.90 $0.00 $0.00 $11,622.90 100% $ $0.00 Gates $ 11,976.00 $11,976.00 $0.00 $0.00 $11,976.00 100% $ $0.00 Maintenance Road 6"Deep RCA $ 13,608.00 $13,608.00 $0.00 $0.00 $13,608.00 100% $ $0.00 Maintenance Road 12"Deep RCA Is 61,915.001 $61,915.00 1 1 $0.00 $0.00 1 $61,915.00 1 100% 1$ $0.00 $ 4,097,276.28 $4,097,276.28 $0.00 $0.00 $4,097,276.28 $ $0.00 ..�v...,.nn.,,,, ... ".,„ rwe�,rv,.n,.v....,,,awn r vn r n t mcg•t, �unsarrurrg APPLICATION NUMBER: 14 Page 3 of 4 ontractor's signed Certification is attached. APPLICATION DATE: 09/11/03 I tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 se Colunin 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 ` A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+ 22 Main Access Road $206,511.75 $206,511.75 $0.00 $0.00 $206,511.75 100% $ $0.00 23 Guide Rail $78,000.00 $78,000.00 $0.00 $0.00 $78,000.00 100% $ $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $2,100.00 $2,100.00 $0.00 $0.00 $2,100.00 100% $ $0.00 24B New Landfill Gas Monitoring Wells $42,560.00 $42,560.00 $0.00 $0.00 $42,560.00 100% $ $0.00 25A Abandon Existing Groundwater Monitoring Wells $22,640.00 $22,640.00 $0.00 $0.00 $22,640.00 100% $ $0.00 25B New Groundwatering Monitoring Wells $25,200.00 $25,200.00 $0.00 $0.00 $25,200.00 100% $ $0.00 R in Plpe In/Outlet Structures,Stilling Basins MH $65,528.00 $65,528.00 $0.00 $0.00 $65,528.00 100% $ - $0.00 Swale Under Drains Anchor Trenches $60,000.00 $60,000.00 $0.00 $0.00 $60,000.00 100% $ $0.00 b Water Supply Well and Electrical Services $4,000.00 $4,000.00 $0.00 $0.00 $4,000.00 100% $ $0.00 29 Siren&Electrical&Telephone Service. $92,000.00 $92,000.00 $0.00 $0.00 $92,000.00 100% $ - $0.00 30 Sand Pit Regrading $0.00 $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ - $0.00 33 Waste Import $64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $0.00 34 Screening 17-acre Material/Stone for Gas Trenches $40,000.01) $40,000.00 $0.00 $0.00 $40,000.00 100% $ - $0.00 35 Spreading of Greenport Pond Material $0.00 $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 36 Southeastern Drainage Diversion System $218,354.00 $218,354.00 $0.00 $0.00 $218,354.00 100% $ $0.00 37 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.0D 100% $ $0.00 38 Consolidation of unscreened compost in BP-CAT 322 $2,156.00 $2,156.00 $0.00 $0.00 $2,156.00 100% $ $0.00 39 Consolidation of unscreened compost in SP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ $0.00 40 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.00 $2,925.00 100% $ $0.00 41 Grading of Eastern Hill-CAT D7 $11,025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ $0.00 42 Separate Loam for Production of VGM-Cat 06 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $0.00 43 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ $0.00 44 Screening of Unscreened Compost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ $0.00 45 Temporary Asphalt Apron $2,835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ $0.00 R Surcharge for Black Vinyl Fencing $3,995.00 $3,995.00 %).DO $0.00 $3,995.00 100% $ $0.00 resting of 17-acre Sand for Gas Venting&BPL $12,970.00 $12,970.00 $0.00 $0.00 $12,970.00 100% $ $0.00 b Enlargement&Construction Changes Recharge Basin 3 $64,667.14 $64,667.14 $0.00 $0.00 $64,667.14 100% $ $0.00 49 Segmented Installation of Geomembrane for 17-acre Road $48,479.80 $48,479.80 $0.00 $0.00 $48,479.80 100% $ $0.00 50 Additional Surveying $58,943.90 $58,943.90 $0.00 $0.00 $58,943.90 100% $ $0.00 51 Gas Migration Control Trench Extension-Scale House Area $808.00 $8,698.00 $0.00 $0.00 $8,698.00 100% $ $0.00 52 Liner Installation Around Eastern Drainage System C.B.1 $1,300.78 $1,300.78 $0.00 $0.00 $1,300.78 100% $ $0.00 53 Final Grading of Recharge Basins 1&2 $4,800.00 $4,800.00 $0.00 $0.00 $4,800.00 100% $ $0.00 54 Transition Area Grading $8,800.00 $8,800.00 $0.00 $0.00 $8,800.00 100% $ $0.00 55 Relocation of Maintenance Road Along McBride Property $7,200.00 $7,200.00 $0.00 $0.00 $7,200.00 100% $ $0.00 Extra Gas Migration Control Trench Vents&Turbines 10.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 56 Elimination of Waterproofing Manholes along SW drainage Syste ($2,100.00) $0.00 $0.00 $0.00 ($2,100.00) 0% $ $0.00 57 Eliminaton of Truck Stand ($700.00) $0.00 $0.00 $0.00 ($700.00) 0% $ $0,00 58 Substitution of Cudexfor erosion Control Blanket ($6,221.50) $0.00 $0.00 $0.00 ($6,221.50) 0% $ $0.00 59 Catch Basin and Pipe by Scale $6,850.00 $6,850.00 $0.00 $0.00 $6,850.00 100% $ $0.00 $ $0.00 $ $0.00 $1,188,774.75 $1,197,796.25 $0.00 $0.00 $1,188,774.75 $ $0.00 $5.286.051.()3 5 0.OO Vendor No. v /� p i�Bei k*i�'�9�y�y{,�'• �*��tt�ir�Fp��1�M�}]��Y£�c�i i�F��i": Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Vendor Name kt 't� e-Syr.�� 1 Vendor Telephone Number § t y Vendor Contact sw ,f.. r i 3 € E, } } z k Invoice Invoice Invoice Net Purchase Order „�r i:�-�r ; ,� ,� t ..�X,�`� Number Date Total Discount Amount Claimed Number Description of Goods or Servicesy.. 7 YUai �, -y4 a .ASF tai,�o-h h*°Fhka y�y'qC t'rr e F l V.s"f-i } iF y+fY .J i4i b5 4 ! i tF,!�e }!d .�} :t 3'i •!f.!�tA'S ft �S�Y,t f/yXf a tFt }iz� Vii`?ri r ..yyi r P yr irk t'r 1 c } # i F#, r t C.�F r k=Xi t c .=fie•e K el i �a.` k 7r'iyc.;.f n�t;4?,4 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. SignatuTitle Signature K � Company Name / '47 'e Date Title Date c� O Vendor No. - - - --.-- Chcek Ncf, Town of Southold, New York - FAyrtlent Voucher Vendor Tax ID Number or Social Security Number Vendor Address _' '�° G `/ 16G i l West ��a�� Sf Vendor Name / ✓r r �✓-7-rG C �/7`� G �'�,'�o r! ,� yF rLi /� T Vendor Telephone Number :r 7 ,2 -7 7o Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services � 3c41 rty Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. y, a, JOBHUA Y.HOATON FATIRICIA A.FINNZGAN Fk r'• Supervisor TOWN ATTORNEY patr4rAa.9nnswnd4uwn.wutho1d ny.ue Town Hall,88095 Route 25 P.O. Box 1179 LC1W HULSE MONTFFUSCO Southold,Now York 11971»0959 ASMSTANT TOWN ATTORNEY Telephone(691)766.1989 1orLmont*fUwo@townmmtho1d.ny.u6 41 ` ► Facsimile(681)7WIS28 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD February 4, 2004 Mr. Robert Terry Terry Contracting and Materials, Inc. Marcy Avenue Riverhead, NY 11901 RE: Release of Claims Dear Mr. Terry: Pursuant to your telephone conversation with my secretary, Lynne, yesterday afternoon in connection with the referenced matter, we are enclosing a revised Release in the sum of$60,000.00 in full settlement of your claims. As you are aware, the Town Board has authorized me to present the enclosed Release to you for signature. Kindly review the Release and return a signed, notarized copy to me at your earliest convenience. If you have any questions, please do not hesitate to contact me. Thank you for your attention. ry truly yours atricia AFnne an Town Attorney PAF/lk Enclosure cc: Members of the Town Board RELEASE TO ALL TO WHOM THESE, PRESENTS SHALL COME OR MAY CONCERN, KNOW THAT,Terry Contracting and Materials,Inc., residing at Marcy Avenue, Riverhead,N.Y. 11901, Releasors, in consideration of the sum of Sixty Thousand ($60.000.00)dollars and no cents, received front the Town of Southold, Southold,N.Y., as Releasee,receipt of which is hereby acknowledged, releases and discharges the Town of Southold, its successors and assigns, from all actions,causes of action, suits, debts, accounts,agreements,damages, claims,and other demands which may have arisen out of the Landfill Closure Contract(dated April 2001)between Terry Contracting and Materials,Inc. and the Town of Southold up through and including September 10,2003. This release includes,but is not limited to,the following claims presented by Releasor in correspondence dated August 7, 2003 to Jim Bunchuk of the Town of Southold from Tom Maher ofDvirka& Bartilucci; Extra Topsoil(55,000), Extra Truck Hire($5,404 , Extra Trommel Screen($5,000), Insurance Extension ($9,575),Delay Claim($52,544), ' and Sand Pit Regrading($200,601). The Releasor acknowledges that the Landfill Closure Contract between Terry Contracting and Materials,Inc. and the Town of Southold dated April 2001 remains in full force and effect. This Release may not be changed orally. IN WITNESS WiEIt1rQF,the RELEASOR has hereunto set RELEASOR'S hand and , seal on the day of February, 2004. r� By: Robert TerT,11vult Terry Contracting and Materials,Inc. ` TERRY CONTRACTING & MATERIALS, INC. 840 WEST MAIN STREET RIVERHEAD,NY 11901 _ (631)727-0170 D E C E U V E JAN 2 8 2003 TOWN OF SOUTHOLD DEPT.OF SOLID WASTE January 26, 2004 Mr. James Bunchuck Town of Southold Solid Waste Management District P.O.Box 962 Cutchogue, NY 11935 Re: Town of Southold Voucher #20170 Dear Mr. Bunchuck: We are returning the enclosed find the Town of Southold payment Voucher #20170 for $ 55,000.00. Please issue a payment voucher for $60,000.00 per our original agreement. Sincerely, L4ert G. Terry President l• JM/jm Enclosure Arr11.116A i IUN ANU UtK I IFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 4 PAGES TO: TOWN OF*SOUTHOLD PRwrcT: APPLICATION: 14 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Stuthold.NY 11971 PERIOD TO: 09/11/03 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 previous months by Owner Change Orders 1 to 12 2. Net change by Change Orders $ 127,385.78 TOTAL $317,929.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 +2) $ 5,343,752.28 te d this Month 4. TOTAL COMPLETED&STORED TO DATE $5,343,752.28 r Date Approved (Column G on G703) 13 6/1/03 5. RETAINAGE: a:,0_y_of Completed Work $0.00 (Col umn D+ E on G703) ($190,543.22) b:_% of Stored Material $ - Net Change by Change Orders 1 $127,385.78 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $0.00 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $5,343,752.28 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ 5,076,564.67 8. CURRENT PAYMENT DUE $267,187.61 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ 0.00 Line 3 less Line 6 State of: W County of: Subscribed and shown -7day o to before me this 7 � 20 03 Date: r Notary Public:C •t�t�(�1 (_t �.- My Commission Jpires; 3 / GINEER'S IFICATE FOR PAYMENT AMOUNT CERTIFIED $ / /grf, ��+ cordance with the Contract Documents,based on on-site observations and the (Attach explanation if amt certified differs from the amount applied for.) ata comprising the above application,the Engineer certifies to the owner that to the ENGIN best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: M?_p the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only IVthe Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.10(;CLAVE NOTAAY PUBLIC STATE OF NEW YORK t� No.01 MCJW56936 C• A (a'ertthed in Suftolk County Commission Expires 03-12-20,-�„� — CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 14 Contractor's signed Certification is attached. APPLICATION DATE: 09/11/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 Use Column 1 on Contracts where variable retainage for line Items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE A11111111111111111 I D OR E) (D+E+F) re-Mobil'Ization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ $000 2 Mobil.,Maint.Demobilization $ 102,000.00 $102,000.00 $0.00 $0.00 $102,000.00 100% $ $0.00 3 Clearing and Grubbing $ 18,000.00 $18,000.00 $0.00 $0.00 $18,000.00 100% $ $0.00 4 Unclassified Excay.&Relandfill(per FOI)-Survey $ 421,425.00 $421,425.00 $0.00 $0.00 $421,425.00 100% $ $0.00 5A Removal&Relandfilling of Buried Waste&Fill 1-Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ $0.00 5B Excavation of Gas Migration Control Trenches $ 15,576.00 $15,576.00 $0.00 $0.00 $15,576.00 100% $ $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ $0.00 5D Waste Excavation Area 2-C.0.4 $ 48,395.00 $48,395.00 $0.00 $0.00 $48,395.00 100% $ $0.00 5E Waste Excavation Area 3-C.O.4 $ 49,726.55 $49,726.55 $0.00 $0.00 $49,726.55 100% $ $0.00 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ $0.00 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $0.00 6 Grading Material General Fill from Onsite Sources $ 332,307.00 $332,307.00 $0.00 $0.00 $332,307.00 100% $ $0.00 7 Geotextile Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 8 Gas venting layer from on site $ 171,900.00 $171,900.00 $0.00 $0.00 $171,900.00 100% $ $0.00 9 60 Mil textured HDPE Geomembrane $ 887,009.16 $887,009.16 $0.00 $0.00 $887,009.16 100% $ $0.00 10 Landfill Gas Vents $ 58,016.00 $58,016.00 $0.00 $0.00 $58,016.00 100% $ $0.00 11 Geocomposite $ 288,044.40 $288,044.40 $0.00 $0.00 $288,044.40 100% $ $0.00 12 Barrier Protection Layer from Onsite Sources $ 300,615.00 $300,615.00 $0.00 $0.00 $300,615.00 100% $ $0.00 13A Vegetative Growth Med Using On Site Comp(FO1) $ 200,074.00 $200,074.00 $0.00 $0.00 $200,074.00 100% $ $0.00 1 ontingency Topsoil Off Site(per F01) $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 osion Control Blanket $ 360,868.89 $360,868.89 $0.00 $0.00 $360,868.89 100% $ $0.00 15 Erosion Control Fabric $ 60,630.00 $60,630.00 $0.00 $0.00 $60,630.00 100% $ $0.00 16 Hydroseeding $ 69,264.40 $69,264.40 $0.00 $0.00 $69,264.40 100% $ $0.00 17 Landscaping $ 45,291.00 $45,291.00 $0.00 $0.00 $45,291.00 100% $ $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 266,907.00 $266,907.00 $0.00 $0.00 $266,907.00 100% $ $0.00 19A 6-Foot High Fencing $ 67,855.50 $67,855.50 $0.00 $0.00 $67,855.50 100% $ $0.00 19B 12-Foot High Fencing $ 11,622.90 $11,622.90 $0.00 $0.00 $11,622.90 100% $ $0.00 19C Gates $ 11,976.00 $11,976.00 $0.00 $0.00 $11,976.00 100% $ $0.00 20 Maintenance Road 6'Deep RCA $ 13,608.00 $13,608.00 $0.00 $0.00 $13,608.00 100% $ $0.00 21 Maintenance Road 12"Deep RCA $ 61,915.00 1 $61,915.00 1 1 $0.00 1 $0.00 1 $61,915.00 100% $ $0.00 $ 4,097,276.28 $4,097,276.28 $0.00 $0.00 $4,097,276.28 $ $0.00 ._ _.. _.. __,... _._...._......✓ va.......airllL -$I f A11TI"11, LUlitarmng APPLICATION NUMBER: 14 Page 3 of 4 Contractor's signed Certification is attached. APPLICATION DATE: 09/11/03 In tabulatiefns below, amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 Use Colump 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE No. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $206,511.75 $206,511.75 $0.00 $0.00 $206,511.75 100% $ $0.00 23 Guide Rail $78,000.00 $78,000.00 $0.00 $0.00 $78,000.00 100% $ $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $2,100.00 $2,100.00 $0.00 $0.00 $2,100.00 100% $ $0.00 24B New Landfill Gas Monitoring Wells $42,560.00 $42,560.00 $0.00 $0.00 $42,560.00 100% $ $0.00 25A Abandon Existing Groundwater Monitoring Wells $22,640.00 $22,640.00 $0.00 $0.00 $22,640.00 100% $ $0.00 25B New Groundwatering Monitoring Wells $25,200.00 $25,200.00 $0.00 $0.00 $25,200.00 100% $ $0.00 26 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $65,528.00 $0.00 $0.00 $65,528.00 100% $ $0.00 27 le Under Drains Anchor Trenches $60,000.00 $60,000.00 $0.00 $0.00 $60,000.00 100% $ $0.00 2 ater Supply Well and Electrical Services $4,000.00 $4,1X10.00 $0.00 $0.00 $4,000.00 100% $ $0.00 29 Siren&Electrical&Telephone Service. $92,000.00 $92,000.00 $0.00 $0.00 $92,000.00 100% $ $0.00 30 Sand Pit Regrading $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ $0.00 33 Waste Import $64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $0.00 34 Screening 17-acre Material/Stone for Gas Trenches $40,000.00 $40,000.01 $0.00 $0.00 $40,000.00 100% $ $0.00 35 Spreading of Greenport Pond Material $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 36 Southeastern Drainage Diversion System $218,354.00 $218,354.00 $0.00 $0.00 $218,354.00 100% $ $0.00 37 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ $0.00 38 Consolidation of unscreened compost in BP-CAT 322 $2,156.00 $2,156.00 $0.00 $0.00 $2,156.00 100% $ $0.00 39 Consolidation of unscreened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ $0.00 40 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.01 $2,925.00 100% $ $0.00 41 Grading of Eastern Hill-CAT D7 $11,025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ $0.00 42 Separate Loam for Production of VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $0.00 43 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ $0.00 44 Screening of Unscreened Compost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ $0.00 45 Temporary Asphalt Apron $2,835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ $0.00 46 Surcharge for Black Vinyl Fencing $3,995.00 $3,995.00 $0.00 $0.00 $3,995.00 100% $ $0.00 47 sting of 17-acre Sand for Gas Venting&BPL $12,970.00 $12,970.00 $0.00 $0.00 $12,970.00 100% $ $0.00 48 r,ement&Construction Changes Recharge Basin 3 $64,667.14 $64,667.14 $0.00 $0.00 $64,667.14 100% $ $0.00 49 Segmented Installation of Geomembrane for 17-acre Road $48,479.80 $48,479.80 $0.00 $0.00 $48,479.80 100% $ $0.00 50 Additional Surveying $58,943.90 $58,943.90 $0.00 $0.00 $58,943.90 100% $ $0.00 51 Gas Migration Control Trench Extension-Scale House Area $8,698.00 $8,698.00 $0.00 $0.00 $8,698.00 100% $ $0.00 52 Liner Installation Around Eastern Drainage System C.B.1 $1,300.78 $1,300.78 $0.00 $0.00 $1,300.78 100% $ $0.00 53 Final Grading of Recharge Basins 1&2 $4,800.00 $4,800.00 $0.00 $0.00 $4,800.00 100% $ $0.00 54 Transition Area Grading $8,800.00 $8,800.00 $0.00 $0.00 $8,800.00 100% $ $0.00 55 Relocation of Maintenance Road Along McBride Property $7,200.00 $7,200.00 $0.00 $0.00 $7,200.00 100% $ $0.00 Extra Gas Migration Control Trench Vents&Turbines $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 56 Elimination of Waterproofing Manholes along SW drainage Syste ($2,100.00) $0.00 $0.00 $0.00 ($2,100.00) 0% $ $0.00 57 Eliminaton of Truck Stand ($700.00) $0.00 $0.00 $0.00 ($700.00) 0% $ $0.00 58 Substitution of Cudex for erosion Control Blanket ($6,221.50) $0.00 $0.00 $0.00 ($6,221.50) 0% $ $0.00 59 Catch Basin and Pipe by Scale $6,850.00 $6,050.00 $0.00 $0.00 $6,850.00 100% $ $0.00 $ $0.00 $ $0.00 $1,188,774.75 $1,197.796.25 $0.00 $0.00 $1,188,774.75 $ - $0.J0000 5 286 051 03 5 295 072.53 0.00 0.00 5 286 1.03 $0.00 0. CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 14 Contractur's signed Certification is attached. APPLICATION DATE: 9/11/03 Ingtabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/11/03 Use Column 1 on Contracts where variable retainage for line Items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 60 RCA for Borrow Pit Turnaround $ 14,720.00 $14,720.00 $0.00 $0.00 $14,720.00 100% $ $0.00 61 Paving Center Access Road $ 25,200.00 $25,200.00 $0.00 $0.00 $25,200.00 100% $ $0.00 62 Wildflower Seed $ 1,300.00 $1,300.00 $0.00 $0.00 $1,300.00 100% $ $0.00 63 Extra Rebar in Headwalls $ 1,716.00 $1,716.00 $0.00 $0.00 $1,716.00 100% $ $0.00 6 Paving Extra for Segmented Installation $ 3,250.00 $3,250.00 $0.00 $0.00 $3,250.00 100% $ $0.00 Alit Rail Fence Southern Boundary of Cap $ 6,221.50 $6,221.50 $0.00 $0.00 $6,221.50 100% $ $0.00 Temporary Fencing $ 5,293.75 $5,293.75 $0.00 $0.00 $5,293.75 100% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 1 $0.00 $0.00 $0.00 0% $ - $0.00 $ 57,701.25 $57,701.25 $0.00 $0.00 $57,701.25 $0.00 $0.00 $ 5,343,752.28 $000 $0.00 $5.343.752.28 0.00 O' )i 3uutiit;[d. i s. t `lt u,, - Y aym,at v ouch,,, . ........ Vendor Tax Ill Number or Social Security Number Vendor Address 1130g6011 gYO wgs /1G,� Sf- Vendor Name baa Vendor Telephone Number , 72- 7- Vendor Contact Invoice Invoice Invoice Net Purchase Order X.. Number Date Total Discount Amount Claimed Number Description of Goods or Services ' i -mss: /be � r I i i Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. Signature Title SGS � - Signature r � Company Name Date W Title date7. C O �/ / Vendor No. ? 1iaok yff FY r G t 3 iE"i �#3 ;iJ Fr+t rid T i Town of Southold, New York - Payment VoucherIN Vendor Tax ID Number or Social Security Number Vendor Address Vendor NameAI / r 12 Vendor Telep one Number 7//moi / V nY I'➢" ^+w ',�r� R:t �q'� '''�,{air irr ; T y"'`"ch: Vendor Contact t.e> Y tit+*x$Cyt#s s€S't1`t a T k�.St •. 4 .j r+k Sy�G R T k i � a';'at``a➢#t�A^b '3,i a s�"d r p' F i�A ➢ R i 4� F ,Yk �" F .e}.'G wc, r �P}�i}F" _}r,•`'3t',.� ➢ rte. +".¢.yg;a t2b, Invoice Invoice Invoice Net Purchase Order h " " 1 i � _ '{'�^�+e f �s�iii t y3'��r�, + ➢�.�i�'� Number Date Total Discount Amount Claimed Number Description of Goods or Services ,, V F iG c➢iit uT T,"f{➢ lS� L�➢ Gl 1 # r3 #'ts � ➢ i /9 � �,, �� ➢ w ,� ,�� .V ➢ k Gye F; %v➢i r "��iv+r� ,i} > �� r.,�➢ t+ � jrt"i}�F G t➢ ri t.y,,�4 Y�v � �"s� � :t"` ',�x'�it{.. 7 A d'V'SIay,G yK9'r" "��,..y j+'➢L��r y,>➢} ,� RP i'� A },.k i�,�t j b r 3t�.0}4'+ $ t' + ➢` sY�i ri� }� * t 4, ± Ryt'�t4 i'�#y�➢e r' �➢ Y'�➢+t��irY�kr P �➢X�$r 'y"G* �'�t yi i �r G + f➢'.Wr'k ,raJiii ➢ a" x i re{i F y}' t r+rF 5'➢'R+ a" t Mt }, x�YS�'}f'iY t xR i � • i i �:.i� t.7S`s. "F -.'�Y.� t 'Y� i+�t i Y s�,� T 4 3➢, t+ i'S '" x x ➢" +t��h s � F^ +.�Y;r,�34 F; F}r i }�x ➢i va � 51'Y +�,, +;iF�+cn�:«f ,.Y"�iyy.1'•i�q ,r±.t»"�,Ss.G,�E.E .4�.an� k .r a� t,!.�M,'� i S :r i ➢ P �}� F: n I }, �. G ryTF Tx'} 5 14'Y'•$"R} YY`+{' t a,:' ,�"aa��I�':`¢}��'i. ��k;R$�Yt�w.N�GFF�}�➢y�r I,t}>�Tf}��y�T is a 3'+>��i4 s. yc Y F�K'Tr➢ e �a; ➢�➢➢ d `�r 7 t#�.�p a �e..>,7 xy+4.y➢ �. s -��iiG�x e+�s`.,F..:,+ i v>x....Fa,i Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. Signature '04- Title G�S Signature /'•'" G� Company Name Date �� 3 Title Date 3 Terry Contracting & Materialoc. 0 840 West Main Street Invoke No. 943 Riverhead,New York 11901 631-727-0170 Fax 631-727-0410 INVOICE Customer Name Town of Southold Department of Solid Waste Date 3/24/04 Address P.O.Box 962 Order No. City Cutchogue Rep State New York 11935 FOB Qty F Description Unit Price TOTAL Trees planted by Town of Southold: 2 Pagoda Dogwood $75.00 $150.00 2 San Jose Holly $60.00 $120.00 30 Peabody Arborvitae $10.00 $300.00 20 Sea Green Juniper $20.00 $400.00 10 Cryptomeria $140.00 $1,400.00 3 Alberta Spruce $40.00 $120.00 17 Norway Spruce $50.00 $850.00 SubTotal $3,340.00 Shipping & Handling $0.00 TOTAL $3,340.00 Terry Contracting & Materialec. • 840 west Main street Invoice No. 944 Riverhead,New York 11901 631-727-0170 Fax 631-727-0410 INVOICE Customer Name Town of Southold Department of Solid Waste Date 3/24/04 Address P.O.Box 962 Order No. City Cutchogue Rep State New York 11935 FOB Qty Description Unit Price TOTAL Noise Barrier Area South of Collection Center: 1 12'tall Hessian Noise Barrier $64,220.00 $64,220.00 SubTotal $64,220.00 Shipping & Handling $0.00 TOTAL $64,220.00 TERRY CONTRACTING & MATERIALS, INC. • 840 WEST MAIN STREET • RIVERHEAD,NY 11901 (631)727-0170 November 3, 2003 Mr. James Bunchuck Town of Southold Solid Waste Management District P.O.Box 962 Cutchogue,NY 11935 Re: Noise Barrier Area South of Collection Center Dear Mr. Bunchuck: Terry Contracting&Materials,Inc.proposes to furnish materials and labor to construct Hessian noise barrier including panels and galvanized steel posts as designed and as designed and as described below: QUANTITY DESCRIPTION PRICE Approx. 204 LF 12' tall Hessian Noise Barrier $64,220.00 Product Description: Quantity of 324 Hessian Series Noise Barrier Panels for 12' 0" post spacing and 12 foot wall height. Quantity of sixteen H-shaped(15* 12= 180 LF) And two (2* 12=24 LF)45-degree angle galvanized steel posts to meet 20 psf wind pressure which the manufacturer believes to be suitable for the project. The typical panel height is 8".Panel length is 11'101/4". Weight 400 lbs.Each Panel bearing pads: two for each bottom panel Color: brown panels,integral pigment,no coatings Reinforcing: epoxy coated . Panel Finish: Random Ribbed both sides Post Finish: galvanized unpainted steel Inclusions: Typical Shop Drawings for panels and posts Engineering with NY PE stamped calculations Wall elevation drawings Please contact us at 631-727-0170 if there are any questions. Sincerely, �Or Robert President JM/jm Tent' Contracting & Materials*. 840 West Main Street Invoic No. 945 Riverhead,New York 11901 631-727-0170 Fax 631-727-0410 INVOICE Customer Name Town of Southold Department of Solid Waste Date 3/24/04 Address P.O.Box 962 Order No. City Cutchogue Rep State New York 11935 FOB Qty Description Unit Price TOTAL Sand Pit Work, Each Machine$1800 per 8 hour Day: 3 9-15-03-330 Hydraulic Excavator, 980 CAT Payloader, $1,800.00 $5,400.00 D6LGP Dozer 3 9-16-03-330 Hydraulic Excavator, 980 CAT Payloader, $1,800.00 $5,400.00 D6LGP Dozer 3 9-17-03- 330 Hydraulic Excavator, 980 CAT Payloader, $1,800.00 $5,400.00 D6LGP Dozer 2 9-18-03-980 CAT Payloader, $1,800.00 $3,600.00 D6LGP Dozer SubTotal $19,800.00 Shipping & Handling $0.00 TOTAL $19,800.00 TERRAONTRACTING & MATERIAL,INC. 840 WEST MAIN STREET RIVERHEAD,NY 11901 (631)727-0170 Southold Landfill Closure Sand Pit Work Monday, 9-15-03: 330 Hydraulic Excavator 8 hrs $5,400.00 980 CAT Payloader 8 hrs D6LGP Dozer 8 hrs Tuesday, 9-16-03: 330 Hydraulic Excavator 8 hrs $5,400.00 980 CAT Payloader 8 hrs D6LGP Dozer 8 hrs Wednesday, 9-17-03: 330 Hydraulic Excavator 8 hrs $5,400.00 980 CAT Payloader 8 hrs D6LGP Dozer 8 hrs Thursday, 9-18-03: 980 CAT Payloader 8 hrs $3,600.00 D6LGP Dozer 8 hrs TOTAL $19,800.00 APPLICA:a ION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 4 PAGES TO: T .JN OF SOUTHO_D vR ccT - APPLICATION: 14 Distribution to: Y21095 Main Road , + 6outhordl- ndfill Closure [ ]OWNER 1 Southold.NY 1197: • ' _ PERIOD TO: 09/11/03 [ ]ARCHITECT • [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS). Terry Contracting&Materials.Inc Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 previous months by Owner Change Orders 1 to 12 2. Net change by Change Orders $ 127,385.78 TOTAL $317,929.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 +2) $ 5,343,752.28 App is Month 4. TOTAL COMPLETED&STORED TO DATE $5,343,752.28 Nu ate Approved (Column G on G703) 13 6/1/03 5. RETAINAGE: of Completed Work $0.00 (Col umn D+E on G703) ($190,54322) b:—% of Stored Material $ - Net Change by Change Orders $127,385.78 $0.00 (Col umn F On G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $0.00 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $5,343,752.28 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ 5,076,564.67 8. CURRENT PAYMENT DUE $267,187.61 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ 0.00 Line 3 less Line 6 State of: XQ,C.fJ County of: ,1 Subscribed a shown before me this^n, _ / n_ / day o .p o r�t 20 B : ."•• C /,'{, Date: C/" 7"O3 Notary Public `-C�lx7a-rr'� -`� _ My Commissioo exp �T'Q / Et CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In aceor with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as f indicated,the quality of the Work is in accordance with the Contract Documents,and By-, Date: .Tis' L•f the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only tWffie Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE *Com, NOTARY PUBLIC STATE OF NEWYORK No.01 MC6055 ;ertifed in Suffolk CountY _ G/� /� 4Z Corristion Expires 03t2-�� om-i. j•� , V NTI N UATI O N SHEET , • - AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 14 Contractor's signed Certification is attached. APPLICATION DATE: 09/11/03 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/11/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE Adftk D OR E) (D+E+F) 1 qq FLLmobiiizabon $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ $0.00 2 Mobil.,Maint.Demobkotion $ 102,000.00 $102,000.00 $0.00 $0.00 $102,000.00 100% $ $0.00 3 Clearing and Grubbing $ 18,000.00 $18,000.00 $0.00 $0.00 $18,000.00 100% $ $0.00 4 Unclassified Excay.&Relandfill(Der F01)-Survey $ 421,425.00 $421,425.00 $0.00 $0.00 $421,425.00 100% $ $0.00 SA Removal&Relandfilluag of buried Waste&Fill I-Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ - $0.00 5B Excavation of Gas Migration Control Trenches $ 15,576.00 $15,576.00 $0.00 $0.00 $15,576.00 100% $ $0.00 5C Removal&Relandfilling of Bunea Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ $0.00 5D Waste Excavation Area 2-C.0 S $ 48,395.00 $48,395.00 $0.00 $0.00 $48,395.00 100% $ $0.00 5E Waste Excavation Area 3-C.0 4 $ 49.726.55 $49,726.55 $0.00 $0.00 $49.726.55 100% $ $0.00 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ $0.00 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $0.00 6 Grading Material General Fill from Onsite Sources $ 332,307.00 $332,307.00 $0.00 $0.00 $332,307.00 100% $ $0.00 7 Geote file Type 1 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 8 Gas venting layer from on site $ 171,900.00 $171,900.00 $0.00 $0.00 $171,900.00 100% $ $0.00 9 60 Mil textured HDPE Geomemorane $ 887,009.16 $887,009.16 $0.00 $0.00 $887,009.16 100% $ $0.00 10 Landfill Gas Vents $ 58,016.00 $58,016.00 $0.00 $0.00 $58,016.00 100% $ $0.00 11 Geocomposlte $ 288,044.40 $288,044.40 $0.00 $0.00 $288,044.40 100% $ $0.00 12 Barrier Protection Layer from Onsite Sources $ 300,615.00 $300,615.00 $0.00 $0.00 $300,615.00 100% $ $0.00 13AVegetative Growth Med Using Or Site Comp(F01) $ 200,074.00 $200,074.00 $0.00 $0.00 $200,074.00 100% $ $0.00 13 ting7'n Topsoil Off Site(per F01) $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 14 Wiontrol Blanket $ 360,868.89 $360,868.89 $0.00 $0.00 $360,868.89 100% $ $0.00 15 Erosion Control Fabric $ 60,630.00 $60,630.00 $0.00 $0.00 $60,630.00 100% $ $0.00 16 Hydroseedmg $ 69,264.40 $69.264.40 $0.00 $0.00 $69.264.40 100% $ $0.00 17 Landscaping $ 45,291.00 $45,291.00 $0.00 $0.00 $45,291.00 100% $ $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 266.907.00 $266,907.00 $0.00 $0.00 $266,907.00 100% $ $0.00 19A 6-Foot High Fencing $ 67,855.50 $67.855.50 $0.00 $0.00 $67,855.50 100% $ $0.00 198 12-Foot High Fencing $ 11,622.90 $11,622.90 $0.00 $0.00 $11,622.90 100% $ $0.00 19C Gates $ 11,976.00 $11,976.00 $0.00 $0.00 $11,976.00 100% $ $0.00 20 Maintenance Road 6'Deep RCL $ 13,608.00 $13,608.00 $0.00 $0.00 $13,608.00 100% $ $0.00 21 Maintenance Road 12"Deep RCA $ 61,915.00 $61,915.00 $0.00 $0.00 $61,915.00 100% $ $0.00 $ 4,097,276.28 $4,097,276.28 $0.00 $0.00 $4,097,276.28 $ $0.00 _-,___.•�_�-- r��i.r surr�r wonr�cc- ; lL,/APPLICATION AND CERTIFICATE FOR PAYMENT, containing. APPLICATION NUMBER: 14 Page 3 of 4 erted Certification is attached. APPLICATION DATE: 09/11/03 ,s below, amounts are stated to the nearest doi)ar. PERIOD TO: 09/11/03 an 1 on Contracts where variable retainage.forJine items may Apply. ARCHITECT'S PROJECT NO: 2000 B C. D. F E F G H 1 4T'EM DESCRIPTION OF WORK SCHEDULED -WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DOBE) (D+E+F) 22 Main Access Road $206.511.75 $206,511.75 $0.00 $0.00 $206,511.75 100% $ $0.00 23 Guide Rail $78,000.00 $78,000.00 $0.00 $0.00 $78.000.00 100% $ $0.00 24A Abandon E>osting Landfill Gas Monitoring Wells $2,100.00 $2,100.00 $0.00 $0.00 $2,100.00 100% $ $0.00 24B New Landfill Gas Monitoring Webs $42.560.00 $42,560.00 $0.00 $0.00 $42,560.00 100% $ $0.00 25A Abandon Existing Groundwater Monitoring Wells $22,640.00 $22,640.00 $0.00 $0.00 $22,640.00 10D% $ $0.00 25B New Grourd+ratggtp Morrtomg Wells $25,200.00 $25,200.00 $0.00 $0.00 $25,200.00 100% 5 $0.00 2 Drain Pipe IMOutlet Structum Stilling Basins MH $65.528.00 $65,528.00 $0.00 $0.00 $65,528.00 100% $ $0.00 Owale Under Drains Anchor Trenches $60,000.00 $60,000.00 $0.00 $0.00 $60,000.00 100% $ $0.00 2 Water Supply Well and Electrical Services $4,000.00 $4,000.00 $0.00 $0.00 S4,00D.00 100% $ $0.00 29 Siren&Electrical&Telephone Service. $92,000.00 S92,000.00 $0.00 $0.00 $92,000.00 100% $ $0.00 30 Sand Pit Regrading $D.00 $0.00 $0.00 $GAO $0.00 0% $ $0.00 31 32 Test Pitting $10.800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ $0.00 33 Waste Import $64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $0.00 34 Screening 17-acre Material/stone for Gas Trenches $40,000.00 $40,000.00 $0.00 $0.00 $40,000.00 100% $ 50.00 35 Spreading of Greenport Pond Material $0.00 $0.00 50.00 $0.00 $0.00 0% $ $0.00 36 Southeastern Drainage Diversion System $218,354.00 5218,354.00 $0.00 $0.00 $218.354.00 100% $ $0.00 37 Handling of C&D Materials-CAT 322 5375.00 $375.00 $0.00 $0.00 $375.00 100% $ $0.00 36 Consolidation of unscreened compost in BP-CAT 322 $2,156.00 $2,156.00 $0.00 $0.00 $2,156.00 100% $ $0.00 39 Consolidation of unscreened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ $0.00 40 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.00 $2.925.00 100% $ $0.00 41 Grading of Eastern Hill-CAT D- $11.025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ $0.00 42 Separate Loam for Production o`VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $0.00 43 Separate Loam for Production a'VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ $0.00 44 Screening of Unscreened Compost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ $0.00 45 Temporary Asphalt Apron S2,835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ $0.00 4 Surcharge for Black Vinyl Fencing $3,995.00 $3,995.00 $0.00 $0.00 $3,995.00 100% $ $0.00 esting of 17-acre Sand for Gas Venting&BPL $12,970.00 $12,970.00 $0.00 $0.00 $12,970.00 100% $ $0.00 Enlargement&Construction Changes Recharge Basin 3 $64,667.14 $64,667.14 $0.00 $0.00 $64,667.14 100% $ $0.00 49 Segmented Installation of Geomembrane for 17-acre Road $48,479.80 $48,479.80 $0.00 $0.00 $48,479.80 100% $ $0.00 50 Additional Surveying $58.943.90 $58.943.90 $0.00 $0.00 558,943.90 100% $ $0.00 51 Gas Migration Control Trench Extension Scale House Area $8,698.00 $8,698.00 $0.00 $0.00 $8,698.00 100% $ $0.00 52 Liner Installation Around Eastern Drainage System C.B.1 $1,300.78 $1,300.78 $0.00 $0.00 $1,300.78 100% $ $0.00 53 Final Grading of Recharge Basins 1&2 54,800.00 $4,800.00 $0.00 $0.00 54,800.00 100% $ $0.00 54 Transition Area Grading $8.800.00 $8,800.00 $0.00 $0.00 $8,800.00 100% $ $0.00 55 Relocation of Maintenance Road Along McBride Property $7,200.00 $7,200.00 $0.00 $0.00 $7,200.00 100% $ $0.00 Endre Gas Migration Control Trench Vents&Turbines $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 56 Elimination of Waterproofing Manholes along SW drainage Syste ($2,100.00) $O.DO $0.00 $0.00 ($2,100.00) 0% $ $0.00 57 Elimmaton of Truck Stand ($700.00) $0.00 $0.00 $0.00 ($700.00) 0% $ $0.00 58 Substitution of Curtex for erosion Control Blanket ($6,221.50) $0.00 $0.00 $0.00 ($6,221.50) 0% $ $0.00 59 Catch Basin and Pipe by Scale $6.850.00 $6,850.00 $0.00 $0.00 $6,850.00 100% $ $0.00 $ $0.00 $ $0.00 $1,188,774.75 $1.197,796.25 $000 $0.00 $1,188,774.75 $ $0.00 $5 286 051.03 1 1 000 $5 286 051.03 0.00 0.00 UATION SHEET AIA DOCUMENT 6703 PAGE OF PAGES F went G702,APPLICATION AND CERTIFICATE FOR PAYMENT, contaiping _ APPLICATION NUMBER: 14 ,ror's signed Certification is attached. APPLICATION DATE: 9/11/03 'iulations below,amounts are stated to the nearest dollar. - PERIOD TO: 9/11/03 .e Column 1 on Contracts where variable retainage for tine Items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 60 RCA for Borrow Pit Tumarouna $ 14,720.00 $14,720.00 $0.00 $0.00 $14,720.00 100% $ $0.00 61 Paling Center Access Road $ 25,200.00 $25,200.00 $0.00 $0.00 $25,200.00 100% $ $0.00 62 WildBowerSeed $ 1,300.00 $1,300.00 $0.00 $0.00 $1,300.00 100% $ $0.00 Rebar in Headwalls $ 1,716.00 $1,716.00 $0.00 $0.00 $1,716.00 100% $ $0.00 g E>Qna for Segmented Installation $ 3,250.00 $3,250.00 $0.00 $0.00 $3.250.00 100% $ $0.00 65 Split Rail Fence Soumem Boundary of Cap $ 6,221.50 $6,221.50 $0.00 $0.00 $6,221.50 100% $ $0.00 66 Temporary Fencing $ 5,293.75 $5,293.75 $0.00 $0.00 $5,293.75 100% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 50.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% Is - $0.00 $ 57,701.25 $57,701.25 $0.00 $0.00 $57,701.25 $0.00 $0.00 $ 5.343,752.28 $0.00 $0.00 $5.343.752.28 0.00 0 9 AFFIDAVIT OF CONTRACTOR TO: 7-oWii 0 6LJl 614 . 3011 5 11,1 /q OJ ✓ 66n ADDRESS: S d (J j W d L..O N RE: Project Name: J d J 1 0 I Cl Lamd Contract No.: V44 Project No.: A J-,73b The undersigned Contractor hereby swears under penalty progress payments received from the owner on account of work pf _Jerred to in the attached claim have been applied by the undersigned to discharge in full all obligations of the undersigned incurred in connection with Work covered by prior Applications for Payment under said contract, being Applications for Payment numbered 1 through kp- inclusive; and (2) all materials and equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment are free and clear of all liens, claims, security interests and encumbrances. Dated 8 a 5 2003 TEPP-y C DurrK1 C?r/X/6 y M Tic/��FiGS ; �ivC (Contractor) By A��- �Z qiZe i Ti e) COUNTY OF ] STATE OF ] SS Before me on this c S day of lJG US-t -, 20 03 personally appeared Wd 6 E2>- C, r".FlL 2 y to me, who being duly sworn, did depose and say that he is the PRFS 1Z2F t1T of the Contractor above mentioned; that he executed the above Application for Payment and statement on behalf of said Contractor; and that all of the statements contained therein are true, correct and complete. Nofiry Public JULIA A.McCLAVE My Commission Expires 06 NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-12-20 07 ♦Engineer's Forms\Affidavit of Contractor APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: WN OF SOUTHOLD PROJECT APPLICATION: 13 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 07/24/03 [ ]ARCHITECT f ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orden approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 t.mb months by Owner Change Orders 1 to 12 2. Net change by Change Orders $ 127,385.78 TOTAL $317,929.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 +2) $ 5,343,752.28 this Month 4. TOTAL COMPLETED&STORED TO DATE $5,343,752.28 Date Approved (Column G on G703) 6/1/03 5. RETAINAGE: a:_5_gL-ofCompleted Work $267,187.61 (COI umn D+E on G703) ($190,543.22) b:_% of Stored Material $ Net Change by Change Orders $127,385.78 $0.00 (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $267,187.61 completed in accordance with the Contract Documents,that ad amounts have been 6. TOTAL EARNED LESS RETAINAGE $5.076,564.67 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ 4,807,031.81 8. CURRENT PAYMENT DUE $269,532.86 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ 267,187.61 Line 3 less Line 6 State of: C W County of: C/+Y'C c A�- / ) 4- d Subscribed and shown to before_me th—isy av day of 20 �3 B ,,/' �' Date: 0 3 Notary Public. �C L( • /� IJLQ�t� My Commission ireeffc � - - 2.Qct -7 GINEER'S CERTIFI AT OR PAYMENT AMOUNT CERTIFIED $ S.'?z f'iG In accordance with the Contract Documents,based on on-site observations and the (Attach n if amount led differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGI ER: P 9 PPI 9 best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: L a the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This CeMcais is not negotiable. The AMOUNT CERTIFIED is payable only to did I Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MCSM936 Certified in Suffolk County Commission Expires 0342-20Q7 CONTINUATION SHEET AIA DOCUMENT 6703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: 07/24/03 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 07/24/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A I B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 1 Pre Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ $10.400.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $71,400.00 $30,600.00 $0.00 $102,000.00 100% $ $5,100.00 3 Clearing and Gruboing $ 18,000.00 $14,400.00 $3.600.00 $0.00 $18,000.00 100% $ $900.00 4 Unclassified Excay.&Relandfi: (per F01)-Survey $ 421,425.00 $421,425.00 $0.00 $0.00 $421,425.00 100% $ $21,071.25 5A Removal&Relandfillmg of Buried Waste&Fill 1-Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ $681.38 5B Excavation of Gas Migration Contra Trenches $ 15,576.00 $15,576.00 $0.00 $0.00 $15,576.00 100% $ $778.80 5C Removal&Reiandfilhng of Burred Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9.000.00 100% $ $450.00 5D Waste Excavation Area 2-C.0.4 $ 48,395.00 $48,395.00 $0.00 $0.00 $48,395.00 100% $ $2.419.75 5E Waste Excavation Area 3-C.0.4 $ 49,726.55 $49,726.55 $0.00 $0.00 $49,726.55 100% $ $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ $133.91 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $47.19 6 Grading Material General Fill from Onsite Sources $ 332,307.00 $332,307.00 $0.00 $0.00 $332,307.00 100% $ $16,615.35 7 Geotextile Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 8 Gas venting layer from on site $ 171,900.00 $171.900.00 $0.00 $0.00 $171,900.00 100% $ $8,595.00 9 60 Mil textured HDD=_Geomembrane $ 887,009.16 $887,009.16 $0.00 $0.00 $887,009.16 100% $ $44,350.46 10 Landfill Gas Vents $ 58,016.00 $58,016.00 $0.00 $0.00 $58,016.00 100% $ $2,900.80 11 Geocomposite $ 288,044.40 $288.044.40 $0.00 $0.00 $288,044.40 100% $ $14,402.22 Barrier Protection Layer from Onsite Sources $ 300,615.00 $300,615.00 $0.00 $0.00 $300,615.00 100% $ $15,030.75 Vegetative Growth Med Using On Sne Comp(F01) $ 200,074.00 $200,074.00 ($28,420.00) $0.00 $200,074.00 100% $ $10,003.70 Contingency Topsoil Off Stte(Dw F01) $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 14 Erosion Control Blanket $ 360,868.89 $360,866.89 ($16,339.11) $0.00 $360,868.89 100% $ $18,043.44 15 Erosion Control Fabric $ 60,630.00 $60,000.00 $630.00 $0.00 $60,630.00 100% $ $3,031.50 16 Hydroseeding $ 69,264.40 $69,264.40 ($2.584.60) $0.00 $69,264.40 100% $ $3,463.22 17 Landscaping $ 45,291.00 $25,992.00 $19.299.00 $0.00 $45,291.00 100% $ $2,264.55 18 Rip Rap Stone Fila Gravel& Reno Mattress $ 266,907.00 $266,907.00 $0.00 $0.00 $266,907.00 100% $ $13,345.35 19A 5-Foot High Fencing $ 67,855.50 $65,012.50 $2,843.00 $0.00 $67,855.50 100% $ $3,392.78 19B 12-Foot High Fencing $ 11,622.90 $11,622.90 $0.00 $0.00 $11,622.90 100% $ $581.15 19C Gates $ 11,976.00 $0.00 $11,976.00 $0.00 $11,976.00 100% $ $598.80 20 Maintenance Road 8"Deep RCA $ 13,608.00 $13,608.00 ($408.00) $0.00 $13,608.00 100% $ $68040 21 Maintenance Roac 12"DeeD RCA $ 61,915.00 $49,008.75 $12,906.25 $0.00 $61.915.00 100% $ $3,095.75 $ 4,097,276.28 $4,015.422.03 $34,102.54 $0.00 $4,097,276.28 $ $204,863.81 ,sG702.APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Page 3 of 4 ,s signed Certification is attached. APPLICATION DATE: 07/24/03 moons below.amounts are stated to the nearest dollar. PERIOD TO: 07/24/03 olumn 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 22 Main Access Roac $206,511.75 $202.227.75 $4,284.00 $0.00 $206,511.75 100% $ $10,325.59 23 Guide Rail $78,000.00 $13,650.00 $64,350.00 $0.00 $78,000.00 100% $ $3,900.00 24A Abandon Existing Landfill Gas Monitoring Wells $2,100.00 $2,100.00 $0.00 $0.00 $2,100.00 100% $ $105.00 248 New Landfill Gas Monitoring Wells $42,560.00 58,025.60 $34,534.40 $0.00 $42,560.00 100% $ $2,128.00 25A Abandon hosting GmurWwater Monitoring Wells $22,640.00 $22,640.00 50.00 $0.00 $22,640.00 100% $ $1.132.00 258 New Groundwatering Monitoring Wells $25,200.00 $0.00 $25,200.00 $0.00 $25,200.00 100% $ $1,260.00 isn Pipe INClullet Structures.Stilling Basins MH $65,528.00 565,528.00 $0.00 $0.00 $65,528.00 100% $ $3.276.40 rai le Under Drams Anchor Trenches $60,000.00 $60,000.00 $0.00 $0.00 $60,000.00 100% $ $3,000.00 28 Water Supply Well and Electrical Services $4,000.00 $4,000.00 $0.00 $0.00 $4,000.00 100% $ $200.00 29 Siren&Electrical&Telephone Service. $92,000.00 $82,800.00 $9,200.00 $0.00 $92,000.00 100% $ $4,600.00 30 Sand Pit Regrading $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ $540.00 33 Waste Import $64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $3,219.25 34 Screening 17-acre Material/Stone for Gas Trenches $40,000.00 $0.00 $40,000.00 $0.00 $40,000.00 100% $ $2,000.00 35 Spreading of Greenport Pond Material $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 36 Southeastern Drainage Diversion System $218,354.00 $218,354.00 $0.00 $0.00 $218,354.00 100% $ $10,917.70 37 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ $18.75 38 Consolidation of ursaeened compost in BP-CAT 322 $2,156.00 $2,156.00 $0.00 $0.00 $2,156.00 100% $ $107.80 39 Consolidation of unsaeened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ $148.28 40 Consolidation of umsareened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.00 $2,925.00 100% $ $146.25 41 Grading of Eastern Hill-CAT D7 $11,025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ $551.25 42 Separate Loam for Production,of VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $20.00 43 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ $32.81 44 Screening of Unscreened Comoost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15.675.00 100% $ $783.75 45 Temporary Asphalt Apron $2,835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ $141.75 Surcharge for Black Vinyl Fencing $3,995.00 $3,995.00 $0.00 $0.00 $3,995.00 100% $ $199.75 Testing of 17-acre Sand for Gas Venting&BPL $12,970.00 $12,970.00 $0.00 $0.00 $12,970.00 100% $ $648.50 48 Enlargement&Construction Changes Recharge Basin 3 $64,667.14 $64,667.14 $0.00 $0.00 $64,667.14 100% $ $3,233.36 49 Segmented Installation of Geornembrane for 17-acre Road $48,479.80 $31,761.69 $16,718.11 $0.00 $48,479.80 100% $ $2.423.99 50 Additional Surveying $58,943.90 $58,943.90 $0.00 $0.00 $58,943.90 100% $ $2,947.20 51 Gas Migration Control Trench Extension-Scale House Area $8,698.00 $8.698.00 $0.00 $0.00 $8,698.00 100% $ $434.90 52 Liner Installation Around Eastern Drainage System C.B.1 $1,300.78 $1,300.78 $0.00 $0.00 $1,300.78 100% $ $65.04 53 Final Grading of Recharge Basins 1&2 $4,800.00 $4.800.00 ($200.00) $0.00 $4,800.00 100% $ $240.00 54 Transition Area Grading $8,800.00 $8.000.00 $800.00 $0.00 $8,800.00 100% $ $440.00 55 Relocation of Maintenance Road Along McBride Property $7,200.00 $7,200.00 ($800.00) $0.00 $7,200.00 100% $ $360.00 Extra Gas Migration Control Trench Vents&Turbines $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 56 Elimination of Waterproofing Manholes along SW drainage Syste ($2,100.00) $0.00 ($2,100.00) $0.00 ($2,100.00) 0% $ ($105.00) 57 Eliminaton of Truck Stand ($700.00) $0.00 ($700.00) $0.00 ($700.00) 0% $ ($35.00) 58 Substitution of Curtez for erosion Control Blanket ($6.221.50) $0.00 ($6,221.50) $0.00 ($6,221.50) 0% $ ($311.08) 59 Catch Basin and Pipe by Scale $6,850.00 $0.00 $6,850.00 $0.00 $6.850.00 100% $ $342.50 $ $000 Is 1 $0.00 $1.188.774.75 $99585974 $191,91501 $0.00 $1.188.774.75 $ $5943874 $5 286_051 03 $5.011.1.281 77 26011-55 $0.00 $5 286 051.03 $0.00 $264302.55 DATION SHEET AIA DOCUMENT G703 PAGE OF PAGES �cument G702.APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 «tractor's signed Certification is attached. APPLICATION DATE: 7/24/03 -n tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 7/24/03 Use Column 1 on Contractswhere variable retainage for line items may apply. ARCHITECT'S PROJECT NO: $2,000.00 A B C D E F G H 1 ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO, VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 60 RCA for Borrow Pi;Tumamonc $ 14,720.00 $0.00 $14,720.00 $0.00 $14,720.00 100% $ $736.00 61 Paving Center Access Road $ 25,200.00 $0.00 $25,200.00 $0.00 $25.200.00 100% $ $1,260.00 Wildflower Seed $ 1,300.00 $0.00 $1,300.00 $0.00 $1,300.00 100% $ $65.00 ra Rebar in Headwalls $ 1,716.00 $0.00 $1,716.00 $0.00 $1,716.00 100% $ $85.80 64 Paving Extra for Segmented fttal6Mon $ 3,250.00 $0.00 $3,250.00 $0.00 $3.250.00 100% $ $162.50 65 Split Rail Fence Southern Boundary of Cap $ 6,221.50 $0.00 $6,221.50 $0.00 $6,221.50 100% $ $311.08 66 Temporary Fencing $ 5,293.75 $0.00 $5,293.75 $0.00 $5,293.75 100% $ $264.69 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $o.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 so.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ 57,701.25 $0.00 $57,701.25 $0.00 $57,701.25 $0.00 $2,885.06 $ 5,343,752.28 $283.718.80 $0.00 $5.343.752.28 $267,187.61 Vendor No. Town of Southold, New York - Payment Voucher . a 7e Vendor Tax ID Number or Social Security Number Vendor Address //3o se 8'�/'o G✓s-� . ' Vendor Name 6�g� Vendor Telephone Numbs !v 2—"1 01 -7 Vendor Contacts/ Invoice Invoice Invoice i Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services i i i i I i Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. Signature Title r'P Signature Company Narne Date GJ / 3 Title Date 9clii' e'riW_'T GHr APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO:, TOWN OF SOUTHOLD PROJECT: APPLICATION: 12 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 06/12/03 [ ]ARCHITECT CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): [ ] Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 previous months by Owner Change Orders 1 to 12 2. Net change by Change Orders $ 89,167.45 TOTAL $317,929.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 +2) $ 5,305,533.95 AAM this Month 4. TOTAL COMPLETED&STORED TO DATE $ 5,060,033.48 NLIWr Date Approved (Column G on G703) 13 6/1/03 ($228,761.55) 5. RETAINAGE: a:_5_o/_of Completed Work $ 253,001.67 (Col umn D+ E on G703) $0.00 ($22s,761.55) b:_5_°J of Stored Material $ - Net Change by Change Orders $89,167.45 $0.00 (C01 umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a +5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ 253,001.67 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ 4,807,031.81 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ 3,855,565.64 8. CURRENT PAYMENT DUE $ 951,466.17 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ 498,502.14 Line 3 less Line 6 State of: /V-2u/ County of: / r7 Subscribed and how to before me this jay 20 0-3 By: Date: b /'� Notary Public: � ' My Commission expires; -O 7 INEER'S CERT ATE FOR PAYMENT AMOUNT CERTIFIED $ g.rZ 144 In accordance with the Contract Documents,based on on-site observations and the (Attach exp�on if amoun rtified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGIN R: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: t'O 6 IP2 the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6056936 CerMW In Suffolk County Commission Expires 03-t2-20-= CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 06/13/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 06/13/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) 0 . (D+E) (NOT IN TO DATE DOBE) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ - $10,400.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $71,400.00 $0.00 $0.00 $71,400.00 70% $ 30,600.00 $3,570.00 3 Clearing and Grubbing $ 14,400.00 $14,400.00 $0.00 ,1 x$0.00 $14,400.00 100% $ - $720.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 421,425.00 $324,750.00 $96,675.00 ' /l' $0.00 $421,425.00 100% $ - $21,071.25 5A Removal&Relandfilling of Buried Waste&Fill 1 Survey $ 13,627.60 $13,627.60 $0.00 I $0.00 $13,627.60 100% $ $681.38 5B Excavation of Gas Migration Control Trenches $ 15,576.00 $7,176.00 $8,400.00 '7r Ikj $0.00 $15,576.00 100% $ $778.80 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ $450.00 5D Waste Excavation Area 2-C.0.4 $ 48,395.00 $48,395.00 $0.00 $0.00 $48,395.00 100% $ $2,419.75 5E Waste Excavation Area 3-C.0.4 $ 49,726.55 $49,726.55 $0.00 $0.00 $49,726.55 100% $ $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ $133.91 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $47.19 6 Grading Material General Fill from Onsite Sources $ 332,307.00 $332,307.00 $0.00 $0.00 $332,307.00 100% $ $16,615.35 7 Geotextile Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 8 Gas venting layer from on site $ 171,900.00 $168,000.00 $3,900.00 3PS $0.00 $171,900.00 100% $ $8,595.00 9 60 Mil textured HDPE Geomembrane $ 887,009.16 $856,560.00 $30,449.16 (! 00 $887,009.16 100% $ - $44,350.46 10 Landfill Gas Vents $ 58,016.00 $58,016.00 $0.00 ! .00 $58,016.00 100% $ $2,900.80 11 Geocomposite $ 288,044.40 $256,200.00 $31,844.40 " S�'� .00 $288,044.40 100% $ $14,402.22 Barrier Protection Layer from Onsite Sources $ 300,615.00 $280,000.00 $20,615.00 eo, 0�o $300,615.00 100% $ - $15,030.75 Vegetative Growth Med Using On Site Comp(F01) $ 228,494.00 $113,029.00 $115,465.00 iCC�,6p r! �aoo $228,494.00 100% $ - $11,424.70 Contingency Topsoil Off Site(per F01) $ $0.00 $0.00 $ 00 $0.00 0% $ $0.00 14 Erosion Control Blanket $ 377,208.00 $136,002.54 $241,205.46 Aaq 10' .00 $377,208.00 100% $ $18,860.40 15 Erosion Control Fabric $ 60,000.00 $39,148.35 $20,851.65 /y p 00 $60,000.00 100% $ $3,000.00 16 Hydroseeding $ 71,849.00 $22,894.40 $48,954.60 Sl�i� *0 $71,849.00 100% $ $3,592.45 17 Landscaping $ 25,992.00 $12,141.00 $13,851.00 �;�li�•�5 .00 $25,992.00 100% $ $1,299.60 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 266,907.00 $233,739.85 $33,167.15 3/��b .00 $266,907.00 100% $ $13,345.35 19A 6-Foot High Fencing $ 85,012.50 $40,885.00 $24,127.50r9��" .00 $65,012.50 76% $ 20,000.00 $3,250.63 19B 12-Foot High Fencing $ 13,637.37 $11,622.90 $0.00 $0.00 $11,622.90 85% $ 2,014.47 $581.15 19C Gates $ 11,976.00 $0.00 $0.00 $0.00 $0.00 0% $ 11,976.00 $0.00 20 Maintenance Road 6"Deep RCA $ 14,016.00 $7,146.00 $6,870.00 CjQ.00 $14,016.00 100% $ - $700.80 21 Maintenance Road 12"Deep RCA $ 49,008.75 $35,875.00 $13,133.75 $0.00 $49,008.75 100% $ - $2,450.44 11iN 7*).1 W _ _ $ 4,127,764.21 $3,353,664.07 $709,509.67 $0.00 $4,063,173.74 $ 64,590.47 $203,158.69 AI/,Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 06/13/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 06/13/03 Use Column 1 on Contracts where variable retainage for line items may apply. r ARCHITECT'S PROJECT N0: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DOBE) (D+E+F) 22 Main Access Road $202,227.75 $202,227.75 $0.00 $0.00 $202,227.75 100% $ - $10,111.39 23 Guide Rail $78,000.00 $13,650.00 $0.00 $0.00 $13,650.00 18% $ 64,350.00 $682.50 24A Abandon Existing Landfill Gas Monitoring Wells $2,100.00 $2,100.00 $0.00 $0.00 $2,100.00 100% $ $105.00 24B New Landfill Gas Monitoring Wells $42,560.00 $8,025.60 $0.00 $0.00 $8,025.60 19% $ 34,534.40 $401.28 25A Abandon Existing Groundwater Monitoring Wells $22,640.00 $22,640.00 $0.00 $0.00 $22,640.00 100% $ - $1,132.00 New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $65,528.00 $0.00 $0.00 $65,528.00 100% $ $3,276.40 Swale Under Drains Anchor Trenches $60,000.00 $60,000.00 $0.00 $0.00 $60,000.00 100% $ $3,000.00 28 Water Supply Well and Electrical Services $4,000.00 $4,000.00 $0.00 $0.00 $4,000.00 100% $ - $200.00 29 Siren&Electrical&Telephone Service. $92,000.00 $0.00 $82,800.00 7ejG60 $0.00 $82,800.00 90% $ 9,200.00 $4,140.00 30 Sand Pit Regrading $0.00 $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ $540.00 33 Waste Import $64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 34 Screening 17 acre Material/Stone for Gas Trenches $40,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 40,000.00 $0.00 35 Spreading of Greenport Pond Material $21,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 21,000.00 $0.00 36 Southeastern Drainage Diversion System $218,354.00 $208,461.60 $9,892.40 1,79 $0.00 $218,354.00 100% $ - $10,917.70 37 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ $18.75 38 Consolidation of unscreened compost in BP-CAT 322 $2,156.00 $2,156.00 $0.00 $0.00 $2,156.00 100% $ $107.80 39 Consolidation of unscreened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ $148.28 40 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.00 $2,925.00 100% $ $146.25 41 Grading of Eastern Hill-CAT D7 $11,025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ $551.25 42 Separate Loam for Production of VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $20.00 43 Separate Loam for Production of VG -Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ $32.81 44 Screening of Unscreened Compost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ $783.75 Temporary Asphalt Apron $2,835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ $141.75 Surcharge for Black Vinyl Fencing $3,995.00 $3,995.00 $0.00 0.00 $3,995.00 100% $ $199.75 Testing of 17-acre Sand for Gas Venting&BPL $12,970.00 $0.00 $12,970.00 la3a),1$400 $12,970.00 100% $ $648.50 48 Enlargement&Construction Changes Recharge Basin 3 $64,667.14 $0.00 $64,667.14 (0/433' $0.00 $64,667.14 100% $ $3,233.36 49 Segmented Installation of Geomembrane for 17-acre Road $31,761.69 $0.00 $31,761.69 30,��3'0�0.00 $31,761.69 100% $ $1,588.08 50 Additional Surveying $58,943.90 $0.00 $58,943.90 s94G,7�o.00 $58,943.90 100% $ $2,947.20 51 Gas Migration Control Trench Extension-Scale House Area $8,698.00 $0.00 $8,698.00 $NO Zj•a$0.00 $8,698.00 100% $ $434.90 52 Liner Installation Around Eastern Drainage System C.B.1 $1,300.78 $0.00 $1,300.78 1.136•74$0.00 $1,300.78 100% $ $65.04 53 Final Grading of Recharge Basins 1&2 $5,000.00 $0.00 $5,000.00 q76-#,#'$0.00 $5,000.00 100% $ $250.00 54 Transition Area Grading $8,000.00 $0.00 $8,000.00 ;F6,00 $0.00 $8,000.00 100% $ $400.00 55 Relocation of Maintenance Road Along McBride Property $8,000.00 $0.00 $8,000.00 7/r/0 $0.00 $8,000.00 100% $ $400.00 Extra Gas Migration Control Trench Vents&Turbines $4,000.00 $0.00 $0.00 $0.00 $0.00 $ 4,000.00 $0.00 56 Elimination of Waterproofing Manholes along SW drainage Syste ($2,100.00) $ _ $000 57 Eliminaton of Truck Stand ($700.00) p�-� tlj Z $ $0.00 58 Substitution of Cudex for erosion Control Blanket ($14,575.00) /[ ► $ $0.00 Asphalt Curb Deleted $ $0.00 $ $0.00 $ - $0.00 $1,177,769.14 $704,825.83 $292,033.91 $0.00 $996,859.74 $ 198,284.40 $49,842.99 5 305 533.35 $4.058.489.90 1 001 543.58 1 $0.00 5 060 033.48 1 1 $262.874.87 $253,001.67 0 9 AFFIDAVIT OF CONTRACTOR TO: ' &w/I 0-r '56 o-r1 d G U ADDRESS: 5 3,0q5 M1J/1v/PD1,VU Sd UT��L D RE: Project Name: SdcrrNOGD L,gNOf/LL C'LDSU�f Contract No.: J) V 6 1 3 1 V Project No.: 2 6� The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress payments received from the owner on account of work performed under the contract referred to in the attached claim have been applied by the undersigned to discharge in full all obligations of the undersigned incurred in connection with Work covered by prior Applications for Payment under said contract, being Applications for Payment numbered 1 through // inclusive; and (2) all materials and equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment are free and clear of all liens, claims, security interests and encumbrances. Dated 200 � -fe y CL(�/2/q rrl'V G N M4 fiF /z /p G s C t (C ntractor) By e andtitle) COUNTY OF �U' I STATE OF Ole w ] SS Before meZ&ei— his 1-7 day of 1U�E , 20 �� personally appeared 7F2le y to me, who being duly sworn, did depose and say that he is the 121eF S /O C" of the Contractor above mentioned; that he executed the above Application for Payment and statement on behalf of said Contractor; and that all of the statements contained therein are true, correct and complete. h-e uxv-f- No ary Public JULIA A.MCCLAVE My Commission Expires �� a Od 7 NOTARY PUBLIC STATE OF NEW YORK No.OI MC6065M Cer#W in Suffolk County Commission Expires 03•t4.20= ♦Engineer's Forms\Af(idavit of Contractor APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 6702 PAGE ONE OF 3 PAGES i 0:,, TOWN OF SOUTHOLD PROJECT: APPLICATION: 11 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 12/13/02 [ ]ARCHITECT A [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials, Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ 5,216,366.50 previous months by Owner Change Orders 1 to 10 2. Net change by Change Orders $ 314,354.00 TOTAL $314,354.00 $0.00- 3. CONTRACT SUM TO DATE(Line 1 + 2 ) $ 5,530,720.50 A d this Month 4. TOTAL COMPLETED&STORED TO DATE $ 4,058,490.15 Nu er Date Approved (Column G on G703) $0.00 5. RETAINAGE: a:_5_%_of Completed Work $ 199,688.80 (Col umn D + E on G703) $0.00b:_5_°J of Stored Material $ 3,840.47 Net Change by Change Orders $314,354.00 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ 202,924.51 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ 3,855,565.64 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ 3,166,681.25 8. CURRENT PAYMENT DUE $ 688,884.39 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ 1,675,154.86 (Line 3 less Line 6) State of: DJ-0 County of: oe Subscribed and sho n to before me tth�iysr // 16 dayf Qom.,, 20 0 3 & / Date: / 3 Notary Public 91 U My Commissio a expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ � Q In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 0342-20_ :�2 74 . CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 Contractor's signed Certification is attached. APPLICATION DATE: 12/13/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/13/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) 9 (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ - $10,400.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $71,400.00 $0.00 $0.00 $71,400.00 70% $ 30,600.00 $3,570.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $2,400.00 ;E.7 SO $0.00 $14,400.00 24% $ 45,600.00 $720.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 370,000.00 $324,750.00 $0.00 $0.00 $324,750.00 88% $ 45,250.00 $16,237.50 5A Removal&Relandfilling of Buried Waste&Fill 1 Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ - $681.38 5B Excavation of Gas Migration Control Trenches $ 7,176.00 $7,176.00 $0.00 $0.00 $7,176.00 100% $ $358.80 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ - $450.00 5D Waste Excavation Area 2-C.0.4 $ 48,545.00 $48,395.00 $0.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 5E Waste Excavation Area 3-C.0.4 $ 54,240.00 $49,726.55 $0.00 $0.00 $49,726.55 92% $ 4,513.45 $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ - $133.91 5G Waste Excavation Area 5 $ 943.78 $943.78 $943.78 100% $0.00 $0.00 $ $47.19 6 Grading Material General Fill from Onsite Sources $ 332,307.00 $314,385.00 $17,922.00 r70.sA*�0.00 $332,307.00100% $ - $16,615.35 7 Geotextile Type 1 $ - $0.00 $0.00 t$0.00 $0.00 0% $ - $0.00 8 Gas venting layer from on site $ 168,000.00 $159,007.09 $8,992.91 8Cy3-a 0 00 $168,000.00 100% $ - $8,400.00 9 60 Mil textured HDPE Geomembrane r.i $ 856,560.00 $704,209.67 $152,350.33 00,73-)- Oioo $856,560.00 100% $ - $42,828.00 10 Landfill Gas Vents $ 58,016.00 $58,016.00 $0.00 $0.00 $58,016.00 100% $ - $2,900.80 iGeocomposite M $ 256,200.00 $239,535.96 $16,664.048?v� 00 $256,200.00 100% $ - $12,810.00 Barrier Protection Layer from Onsite Sources $ 280,000.00 $178,186.55 $101,813.45 (.� 0 $280,000.00 100% $ - $14,000.00 13A Vegetative Growth Med Using On Site Comp(F01) $ 140,000.00 $113,029.00 $0.00 $0.00 $113,029.00 81% $ 26,971.00 $5,651.45 13B Contingency Topsoil Off Site(per F01) $ 50,466.39 $0.00 $0.00 'b I'do.00 $0.00 0% $ 50,466.39 $0.00 14 Erosion Control Blanket $ 453,600.00 $77,232.60 $39,750.00 $19,019.94 $136,002.54 30% $ 317,597.46 __$6,800.13 15 Erosion Control Fabric M $ 60,000.00 $13,544.25 $6,072.50 tl\ $19,531.60 $39,148.35 65% $ 20,851.65 - $1,957.42 16 Hydroseeding $ 90,400.00 $12,894.40 $10,000.00 Q,,, $0.00 $22,894.40 25% $ 67,505.60 - $1,144.72 17 Landscaping $ 53,200.00 $0.00 $12,141.00 1.))44), *to.00 $12,141.00 23% $ 41,059.00 - $607.05 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $168,325.43 $65,414.42 X14 3,740.00 $233,739.85 87% $ 36,023.15 $11,686.99 19A 6-Foot High Fencing $ 113,062.50 $14,250.00 $0.00 $26,635.00 $40,885.00 36% $ 72,177.50 - $2,044.25 19B 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $11,622.90 $11,622.90 37% $ 19,977.10 $581.15 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $7,146.00 099174ps0.� $7,146.00 46% $ 8,454.00 $357.30 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $35,875.00 gt:)91.?0. $35,875.00 100% $ - $1,793.75 $ 4,146,860.37 $2,800,312.98 $476,541.65 $76,809.44 $3,353,664.07 $ 793,196.30 $167,683.20 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 Contractor's signed Certification is attached. APPLICATION DATE: 12/13/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/13/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 /. B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DOR (D+E+F) 22 Main Access Road $276,250.00 $41,565.00 $160,662.75 /-,r-?j ° $0.00 $202,227.75 73/0 $ 74,022.25 $10,111.39 23 Guide Rail $78,000.00 $13,650.00 $0.00 $0.00 $13,650.00 18% $ 64,350.00 $682.50 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $2,100.00 $0.00 $0.00 $2,100.00 14% $ 13,500.00 $105.00 24B New Landfill Gas Monitoring Wells $43,320.00 $8,025.60 $0.00 $0.00 $8,025.60 19% $ 35,294.40 $401.28 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $22,640.00 $0.00 $0.00 $22,640.00 39% $ 36,160.00 $1,132.00 25B New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $43,961.58 $21,566.42 )C q1W1/10.00 $65,528.00 100% $ - $3,276.40 - Swale Under Drains Anchor Trenches $60,000.00 $31,824.00 $28,176.00 6,76•:8$0.0.00 $60,000.00 100% $ - $3,000.00 28 Water Supply Well and Electrical Services $42,000.00 $4,000.00 $0.00 $0.00 $4,000.00 10% $ 38,000.00 $200.00 29 Siren&Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 219,000.00 $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ - $540.00 33 Waste Import $75,000.00 $64,385.00 $0.00 $0.00 $64,385.00 86% $ 10,615.00 $3,219.25 34 Screening 17 acre Material/Stone for Gas Trenches $40,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 40,000.00 $0.00 35 Spreading of Greenport Pond Material $21,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 21,000.00 $0.00 36 Southeastern Drainage Diversion System $218,354.00 $208,461.60 $0.00 $0.00 $208,461.60 95% $ 9,892.40 $10,423.08 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ - $18.75 Consolidation of unscreened compost in BP-CAT 322 $2,156.25 $2,156.25 $0.00 $0.00 $2,156.25 100% $ $107.81 Comsoildation of unscreened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ - $148.28 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.00 $2,925.00 100% $ - $146.25 Grading of Eastern Hill-CAT D7 $11,025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ - $551.25 Separate Loam for Production of VGM-Cat D6 $400.00 $400.00 $0.000 $0.00 $400.00 100% $ $20.00 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 ° $656.25 100% $ $32.81 Screening of Unscreened Compost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ _ $783.75 Temporary Asphalt Apron $2,835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ $141.75 Surcharge for Black Vinyl Fencing $3,995.00 $3,995.00 $0.00 $0.00 $3,995.00 100% $ - $199.75 $1,383,860.13 $494,420.91 $210,405.17 $0.00 $704,826.08 $ 679,034.05 $35,241.30 $5,530,720.50 $3,294.733.89 $686.946.82 76809.44 $4,058,490.15 $1,472,230.35 $202.924.51 .0 Town of Southold, New York - Standard Voucher PAY TO: Payee Tax Identification Number Payee Name: t or Social SecurityNumber: f / y T,r-�c� �!y-�✓/I-c-�ry+ �,o�e��al/1,11 (/1 Address: 7 0 Payee Reference ! Phone No.(lv3/ ) 7Z`? 7 Invoice Number Invoice Date Vendor Contact Purchase Order Number P.O. Date Cash Discount % Days Item Number Description of Materials/Services Quantity pricte Amount o J a' SS 3� Total Net �j' Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that Wpar, as bee paiVexct as therein stated,and that the balance therein stated is actually due and wing. Signature v _ Title lJ71. Dated Department Certification 1 hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and t t the�-"�i /quantities thereof have verified with the exceptions or discrepancies noted,and payment is approved Signature '- L'�-`�` "<< Title Dated J—/ 7-6_3 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES :0: TOWN OF SOUTHOLD PROJECT: APPLICATION: 10 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 10/04/02 [ ]ARCHITECT • [ ]CONTRACTOR FROM(0-0 Pi i RACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner Change Orders 1 to 10 2. Net change by Change Orders $ $314,354.00 _ TOTAL $314,354.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 + 2) $ $5,530,720.50 Ar this Month 4. TOTAL COMPLETED& STORED TO DATE $ $3,333,348.68 Nu r Date Approved (Column G on G703) $0.00 5. RETAINAGE: a:_5_%_of Completed Work $ $152,938.25 (Col umn D + E on G703) $0.00 b:_5_% of Stored Material $ $13,729.18 Net Change by Change Orders $314,354.00 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $166,667.43 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $3,166,681.25 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $2,973,337.30 8. CURRENT PAYMENT DUE $ $193,343.95 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $2,364,039.25 Line 3 less Line 6 State of: ->Zuj County of: G Subscribed and shown t6 before me this day f a< -� ,20 d 7i B, s' Date: « OIL Notary Public: a 6�� My Commission xpi �.t�"-�a " DL" 3 ENGINEER'S CERTIFIC FOR PAYMENT AMOUNT CERTIFIED $ /`7313433-T In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: jy��0�0?r the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This 96rti Cate is not negotiable. The AM NT CERTIFIED is payable only to the Cont named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County 3 Commission Expires 03-12.20__ CO A TI N UATI O N SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 10 Contractor's signed Certification is attached. APPLICATION DATE: 10/08/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10/04/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) 0 (D+E) (NOT IN TO DATE DOR E) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ - $10,400.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $71,400.00 $0.00 $0.00 $71,400.00 70% $ 30,600.00 $3,570.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 370,000.00 $324,750.00 $0.00 $0.00 $324,750.00 88% $ 45,250.00 $16,237.50 5A Removal&Relandfilling of Buried Waste&Fill 1 Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ - $681.38 5B Excavation of Gas Migration Control Trenches $ 7,176.00 $7,176.00 $0.00 $0.00 $7,176.00 100% $ $358.80 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ - $450.00 51) Waste Excavation Area 2-C.0.4 $ 48,545.00 $48,395.00 $0.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 5E Waste Excavation Area 3-C.0.4 $ 54,240.00 $49,726.55 $0.00 $0.00 $49,726.55 92% $ 4,513.45 $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ - $133.91 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $47.19 6 Grading Material General Fill from Onsite Sources $ 314,385.00 $303,249.00 $11,136.00 $0.00 $314,385.00 100% $ $15,719.25 7 Geotextile Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 8 Gas venting layer from on site $ 168,000.00 $107,365.09 $51,642.00 $0.00 $159,007.09 95% $ 8,992.91 $7,950.35 9 60 Mil textured HDPE Geomembrane $ 856,560.00 $551,676.73 $0.00 $152,532.94 $704,209.67 82% $ 152,350.33 $35,210.48 10 Landfill Gas Vents $ 58,016.00 $58,016.00 $0.00 $0.00 $58,016.00 100% $ - $2,900.80 0 Geocomposite $ 256,200.00 $173,214.31 $0.00 $66,321.65 $239,535.96 93% $ 16,664.04 $11,976.80 Barrier Protection Layer from Onsite Sources $ 280,000.00 $178,186.55 $0.00 $0.00 $178,186.55 64% $ 101,813.45 $8,909.33 13A Vegetative Growth Med Using On Site Comp(1`01) $ 140,000.00 $61,558.00 $51,471.00 $0.00 $113,029.00 27% $ 26,971.00 $5,651.45 13B Contingency Topsoil Off Site(per F01) $ 68,388.39 $0.00 $0.00 $0.00 $0.00 0% $ 68,388.39 $0.00 14 Erosion Control Blanket $ 453,600.00 $15,660.06 $48,822.54 $31,769.94 $96,252.54 21% $ 357,347.46 $4,812.63 15 Erosion Control Fabric $ 60,000.00 $3,870.90 $5,309.10 $23,959.10 $33,139.10 62% $ 26,860.90 $1,656.96 16 Hydroseeding $ 90,400.00 $0.00 $12,894.40 $0.00 $12,894.40 14% $ 77,505.60 $644.72 17 Landscaping $ 53,200.00 $0.00 $14,250.00 $0.00 $14,250.00 27% $ 38,950.00 $712.50 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $168,325.43 $0.00 $0.00 $168,325.43 62% $ 101,437.57 $8,416.27 19A 6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 19B 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 $0.00 1 0% $ 35,875.00 1 $0.00- $ 4,146,860.37 $2,368,819.10 $195,525.04 $274,583.63 $2,838,927.77 $ 1,307,932.60 $141,946.39 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 10 Contractor's signed Certification is attached. APPLICATION DATE: 10/08/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10/04/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $41,565.00 $0.00 $0.00 $41,565.00 15% $ 234,685.00 $2,078.25 23 Guide Rail $78,000.00 $13,650.00 $0.00 $0.00 $13,650.00 18% $ 64,350.00 $682.50 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $2,100.00 $0.00 $0.00 $2,100.00 14% $ 13,500.00 $105.00 24B New Landfill Gas Monitoring Wells $43,320.00 $8,025.60 $0.00 $0.00 $8,025.60 19% $ 35,294.40 $401.28 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $22,640.00 $0.00 $0.00 $22,640.00 39% $ 36,160.00 $1,132.00 New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $43,961.58 $0.00 $0.00 $43,961.58 67% $ 21,566.42 $2,198.08 Swale Under Drains Anchor Trenches $60,000.00 $31,824.00 $0.00 $0.00 $31,824.00 53% $ 28,176.00 $1,591.20 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $4,000.00 $0.00 $4,000.00 10% $ 38,000.00 $200.00 29 Siren&Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 219,000.00 $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ - $540.00 33 Waste Import $75,000.00 $64,385.00 $0.00 $0.00 $64,385.00 86% $ 10,615.00 $3,219.25 34 Screening 17-acre Material/Stone for Gas Trenches $40,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 40,000.00 $0.00 35 Spreading of Greenport Pond Material $21,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 21,000.00 $0.00 36 Southeastern Drainage Diversion System $218,354.00 $208,461.60 $0.00 $0.00 $208,461.60 95% $ 9,892.40 $10,423.08 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ - $18.75 Consolidation of unscreened compost in BP-CAT 322 $2,156.25 $2,156.25 $0.00 $0.00 $2,156.25 100% $ $107.81 Comsoildation of unscreened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ $148.28 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.00 $2,925.00 100% $ $146.25 Grading of Eastern Hill-CAT D7 $11,025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ $551.25 Separate Loam for Production of VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ $20.00 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ $32.81 Screening of Unscreened Compost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ $783.75 Temporary Asphalt Apron $2,835.00 $2,835.00 $0.00 $0.00 $2,835.00 100% $ $141.75 Surcharge for Black Vinyl Fencing $3,995.00 $0.00 $3,995.00 $0.00 $3,995.00 1 100% $ - $199.75 $1,383,860.13 $486,425.91 $7,995.00 $0.00 $494,420.91 $ 889,439.22 $24,721.05 $5.530.720.50 $2.855.245.01 $203,520.04 $274.583.63 $3.333.348.68 $2,197,371.82 $166,667.43 3495 S� l Town of Southold, New York - Standard Voucher PAY TO: Payee Tax Identification Number Payee Name: // or Social Security Number: Address: p!/ Payee Reference /Cll2"r�n� ItlY //go/ Phone No.0; 71 ) '7 7 O / 7 D Vendor Contact Invoice Number Invoice Date Purchase Order Number P.O.Date Cash Discount % Days em Number Description of Materials/Services Quantity Price Amount I� w g h /O Cdr &ll C/Oslmo l3 04 Total Net I q3 3y3. Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no part has been paid,except aass/therein stated,and that the balance therein stated is actually due and owing. Signature Title ,��//x'�'1h rf�ne'�/s� Dated AO - /0- O.7 Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted,and payment is approved Signaturer .fQ �t Dated /D /CP Off, A.PPLToCAToIONTAND CERTIFICATE FOR PAYMENTO,ECT AAIA DOp �CUUMENT G702 TION: 9 PAGE ONE ODFstributAGtionEo TO 53095 Main R,oa= Southold Landfill Closure [ )OWNER. Southold.NY 11971 PERIOD TO: 09/09/02 [ )ARCHITECT [ )CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY { Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner Change Orders 1 to 10 2. Net change by Change Orders $ $314,354.00 TOTAL $314,354.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 + 2 ) $ $5,530,720.50 Appr s Month 4. TOTAL COMPLETED&STORED TO DATE $ $3,129,828.74 Numbe ate Approved (Column G on G703) $0.00 5. RETAINAGE: a:_5_%_of Completed Work $ $141,785.71 (Col umn D+ E on G703) $o.00 b:_5_°J of Stored Material $ $14,705.73 Net Change by Change Orders $314,354.00 $0.00 1 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $156,491.44 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $2,973,337.30 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $2,768,890.65 8. CURRENT PAYMENT DUE $ $204,446.65 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $2,557,383.20 Line 3 less Line 6 State of: 'e w 'a, County of: � Subscribed and o^t before me this "7 da o 20 C)?� By: Date: g-�7"nZ Notary Public: �C� �✓t✓�(„Q� My Commission oVpires: 3- /Z - 2,c-C 3 ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 2-v4,444;• (oT In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: 4' 7j:' Date: 9/7•0L?i the Contractor is entitled to payment of the AMOUNT CERTIFIED. CURRENT This Krtivcate is not negotiable. The AM4RNT CERTIFIED is payable only to the Contra"eW named herein, Issuance,paymelk and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.OIMC6055936 Certified in Suffolk County Commission Expires 03-t2-20 Z i f CONTINUATION SHEET AIA DOCUMENT 6703 PAGE 2 OF 3 PAGES 41A Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 9 C'ontractor's signed Certification is attached. APPLICATION DATE: . 09/13/02 =n tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/09/02 »Jse Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D - E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 obilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ $10,400.00 2 Mobil.,Wint.Demobilization $ 102,000.00 $71,400.00 $0.00 $0.00 $71,400.00 70% S 30,600.00 $3,570.00 ! 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 ! 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 370,000.00 $324,750.00 $0.00 $0.00 $324,750.00 88% $ 45,250.00 $16,237.50 j 5A Removal&Relandfillmb of Buried Waste&Fill 1-Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ - $681.38 5B Excavation of Gas Migration Control Trenches $ 7,176.00 $7,176.00 $0.00 $0.00 $7,176.00 100% $ $358.80 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ - $450.00 SO Waste Excavation Area 2-C.0.4 $ 48,545.00 $48,395.00 $0.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 5E Waste Excavation Area 3-C.0.4 $ 54,240.00 $49,726.55 $0.00 $0.00 $49,726.55 92% $ 4,513.45 $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ - $133.91 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ - $47.19 6 Grading Material General Fill from Onsite Sources $ 304,815.00 $270,102.00 $33,147.00 $0.00 $303,249.00 100% $ 1,566.00 $15,162.45 7 Geotextile Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 8 Gas venting layer from on site S 168,000.00 $107,365.09 $0.00 $0.00 $107,365.09 64% $ 60,634.91 $5,368.25 9 60 Mil textured HDPE Geomembrane $ 856,560.00 $551,676.73 $0.00 $152,532.94 $704,209.67 82% $ 152,350.33 $35,210.48 10 Landfill Gas Vents $ 58,016.00 $44,992.00 $13,024.00 $0.00 $58,016.00 97% $ - $2,900.80 11 Geocomposite $ 256,200.00 $173,214.31 $0.00 $66.321.65 $239,535.96 93% $ 16,664.04 $11,976.80 12lErosion er Protection Layer from Onsite Sources $ 280,000.00 $166,666.65 $11,520.00 $0.00 $178,186.65 60% $ 101,813.35 $8,909.33 13Atative Growth Med Using On Site Comp(FO1) $ 140,000.00 $37,352.00 $24,206.00 $0.00 $61,558.00 27% $ 78,442.00 $3,077.90 13Bngency Topsoil Off She(per F01) $ 81,953.39 $0.00 $0.00 $0.00 $0.00 0% $ 81,953.39 $0.00 14 Control Blanket $ 453,600.00 $0.00 $0.00 $47,430.00 $47,430.00 0% $ 406,170.00 $2,371.50 1 15on Control Fabric $ 60,000.00 $0.00 $0.00 $27,830.00 $27,830.00 0% $ 32,170.00 $1,391.50 j 16 oseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 18 Rip Rap Stone Fill.Gravel& Reno Mattress $ 269,763.00 $168,325.43 $0.00 $0.00 $168,325.43 62% $ 101,437.57 $8,416.27 ! 19A 6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 i ! 198 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 1 $0.00 1 0% $ 35,875.00 1 $0.00 j $ 4,150,855.37 $2,267,391.24 $81,897.00 $294,114.59 $2,643,402.83 $ 1,507,452.54 $132,170.14 ,,#Rl%atut.,mr"r-LlrrAlIvim miiw VLn5itINAiGFull wI 'i i , k.1.1, IC !. /s signed Certification is attached. APPLICATIO Si illi.►i j.'Lo4 ,s. Ations below, amounts are stated to the nearest dollar. PERIOD TO: 09/09/02 zolumn 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $41,565.00 $0.00 $41,565.00 0% $ 234,685.00 $2.078.25 23 Guide Rail $78,DD0.00 $0.00 $13,650.00 $O.DO $13,650.00 0% $ 64,350.00 $682.50 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $2,100.00 $0.00 $0.00 $2,100.00 14% $ 13,500.00 $105.00 245 New Landfill Gas Monitoring Wells $43,320.00 $8,025.60 $0.00 $0.00 $8,025.60 19% $ 35,294.40 $401.28 25A Abandon Exdsfing Groundwater Monitoring Wells $58,800.00 $22,640.00 $0.00 $0.00 $22,640.00 39% $ 36,160.00 $1,132.00 25B New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0.00 26 in Pipe InlOutlet Structures,Stilling Basins MH $65,528.00 $43,961.58 $0.00 $0.00 $43,961.58 67% $ 21,566.42 $2,198.08 27 le Under Drains Anchor Trenches $60,000.00 $31,824.00 $0.00 $0.00 $31,824.00 53% $ 28,176.00 $1,591.20 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren&Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 219,000.00 $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ - $540.00 33 Waste Import $75,000.00 $64,385.00 $0.00 $0.00 $64,385.00 86% $ 10,615.00 $3,219.25 34 Screening 17-acre Material/Stone for Gas Trenches $40,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 40,000.00 $0.00 35 Spreading of Greenport Pond Material $21,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 21,000.00 $0.00 36 Southeastern Drainage Diversion System $218,354.00 $206,461.60 $0.00 $0.00 $208,461.60 95% $ 9,892.40 $10,423.08 Handling of C&D Materials-CAT 322 $375.00 $375.00 $0.00 $0.00 $375.00 100% $ - $18.75 Consolidation of unscreened compost in BP-CAT 322 $2,156.25 $2,156.25 $0.00 $0.00 $2,156.25 100% $ - $107.81 Comsoildation of unscreened compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 $0.00 $2,965.63 100% $ - $148.28 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $2,925.00 $0.00 $0.00 $2,925.00 100% $ - $146.25 Grading of Eastern Hill-CAT D7 $11,025.00 $11,025.00 $0.00 $0.00 $11,025.00 100% $ - $551.25 Separate Loam for Production of VGM-Cat D6 $400.00 $400.00 $0.00 $0.00 $400.00 100% $ - $20.00 Separate Loam for Production of VGM-Cat 322 $656.25 $656.25 $0.00 $0.00 $656.25 100% $ - $32.81 Screening of Unscreened Compost-Trommel 725 $15,675.00 $15,675.00 $0.00 $0.00 $15,675.00 100% $ - $783.75 emporaryAsphaltApron $2,835.00 $0.00 $2,835.00 $0.00 $2,835.00 100% $ - $141.75 $ - $1,379,865.13 $428,375.91 $58,050.00 $0.00 $486,425.91 $ 893,439.22 $24,321.30 $5.530.720.50 $2,695.767.15 1112,2_47.00 $294.114.59 13.129.828.74 12.400.891.76 156 491.44 Town of Southold, New York - Standard Voucher PAY TO: , Payee Tax Identification Number Pawee Name:/ or Social Security Number: ltrr�/ �r��rn � i, .—nom 3a6© /t Adafress: S, yV W r&-- �� Payee Reference lY\r Phone No.(4"1/ ) 7 a 7- O f� Vendor Contact Invoice Number Invoice Date Purcbase Order Number P.O.Date Cash Discount Days Item Number Description of Materials/Services Quantity Unit nit Amount q e,. . re �oyyy6 . i i Total Net Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no part has been paid,except as therein stated,and that the balance therein stated is actually due and owing. Signature �+�- / Title fy%C'r'i��"n��'�'f Dated 9 •�3 �a r Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been ve' ied with the exceptions or discrepancies noted,and payme t is approved Signature� CX- "� j c f✓Lc Tit Dated 3 C APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TOWN OF SOUTHOLD PROJECT APPLICATION 8 Distribution to: 53095 Main Road -Southold Landfill Closure [ ]OWNER Southold NY 11971 PERIOD TO. 07/24/02 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous nronths by Owner Change Orders 1 to 10 2. Net change by Change Orders $ $314,354.00 TOTAL $314,354.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 + 2) $ $5,530,720.50 Ap this Month 4. TOTAL COMPLETED& STORED TO DATE $ $2,914,621.74 NAW Date Approved (Column G on G703) $0.00 5. RETAINAGE: a:_5_%_of Completed Work $ $134,788.36 (Col umn D+ E on G703) $0.00b:_5_% of Stored Material $ $10,942.73 Net Change by Change Orders $314,354.00 $0.00 1 (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $145,731.09 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $2,768,890.65 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $2,338,564.67 8. CURRENT PAYMENT DUE $ $430,325.98 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $2,761,829.85 Line 3 less Line 6 State of: 'jou% County of: p / Subscribed and shon.bef,re�ne t� 30 da o c�_ 20 G Z By: Date: 6 C c2l Notary Public: � d My Comnrssion xpires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 4.30, In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineers knowledge,information and belief the Work has progressed as �((^^ indicated,the quality of the Work is in accordance with the Contract Documents,and By: es_Q 2 Date: $Al f O 2— the Contractor is entitled to payment of the AMOUNT CERTIFIED. This to is not negotiable. The AMOU ERTIFIED is payable onlyto th Contra amed herein, Issuance,payment anl acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County CormisVion Expires 03-12-20J,� CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 8 Contractor's signed Certification is attached. APPLICATION DATE: 07/24/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/24/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 Pre-Wbilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ - $10,400.00 2 Mobil,Maint.Demobilization $ 102,000.00 $71,400.00 $0.00 $0.00 $71,400.00 70% $ 30,600.00 $3,570.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 4 Unclassified Excay.&Relandfill(per F01)-Surrey $ 370,000.00 $324,750.00 $0.00 $0.00 $324,750.00 88% $ 45,250.00 $16,237.50 5A Removal&Relandfilling of Burled Waste&Fill 1-Survey $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ - $681,38 56 Excavation of Gas Migration Control Trenches $ 7,176.00 $6,107.88 $1,068.12 $0.00 $7,176.00 100% $ $358.80 5C Removal&Relandfilling of Buried Waste&FB 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ - $450.00 5D Waste Excavation Area 2-C.0.4 $ 48,545.00 $48,395.00 $0.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 SE Waste Excavation Area 3-C.0.4 $ 54,240.00 $49,726.55 $0.00 $0.00 $49,726.55 92% $ 4,513.45 $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00 $2,678.10 100% $ - $133,91 SG Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ - $47.19 6 Grading Material General Fill from Onsite Sources $ 270,102.00 $249,483.00 $20,619.00 $0.00 $270,102.00 100% $ - $13,505.10 7 Geote file Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 8 Gas renting layer from on she $ 168,000.00 $71,728.00 $35,637.09 $0.00 $107,365.09 64% $ 60,634.91 $5,368.25 9 60 Mill textured HDPE Geomembrane $ 856,560.00 $429,951.06 $121,725.67 $152,532.94 $704,209.67 82% $ 152,350.33 $35,210.48 10 Landfill Gas Vents $ 46,176.00 $39,072.00 $5,920.00 $0.00 $44,992.00 97% $ 1,184.00 $2,249.60 Geocomposhe $ 256,200.00 $123,807.53 $49,406.78 $66,321.65 $239,535.96 93% $ 16,664.04 $11,976.80 Barrier Protection Layer from Onsite Sources $ 280,000.00 $91,666.65 $75,000.00 $0.00 $166,666.65 60% $ 113,333.35 $8,333.33 Vegetative Growth Med Using On Site Comp(FO1) $ 140,000.00 $0.00 $37,352.00 $0.00 $37,352.00 27% $ 102,648.00 $1,867.60 13B Contingency Topsoil Off Site(per F01) $ 131,341.39 $0.00 $0.00 $0.00 $0.00 0% $ 131,341.39 $0.00 14 Erosion Control Blanket $ 453,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 15 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 16 Hydmseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $109,507.00 $58,818.43 $0.00 $168,325.43 62% $ 101,437.57 $8,416.27 19A 6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 196 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maielenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maislenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 1 $0.00 1 0% $ 35,875.00 $0.00 $ 4,153,690.37 $1,861,844.15 $405,547.09 $218,854.59 $2,486,245.83 $ 1,667,444.54 $124,312.29 WAIA Document 6702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 8 Pontractor's sipled Certification is attached. APPLICATION DATE: 07/24/02 In tatulatiens below,amounts are stated to the nearest dollar. PERIOD TO: 07/24/02 Use-Column 1 aContracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C d ITEM DESCRIPTION OF WORK SCHEDULED E F G H I WORK COMPLETED MATERIALS TOTAL _ NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED SL.aSw�,` APPLICATION STORED AND STORED L (D+E) (NOT IN TO DATE D OR E) (D+E+F) 22 Main Access Road $276,250.00 50.00 $0.00 $0.00 $0.00 23 Guide Rad $78,000.00 $0.00 $0.00 ;L 7,;,s'f So.00 So.00 f OG$�� I 24A Abandon Eaisting Landfill Gas Monitoring Wells $15,600.00 $900.00 $1,200.00 246 New Lando Gas Monitoring Wells $43.320.00 $0.00 $8,025.60 $0.00 $2,$0.00 $8.025.660 Z 0 100. oG ci -4 el/14/O . $ !lt �• 25A Abandon Etasting Groundwater Monitoring Wells $58,800.00 $22.640.00 $0.00 $0.00 $22.640.00 77 L1 S�j g r 3 25B Now GrounOvateringMonitoring Wells $25,200.00 $0.00 S~6 7� / Drain Pipe WO"Structures,Stilling Basins MH $65,528.00 $0.80 $0.00 $0.00 $37.520.78 $6,440.80 $0.00 $43.961.58 � Swale Under Drains Anchor Trenches $60,000.00 $17,244.00 $14,580.007 5/- $31,824.00 28 Water Sup*Well and Electrical Services $,t2 000.00 $0.00 $0 sD.00 w.00 $o.00 so.00 v 3 7,,sa X 29 Siren S Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 30 Sand Pit Regrading $219,000.00 n m ,t G 50.00 $0.00 50.00 s 31 32 Test Pitting $10,800.00 $18,800.00 $0.00 ISN 33 Waste Impod $75,000.00 $64,385.00 $0.00 x 34 Screening 17-acre Material/Stone for Gas Trenches $40,00000 $000 $000 35 Spreading d Greenport Pond Material $21,000.00 $0.00 $0.00 36 Southeastern Drainage Diversion System $218,354.00. $208,461.60 $0.00 S� $0.00 Handling of C3 D Materials-CAT 322 00 ii♦ $10,423.08 Consolidation of unscreened compost in BP-CAT 322 $2,15625 $2,15625 50.00 �� $18.75 Comsoildetion of unscromW compost in BP-CAT 980 $2,965.63 $2,965.63 $0.00 ` $107.81 Consolidation of unscreened compost in BP $0.00 -CAT D7 $2,925.00 $2,925.00 / $148.28 Grading of Eastern Hill-CAT D7 $11,025.00 $14,025.00 S0.00 $146.25 Separate loam for Production of VGM-Cat D6 i400.00 $0.00 $400.00 $551.25 Separate Loam for Production of VGM-Cat 322 $65625 $0.00 $65625 $20.00 Screening ofUnscreened Compost-Trommel 725 $15,675.00 $0.00 15,675.00 $32.81 $783.75 Ll $1,377,030.13 $381,398.26 $46,977.65 $21,418.80 530 720.50 2 243,2:&41 5252474 218 $$21.731.09 514 IIII er�aiasrursrraou til II _ _. Town �outhold, New York - Standard her PAY TO: Payee Tax Identificatio mber Payee Name: CO or Social Security Number: u / Address: Payee Reference Phone No.( G 3 7 — l/ / 7e, Vendor Contact Invoice Number Invoice Date Purchase Order Number P.O. Date Cash Discount % Days Im Number Description of Materials/Services Quantity price Amount Total Net Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no part has been paid,except as/therein stated,and that the balance therein stated is actually due and owing. SignatureT / ` Title 11 Dated V,;?, Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been ve fied with the exceptions or discrepancies noted,and payment is approved Signature ' '`^-"` 4 '�"�—^ rt Dated 1 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 NAtat UNt UI- J rhUl=Z) TO T01MN OF SOUTHOLD PROJECT APPLICATION 7 Distribution to: '53095 Main Road Southold Landfill Closure j )OWNER Southold NY 11971 PERIOD TO 05/31/02 [ j ARCHI I ECT [ )CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials, inc Dvirka&Bartilucci PROJECT NO: 2000 $40 West Main Street 330 Crossways Park Dr+ve Riverhead,NY 11901 Woodbury.New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: _ CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below, in connection with the Contract. Continuation Sheet, AIA Document 6703,is attached. CHANGE ORDER SUMMARY Change Orders approved inADDITIONS DEDUCI-IONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner Change Orders 1 to 10 2. Net change by Change Orders $ $314,354.00 TOTAL $s 14,354.00 $0oc 3. CONTRACT SUM TO DATE(Line 1 + 2) $ $5,530,720.50 Aporift.is Month 4. TOTAL COMPLETED&STORED TO DATE $ $2,461,647.02 Numb Date Approved (Column G on G703) $0.00 5. RETAINAGE: a:__5_%_of Completed Work S $102,988.03_ (Col umn D+ E on G703) $o 0o b:_5_% of Stored Material $ $20,094.32 Net Change by Change Orders $314.35400 $O.oO (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractors knaMedge, Total Retainage(Line 5a+ 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $123,082.35 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $2,338,564.67 paid by the Contractor for Work for which previous Certificates of Payment were (!Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $1,900,914.60 8. CURRENT PAYMENT DUE $ $437,650.07 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $3,19.2,155.83 (Line 3 less Line 6) _ -f J State n1. AiFW Countyof SuIrFQL 1t Subscribed and shown to before me this . &,day of 20 Z B . + Date:, CO j/l� Notary Public: � C,L My Commission4mres: -.41r13 ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation 9 amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineers knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: 1 oL the Contractor is entitled to payment of the AMOUNT CERTIFIED. ThilffertVcate is not negotiable. The AjeUNT CERTIFIED is payable only t&the Centra or named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. _ JULIA A.MlcCLAVE NOTARY PUBLIC STATE OF NEW YORK No.OIMC6055936 Certified in Sufbgt County Commission Expires 03-t2.20 b 3 ►IA Document G702,APPLICATION ANL)(;LK I It ICA I L run rA t m Lt.a, ►,vni.nwnr, :ontractor's signed Certification is attached. APPLICATION DATE: 06/05/02 n tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 05/31/02 )se Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE _ DOR E) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $0.00 50.00 $0.00 0% $ 276,250.00 $0.00 23 Guide Rail $78,000.00 $0.00 $000 $0.00 $0.00 09'o $ 78,000.00 $0,00 24A Abandon Existing Landfill Gas Monitoring Wells $15,600-00 $0.00 $900.00 $0.00 $900.00 6% $ 14.700.00 $45.00 246 Now Landfill Gas Monitoring Wells $43,320.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $000 $22,640.00 $0.00 $22,640.00 390/0 $ 36,160.00 $1,132.00 258 New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0-00 in Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $37,520.78 $0.00 $0.00 $37,520.78 57% $ 28,007.22 $1,876.04 2 Swale Under Drains Anchor Trenches $60,000.00 $17,244.00 $0.00 $0.00 $17,244.00 29% $ 42,756.00 $862.20 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren A Electrical&Telephone Service. $92,000.00 $0.00 $0.11X1 $0.00 $0.00 0% $ 92,000 00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 219,000.00 $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ $540.00 33 Waste Import $75,000.00 $64,385.00 $0.00 $0.00 $64,385.00 86% $ 10,615.00 $3,21925 34 Screening 17acreMaterial/Stone for Gas Trenches $40,000.00 $0.00 $0.00 $0.00 $0,00 0% $ 40 000,00 f0,00 35 Spreading of Greenport Pond Materiai $21,000.00 $0.00 $0.00 $0.00 $0.00 00(o $ 21,000.00 $0.01 36 Southeastern Drainage Diversion System $218.354.00 $31,755.00 $176,706.60 $0.00 $208,461.60 89% $ 9,892.40 $10,423.08 Handling of Cd.D Materials-CAT 322 $375.00 $0.00 $375.00 $0.00 $375 00 1100% $ - $18.75 Consolidation of unscreened compost in BP-CAT 322 $2,156.25 $000 $2,156.25 $0.00 $2,15625 10D% $ $107.81 msoildation of unscreened compost in SP-CAT 980 $2,965.63 $0.00 $2,965.63 $0.00 $2.%5-63 1009'0 $ - $148.28 Consolidation of unscreened compost in BP-CAT D7 $2,925.00 $0.00 $2.925.00 $0-00 $2,925.00 1100%. $ - $14625 Grading of Eastern Hill-CAT 07 $11,025.00 $0.00 $11,02500 $0.00 $11,02500 100% $ $551.25 $ I i$ 1 $ $ 1 $1,360,298.88 $161,704.78 $219,693.48 $0.00 $381,398.26 $ 978,900.62 $19,069.91 530 .5011&2L789.08 971 45 1 8B6 9 461 r�4?.02 069 073.48 1 082.35 41 1\;2 q'-57 �b + 31 72 7 4" 31 ^ �� ✓� 016 �� q37.so _ GB,t"Vv� a � U�11/ X7,3$ CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 7 Contractor's signed Certification is attached. APPLICATION DATE: 06/05/02 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO. 05/31/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: 2000 A 1 8 C D E F G H I I t ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORS) (D+E+F) 1 Pre-Nbbilization $ 208,000.00 $208,000.00 $0.00 $0,00 $208,000.00 100% $ - $10,400.00 2 Mobil,Maint.Derrabilization $ 102,000.00 $61,200.00 $10,200.00 $0.00 $71,400.00 70% $ 30,600.00 $3,570.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 4 Unclassified Excay.8 Relanntill(per FOt)Survey $ 370,000.00 S324,750.00 $0.00 $0.00 $324,750.00 88% $ 45,250.00 $16,237.50 SA Removal&Relandfilling of Buried Waste&Fill 1 Survey S 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ - $681.38 5B Excavation of Gas Migration Control Trenches $ 6,107.88 $4,890.72 $1,217.16 $0.00 $6,107.88 100% $ S305.39 5C Removal&Relandf0ing of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0,00 $9,000.00 100% $ - $450.00 5D Waste Excavation Area 2-C.O.4 $ 48,545.00 $48,396.00 $0.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 5E Waste Excavation Area 3-C.O.4 $ 54.240.00 $49,726.55 $0.00 $0,00 $49,726.55 92% $ 4,513.45 $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $2,678.10 $0.00 $0.00. $2,678.10 100% $ - $133.91 5G Waste Excavation Area 5 $ 943.78 $943.78 $0.00 $0.00 $943.78 100% $ $47.19 6 Grading Material General Fill from Onsite Sources $ 249,483.00 $191,736.00 $57,747.00 $0.00 $249,483.00 100% $ $12,474.15 7 Geotextiile Type 1 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 8 Gas venting Iayer from on sde $ 168,000.00 $55,000.00 $16,278.00 $0.00 $71,278.00 42% $ 96,722.00 $3,563.90 9 60 Mil textured HDPE Geomembrane $ 856,560.00 $302,237.00 $21,038.11 $259 208.89 $582,484.00 68% $ 274,076.00 $29,124.20 10 Landfill Gas Vents $ 46.176.00 $28,416.00 $10,656.00 $0.00 $39,07200 85% $ 7,104.00 51,953.60 Geocomposile $ 256,200.00 $45,309.90 $2,141.70 $142677.60 $190,129.20 74% $ 66,07080 $9.506.46 Border Protection Layer from Onsite Sources $ 280,000.00 591,666.65 $0.00 ` 0.00 $91.666.65 33% $ 188,333.35 $4,583.33 13A Vegthie Growth Med Using On Site Comp(FO1) $ 140.000.00 $0.00 $0.00 $0-00 50.00 0% $ 140,000.00 $0.00 13B Contingency Topsoil Off Site(per F01) $ 169,759.76 $0.00 50.00 $0.00 $0.00 0% $ 169,759.76 $0.00 14 Erosion Control Blanket $ 453,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 15 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 16 Hydroseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 18 Rip Rap Stone Fill,Gravel& Rena Mattress $ 269,763.00 $87,507.00 522,000.00 $0.00 $109507.00 41% $ 160,256.00 $5,475.35 19A6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 19812-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.0c 19C ales s 6,000.00 $0.00 $0.00 $0.00 $0.00 D% $ 6,000.00 $0.00 20 mance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 nntnarrce Road 12"Deep RCA $ 35,875.00 $0,00 $0.00 $0.00 $0.00 0% s 35,875.00 $0.00 $ 4,170,421.62 $1,537,084.30 $141,277.97 $401,886.49 $2,080,248.76 $ 2,090,172.86 $104,012.44 LandN Payment Application 7-Through May 31,2002 ��/+ �- Lit Work Compww From materials Contract UnN Work Completed This Period Work Completed This Period roam No. Description of Work Price Contract Unit Previous AmAcabom(in (in Contract Units) (in Domm) Preftrdy Shwed on Site 2 Mobs. Maim. Domabilizdfon $61200.00 $10200.00 58 Excavations of Gas Aft#on Control Trenches $2.78 cubic yard $4.890.72 441 $1.217.16 6 Contour 2Tft Mstenial 1 General F#I from Onsite Sources 13.00 cubic yard 5194135.00 10249 $57.747M- 8 57 747.00 13.00 1 cubic IMA $55,000.00 5428 9 60 Mi Towed HDPE Geomembranc $5.18 $302,237. 7650 $28 2038_ $25,2N.99 10 1_arnfAl Gas Vends i! 184.00 each 528 418.00 9 10658.00 Al 1Geocompolits .20 $0 309.90 1298 $2,1141.10 5442 877.80 i9 Rip Rep.Stone Fill,Grsnrel Fig and Reno Mhltresses $Z89 783.00 LS. $87,507.00 122 000.00 19 Abandon LwxW Gm MwAwng Walt "0.00 Foot 0.00 15 $900.00 25B Group*mW Wds le.00 Foot 001 522840.0 38 S*L*wW Drwqp IDivention $218354,00 L.S. $31,755.00 $175,708.60 t!nft of C+ -CAM $167.50 hour $0.00 2 75.00 Consoidaiianof Uneceensd C aut-CAT 322 $187.50 t 10.00 41.5 52158.25 Consaidew of lhrasened C -CAT 980 5228.125 per hour $0.00 13 $2.966.83 Cwwoti wm of Uracreened Co -CAT D7 $225.00 hour $0.00 131S2 925.00 of astern Htl-CA $225.00 r hour $0.00 49 511 025.00 $360,971.45 $40+,,888.49 Compost Payment Appieaion 7 -Through May 31,2002 Work Completed From Item No. Description of Work Ccr Price Unit Contract Unit Previous Applications(in Wow Completed This Period Work Completed This Period Price DoNers) (In Contact Units) (In Dollars) 40 Said Susan' -$3-651CY $385 cubic 5416358.3 7431 $27123.45 16 and ' -CAT 322 $167.50 hour $0.00 43 $800250 17 oad C, -CAT D7 $?25.00 hour 10.00 55.5 $42487.50 18 Wood -Daewoo 330 $225.00 hour $0.00 21 725.00 19 Wood -Hamm Roller $4!2.50 hour $0.00 11.5 51293.75 20 of 17-Acres-CAT D7 225.00 trout $0.00 48 S3 800.00 21 of 17-Aces-CAT 08 5200.00 hour 30.00 16 $3.2W.00 22 Gradim of 17-Acres-CAT 322 $197.50 W hour 50.00 14 $2625.00 23 of 17-Acres-Daewoo 330 5225.00 hour SD.00 4 $900.00 24 of 17-Aces-Terex TA40 $275.00 tar $0.001, 24 800.00 25 of 17-Acres-Hamm Rolex $11250 hour 50.00 20 $2,250.001 $72,888.90 Town of Southold, New York - Standard Voucher [ ]OWNER PAY TO: Payee Tax Identification Number 02 [ ]ARCHITECT Payee Name: --- --� // w 1 / or Social SecurityNumber: // [ ]CONTRACTOR ' Address: `7 Payee Reference 100 Phone No.(�'T/ )_ ?7- 01767 67 '01 Invoice NumberInvoice Date Vendor Contact Purchase Order Number P.O.Date Cash Discount cion with the Contract. % Days Number Description of Materials/Services Unit Quantity price Amount $ $ 5,216,366.50 $ $314,354.00 j $ $5,530,720.50 "73 7 - $ $2,461,647.02 $102,988.03 $20,094.32 $123,082.35 $ $2,338,564.67 Total $ $1,900,914.60 $ $437,650.07 $ $3,192,155.83 Net E2 2, 0 G� SUFFOL k Payee Certification &-day of 2007- 'Me 00ZThe undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and tha=nohas been aid,qpept as therein stated,and that the balance therein stated is actually due and owing. Signature Title Dated CO' $ unt applied for.) Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted,and payment is approved j f aL Signature.V -tTitle Dated t�0 �.�- —O �-- ayable only A the payment are with- ::ontract. NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-t2-20 6 , APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES Ta J" TOWN OF SOUTHOLD PROJECT: APPLICATION: 6 Distribution to: 53095 Main Road Southold Landfill Closure [ )OWNER Southold.NY 11971 PERIOD TO: 03/26/02 j ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartitucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change orders approved in , ADDITIONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner Change Orders 1 to 7 2. Net change by Change Orders $ $314,354.00 TOTAL $75,000.00 $0.00 3. CONTRACT SUM TO DATE(Line i +2) $ $5,530,720.50 A his Month 4. TOTAL COMPLETED&STORED TO DATE $ $2,000,962.74 NuffiW Date Approved (Column G on G703) 8 3/26/02 $0.00 $0.00 5. RETAINAGE: 9081 3/26/02 $21,000.00 a:_5%_of Completed Work $ $83,852.11 0 3/26/02 $ 218,354.00 (Col umn D+ E on G703) $239,354.00 b:_5_% of Stored Material $ $16,196.03 Net Change by Change Orders $314,354.00 $0.00 (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractors imowledge, Total Retainage(Line 5a+5b or information and belief the Work covered by ft Application for Payment has been Total in Column I of G703 $100,048.14 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $1,900,914.60 paid by the Contractor for work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $1,554,602.11 8. CURRENT PAYMENT DUE $ $346,312.49 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $3,629,805.90 Line 3 less Line 6 State of �t.u,V County of: Subscribed and sh to beforre a t� _ y 2 da 20 0 Z. B V ' Date: 4/z, © Notary Public: My Commis " piresl 3 Z ZO"D 3 ENGINEM)CERTIFICATI FOR PAYMENT AMOUNT CERTIFIED $ 3 L140312. Y �f In accordarm with the Cortract Docurnerft,based on on-site obseivatiara and the (Attach e*tanation if amount certified differs from the amount applied for.), data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineers knowledge,information and belief the Work las progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date. Z the Contractor is entitled to payment of the AMOUNT CERTIFIED. This C&Vhcde is not negotiable. The AMOUNT CERTIFIED is payable only tine Contimtor named herein, Issuance,paymmit and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.Ott , Certtfad in Sutl*Counw Commilssicn E 03-12-20.D-3 7 S` 77'74 s' CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2Of3 PAGES AIA Document 1270,APPL CA ION AND CERTIFICATE FOR PAYMENT, containing APPLICATION U 6 Contractor's signed Certification is attached. APPLICACATOI DATE:> 03/26/02 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 03126/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: 2000 A B C D E F G N ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL 1% BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH, APPLICATION STORED ANDSTORED (C G): (D+E) (NOT IN= TO DATE DOR Q (DIE+ $ 208,000.00 5208,000.00 $0.00 50.00 $208.000.00 100% $10,400)0 2 MON.,MOW.Demobilization $ 102,000.00 $51,000.00 $10,200.00 $0.00 $61,200.00 W% $ 40.800.00 $3,060.00 3 Clearing and Grubbing $ 60,00D.00 $12,000.00 $0.00 $0.00 $12.000.00 20% $ 48,000.00 $600.00 4 Unclassified Excay.&Reland6ll(per F01)-Survey $ 370,000.00 $324,750.00 $0.00 $0.00 $324,750.00 86% $ 45250.00 $16,237.50 SA Removal&Relandfilling of Buried Waste&Fill 1 Su $ 13,627.60 $13,627.80 $0.00 $0.00 $13,62TAD 100% $ - $11181.38 58 Excavation of Gas Migration Control Trenches $ 6,072.00 $2,622.00 $2,266.72 $0.00 $4,890.72 81% $ 1,18128 $244.54 5C Removal&Reuling of Buried Waste&Frit 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 1 DD% $ - $450.00 SO Waste Excavation Area 2-C.OA $ 48,545.00 $48,395110 $0.00 $DAD° $48,395110 99% $ 150.00 $2.419.75 5E Weeft Excavation Area 3-C.0.4 $ 54,240.00 $49.726.55 $GAO $0.00 $49.72655 92% $ 4513.45 52,486:33 5F Waste Excavation Area 4 $ 2,678.10 $2.678.10 $0.00 $0.00 $2,678.10 100% $ - $13321 5G Waste Excavation Area 5 $ 943.78 $0.00 $943.78 $0.00 $943.78 100% $ - $17.19 6 Grading Material General FRI from Onsite Sources $ 191,736.00 $190,083.00 $1,653.00 $0.00 $191,736.00 100% $ - $9,586.80 7 Geotextile Type 1 $ 42,189.52 $0.00 $0.00 $0.00 $0.00 0% $ 42,189.52 $0.00 8 Gas venting sayer from on site $ 1681000.00 $55,000.00 $0.00 $0.00 $55,000.00 33% $ 113,000.00 $2,750.00 9 W Nil textured HDPE Geomembrane $ 856,560.00 $283,800.00 $0.00 $193,88701.58 $477,670.58 56% $ 378,889.42 $23,883.53 10 Landfill Gas Vents $ 46,176.00 $28,416.00 $0.00 f t e'7,794ib $28,416.00 61% $ 17,760.00 $1.420.80 11 GeeMmposrtls $ 256,200.00 $42.000.00 $0.00 $130,050.00 $172,050.00 67% $ 84,150.00 $8.602.50 i Protection Layer from Onsite Sources $. 280,000.0D $ODD $91,666.65 $0.00 $91,686.65 33% 5 188,333.35 $4,583.33 Vag"Gmv^Med Using On Site Comp(F01) $ 140)WAO $0.00 $0.00 $0.00 $0.00 0% $ 140.000.00 $0.00 136 Contingency Topsoil OR Sae(per F01) $ 204,SWAD $0.00 $0.00 $0.00 $0.00 0% $ 204AW.00 $0.00 14 Erosion Cartrol Blanket $ 453,600.06 $(X00 $0.00 f0A0 $0110 0% 5 453.SW.00 $0.00 15 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 16 Hydressedirg $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% 5 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53.200.00 $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $20,000.00 $67,507.00 $0.00 $87,507.00 32% $ 182.256.00 $4,375.35 19116-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113.062.50 $0.00 19B 12-Foot High Fencing $ 31,60D.OD $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gales $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6.000.00 $0.00 20 Maintenance Raid 6-Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15.600.00 $0.00 21 kilaintenarwe Road 12-Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 $0.00 0% $ 35.875.00 $0.00 $ 4,189,868.50 $1,341,09825 $174,239.15 $323,920.58 51,839257.98 $ 2,350,610.52 $911962.90 702.APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLIL;A►IUN wu INDLIn. I signed Certification is attached. APPLICATION DATE: 03/26/02 ions below,amounts are stated to the nearest dollar. PERIOD TO: 03/26/02 olumn 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: 2000 i A B C D E F G H 1 ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISN APPLWATWN STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $0.00 $0.00 $0.00 096 S 276250.00 $0.00 23 Guide Rab $78,000.00 $0.00 $0.00 $0.00 $0.00 0% IS 78;000.00 $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $0.00 $0.00 sow $0.00 0% $ 15,600.00 $0.00 248 New Landfill On Monkoring Wags $43,330.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 26A Abarxion Existing Groundwater Monitoring Wells $58.800.00 $0.00 $0.00 $DAD SOHO 0% $ 58,800.00 50.00 25B New GmwWwkeri g Monritoring Woks $25,200.00 $O.00 $0.00 $CAD $0.00 0% $ 25200.00 $0.00 Drain Pipe INOuttet Structures.Sting Basins MH $65=11.00 $0.00 $37,520.76 $0.00 $37,520.76 57% $ 28,007.24 $1,876JD4 Swale Under Drains Anton Trenches $60.000.00 $0.00 $17,244.00 WAO $17244.00 29% $ 42.756.00 $862.20 28 Water Supply Wal and Electrical Services $42.000.00 $0.00 $0.00 $ODD $0.00 0% $ 42,000.00 $0.00 29 Siren 8 Electrical 3 Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 219,000.00 $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ - $540.00 33 Waste Import $76,000.00 $64,385.00 $0.00 $0.00 $64.385.00 W% $ 10,615.00 $3219.25 34 Screw ing 17•arxe Material/Stan for Gas Trmches :40,000.00 $0.00 $0.00 $GAD $0.00 0% $ 40,000.00 $0.00 35 Spreading ofGreenport Pond Material $21AW.00 $0.00 $0.00 $0.00 $0.00 0% $ 21,000.00 $0.00 36 Southeastern Dnaimge Diversion System $218,354.00 $0.00 $31,755.00 $0.00 $31,755.00 15% $ 186,599.00 $1,587.75 $1,340,852.0D $75,185.00 $85,519.76 $0.00 $161,704.76 $ 1.179,147.24 $8.085.24 SIA16.211326 756. 000 7l14 i i z Town &uthold, New York - Standard Noher PAY TO: Payee Tax Identification Number Payee Name: ,�. J S �ficial Security Number: t ' .3O y Q 1 e,r�.� ✓t o a U) ► , Address: qn9 6) W, ��1,� cJ Payee Reference 1 t/14 �Q C/I Jll l�O 1 Phone No.(_3_) 7 D Vendor Contact b Invoice Number Invoice Date Purchase Order Number P.O.Date Cash Discount % Days Item Number of Materials/Services Quantity pna Amount Number G wl Qvt f �o ; dart '�� C of �'�• 9' Total Net Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no part has been paid,except as therein stated,and that the balance therein stated is actually /due and owing. SignatureT— itle sU/x'rcc�in� Dated Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted,and payment is approved Dated / Signature I -- �'e'`` le �� 7` ��' APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: TOWN OF SOUTHOLD PROJECT APPLICATION: 5 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 01/28/02 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner C.0.1,C.0.2,C.O.3,C.0.4 2. Net change by Change Orders $ $75,000.00 TOTAL $75,000.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 + 2 ) $ $5,291,366.50 A d this Month 4. TOTAL COMPLETED& STORED TO DATE $ $1,636,423.27 Number Date Approved (Column G on G703) $0.00 5. RETAINAGE: $0.00 a:_5_%_of Completed Work $ $71,014.16 (Col umn D + E on G703) b:_5_0 of Stored Material $ $10,807.00 Net Change by Change Orders 1 $0.001 $0.00 (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $81,821.16 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $1,554,602.11 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $1,310,720.89 ,/� 8. CURRENT PAYMENT DUE $ $243,881.22 CONTRACTOR: Q,. `1 /7/h� ' 3 LY1 C� 9. BALANCE TO FINISH, PLUS RETAINAGE $ $3,736,764.39 (Line 3 less Line 6) State of: County of: L4 Subscribed and shown to before me this day of 20 B T ' Date7 Notary Public: Mill My Commission expires: ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ Z Z. t - ZZ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGIhIEE best of the Engineer's knowledge,information and belief the Work has progressed as i indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: -'-'7 0-2- the the Contractor is entitled to payment of the AMOUNT CERTIFIED. This ertificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. bb6cl de-Jucl.,J LS m�c+cifiu^ f��nS (�: v►'lu-ham'-d nc'+ teed CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 5 Contractor's signed Certification is attached. APPLICATION DATE: 01/28/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 01/28/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C.G) (D+E) (NOT IN TO DATE 0 1 DORE) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $208,000.00 $0.00 $0.00 $208,000.00 100% $ - $10,400.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $40,800.00 $10,200.00 $0.00 $51,000.00 50% $ 51,000.00 $2,550.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 370,000.00 $324,750.00 $0.00 $0.00 $324,750.00 86% $ 45,250.00 $16,237.50 5A Removal.&Relandfilling of Buried Waste&Fill 1 Surve $ 13,627.60 $13,627.60 $0.00 $0.00 $13,627.60 100% $ - $681.38 5B Excavation of Gas Migration Control Trenches $ 6,072.00 $0.00 $2,622.00 $0.00 $2,622.00 43% $ 3,450.00 $131.10 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ - $450.00 5D Waste Excavation Area 2-C.0.4 $ 48,545.00 $48,395.00 $0.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 5E Waste Excavation Area 3-C.0.4 $ 54,240.00 $46,856.58 $2,869.97 $0.00 $49,726.55 92% $ 4,513.45 $2,486.33 5F Waste Excavation Area 4 $ 2,678.10 $0.00 $2,678.10 $0.00 $2,678.10 100% $ - $133.91 6 Grading Material General Fill from Onsite Sources $ 190,083.00 $176,007.00 $14,076.00 $0.00 $190,083.00 100% $ - $9,504.15 7 Geotextile Type 1 $ 44,786.30 $0.00 $0.00 $0.00 $0.00 0% $ 44,786.30 $0.00 8 Gas venting layer from on site $ 168,000.00 $0.00 $55,000.00 $0.00 $55,000.00 33% $ 113,000.00 $2,750.00 9 60 Mil textured HDPE Geomembrane $ 856,560.00 $132,550.00 $151,250.00 $86,090.02 $369,890.02 43% $ 486,669.98 $18,494.50 10 Landfill Gas Vents $ 46,176.00 $21,312.00 $7,104.00 $0.00 $28,416.00 61% $ 17,760.00 $1,420.80 11 Geocomposite $ 256,200.00 $25,500.00 $16,500.00 $130,050.00 $172,050.00 67% $ 84,150.00 $8,602.50 40 Barrier Protection Layer from Onsite Sources $ 280,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 280,000.00 $0.00 Vegtive Growth Med Using On Site Comp(F01) $ 140,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 140,000.00 $0.00 13B Contingency Topsoil OH Site(per F01) $ 244,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 244,800.00 $0.00 14 Erosion Control Blanket $ 453,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 15 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 16 Hydroseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $24,000.00 $0.00 $0.00 $24,000.00 9% $ 245,763.00 $1,200.00 19A 6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 19B 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 $0.00 0% $ 35,875.00 $0.00 $ 4,229,868.50 $1,082,798.18 $262,300.07 $216,140.02 $1,561,238.27 $ 2,668,630.23 $78,061.91 AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 5 Contractor's signed Certification is attached. APPLICATION DATE: 01/23/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 01/18/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $0.00 $0.00 $0.00 0% $ 276,250.00 $0.00 23 Guide Rail $78,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 78,000.00 $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 24B New Landfill Gas Monitoring Wells $43,320.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 58,800.00 $0.00 25B New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.D0 - 0% $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $0.00 $0.00 $0.00 $0.00 0% $ 65,528.00 $0.00 Swale Under Drains Anchor Trenches $60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren&Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 219,000.00 $0.00 31 32 Test Pitting $10,800.00 $10,800.00 $0.00 $0.00 $10,800.00 100% $ $540.00 33 Waste Import $75,000.00 $64,385.00 $0.00 $0.00 $64,385.00 86% $ 10,615.00 $3,219.25 a.,L3 , r t11 aeV $1,061,498.00 $75,185.00 $0.00 $0.00 �7 t 1,ab` 25 5 291 366.50 $1,157,983.18 $262,300.07 $216,140.02 1 �) "� `'a 16 i ell- , qua-7-ly ��6 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 4 Distribution to: 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 11/28/01 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner C.0.1,C.0.2 2. Net change by Change Orders $ $75,000.00 Alldhk TOTAL $0.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 + 2) $ $5,291,366.50 A ed this Month 4. TOTAL COMPLETED&STORED TO DATE $ $1,379,706.20 Number Date Approved (Column G on G703) C.O.3 10/9/01 $75,000.00 $0.00 5. RETAINAGE: C.o.4 $0.00 a:_5_%—of Completed Work $ $53,080.81 (Col umn D + E on G703) b:_5_a/ of Stored Material $ $15,904.50 Net Change by Change Orders $75,000.00 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractors knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ $68,985.31 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $1,310,720.89 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS.CE RTI FICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $827,941.20 8. CURRENT PAYMENT DUE $ $482,779.69 CONTRACTOR: i� J�xC, 9. BALANCE TO FINISH, PLUS RETAINAGE $ $3,980,645.61 J (Line 3 less Line 6) State of: County of: Subscribed and shown to before me this day of 20 5 Date: // p Notary Public: My Commission expires: ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 482.,779, /.? In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineers knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By. Date: flb&& Of the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Ce Pica is not negotiable. The AMOUN RTIFIED is payable only to the ContracIQLDdlmed herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. t CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 4 Contractor's signed Certification is attached. APPLICATION DATE: 11/29/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 11/28/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $166,400.00 $41,600.00 $0.00 $208,000.00 100% $ - $10,400.00 1r2 Mobil.,Maint.Demobilization $ 102,000.00 $30,600.00 $10,200.00 $0.00 $40,800.00 40% $ 61,200.00 $2,040.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 370,000.00 $324,750.00 $0.00 $0.00 $324,750.00 86% $ 45,250.00 $16,237.50 5A Removal&Relandfilling of Buried Waste&Fill 1-Surve $ 13,627.60 $1,966.00 $11,661.60 $0.00 $13,627.60 100% $ - $681.38 SB Excavation of Gas Migration Control Trenches $ 6,072.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,072.00 $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100% $ - $450.00 50 Waste Excavation Area 2-C.0.4 $ 48,545.00 $48,395.00 $0.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 ♦�_5E Waste Excavation Area 3-C.0.4 $ 54,240.00 $36,510.30 $10,346.28 $0.00 $46,856.58 86% $ 7,383.42 $2,342.83 6 Grading Material General Fill from Onsite Sources $ 176,007.00 $82,227.00 $93,780.00 $0.00 $176,007.00 100% $ - $8,800.35 7 Geotextile Type 1 $ 153,940.40 $0.00 $0.00 $0.00 $0.00 0% $ 153,940.40 $0.00 8 Gas venting layer from on site (� $ 168,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 168,000.00 $0.00 Ilk 60 Mil textured HDPE Geomembrane`r $ 856,560.00 $0.00 $0.00 $218,640.02 $218,640.02 25% $ 637,919.98 $10,932.00 10 Landfill Gas Vents $ 46,176.00 $0.00 $21,312.00 -$0.00 $21,312.00 46% $ 24,864.00 $1,065.60 11 Geocomposite $ 163,800.00 $0.00 $0.00 $99,450.00 $99,450.00 60% $ 64,350.00 $4,972.50 12 Barrier Protection Layer from Onsite Sources $ 280,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 280 0.00 000.00 $ Veglive GrovAh Med Using On Site Comp(FO1) $ 140,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 140,000.00 $0.00 Contingency Topsoil Off Site(per F01) $ 244,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 244,800.00 $0.00 Erosion Control Blanket $ 453,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 15 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 16 Hydroseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $24,000.00 $0.00 $0.00 $24,000.00 9% $ 245,763.00 $1,200.00 19A 6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 19B 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 $0.00 1 0% Is 35,875.00 1 $0.00 $ 4,229,868.50 $735,848.30 $188,899.88 $318,090.02 $1,242,838.20 $2,987,030.30 $62,141.91 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 4 Contractors'signed Certification is attached. APPLICATION DATE: 11/29/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 11/28/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H i ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $0.00 $0.00 $0.00 0% $ 276,250.00 $0.00 23 Guide Rail $78,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 78,000.00 $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 248 New Landfill Gas Monitoring Wells $43,320.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 58,800.00 $0.00 5B New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $0.00 $0.00 $0.00 $0.00 0% $ 65,528.00 $0.00 f Swale Under Drains Anchor Trenches $60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren h Electrical 3 Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $61,683.00 $0.00 $0.00 $61,683.00 3% $ 157,317.00 $3,084.15 31 }r 32 Test Pitting $10,800.00 $9,600.00 $1,200.00 $0.00 - $10,800.00 100% $ $540.00 33 Waste Import $75,000.00 $64,385.00 $0.00 $0.00 $64,385.00 86% $ 10,615.00 $3,219.25 $1,061,498.00 $135,668.00 $1,200.00 $0.00 $136,868.00 $924,630.00 $6,843.40 5 291 368.60 871 516.30 $190.099.88 _ 318 090.02 $1,379,706.20 3 911 660.30 68 985.31 Town of Southold, New York - Standard Voucher PAY TO: Payee Tax Identification Number Payee Name.:-� or Social Security Number: d✓'�as C.��y'�Z'�rv� d Address: �e% /A Payee Reference p77'' l?/GJS /,`/y/7..' /5.4 O Phone No.( 63 /) 7Z-`-7 Vendor Contact Invoice Number Invoice Date Purchase Order Number P.O.Date Cash Discount % Days Item Number Description of Materials/Services Quantity Unit nit Amount Total -7-7 C7� Net -7 1 Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no p has been paip,exce as therein stated,and that the balance therein stated is actually due and owing. Signature Title Dated / v Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and hat the quantit=thereof have been rified with the exceptions or discrepancies noted,and ayment i approved Signature" C le Dated Check # Town of Southold BILL OF Vendor No. Invoice No. / R3 0 . . . . . Invoice Date j ( �d.�/� . . . ^/ G� Amount Claimed $ , ?dj 7 71!6 O- `� ` �`��' Purchase Order No. For Services and Disbursements as Fund and Account . . . . . . . . . . Entered by . . . . . . . . . . . . . . . Allowed, $ . . . . . . . . . . . . . . . Audited . . . . . . . . . . . 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . Town Clerk 4 - • ., Town of Southold, New York - Standard Voucher w PAY TO: Payee Tax Identification Number Payee Name: 01 or Social Security Number: ,oit/ �n vc- i�i. i r�. ZK . //30 41�0 /l Address: Payee Reference h'YC✓YS[,Oa /,/go Phone No.(G3/ ) 72-47 Q/ '7 O Vendor Contact Invoice Number Invoice Date Purchase Order Number P.O.Date Cash Discount % Days Item it Number Description of Materials/Services Quantity price Amount Total 7 s Net L�/� Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no part has been paid,excenLas therein stated,and that the balance therein stated is actually due and owing. Signature Title .g!5�9'f S. Dated�[Qo t Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantitie thereof have been verified with the exceptions or discrepancies noted,and payment is approved Signature Title Dated /G APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO:r T6WN OF SOUTHOLD PROJECT: APPLICATION: 3 Distribution to: .e 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 10/22/01 ( ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner C.0.1,C.0.2 2. Net change by Change Orders $ $75,000.00 TOTAL $0.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 + :2) $ $5,291,366.50 ved this Month 4. TOTAL COMPLETED& STORED TO DATE $ $871,517.05 er Date Approved ' (Column G on G703) 7tNet 10/9/01 $75,000.00 $0.00 5. RETAINAGE: $0.00 a:_5_%_of Completed Work $ $43,575.85 (Col umn D+ E on G703) b: of Stored Material $ $0.00 Change by Change Orders $75,000.00 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ $43,575.85 completed In accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $827,941.20 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $515,160.30 8. CURRENT PAYMENT DUE $ $312,780.90 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $4,463,425.30 (Line 3 less Line 6) State of: County of: Subscribed and shown to before me this day of 20 Date: Notary Public: My Commission expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineers knowledge,information and belief the Work has progressed as _ indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: /O Lr a the Contractor is entitled to payment of the AMOUNT CERTIFIED. This C ific a is not negotiable. TheAM T CERTIFIED is payable only to e Cont rac med herein, Issuance,paymen nd acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. Y � J CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 3 Contractor's signed Certification is attached. APPLICATION DATE: 10/24/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10/22/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED % (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $124,800.00 $41,600.00 $0.00 $166,400.00 80% $ 41,600.00 $8,320.00 !a 2 Mobil.,Maint.Demobilization $ 102,000.00 $20,400.00 $10,200.00 $0.00 $30,600.00 30% $ 71,400.00 /* $1,530.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 �p$600.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 370,000.00 $320,000.00 $4,750.00 $0.00 $324,750.00 86% $ 45,250.00 3 ."$76,237.50 SA Removal&Relandfilling of Buried Waste&Fill 1-Surve $ 13,560.00 $1,966.00 $0.00 $0.00 $1,966.00 15% $ 11,594.00 $98.30 5B Excavation of Gas Migration Control Trenches $ 6,072.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,072.00 $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $0.00 $9,000.00 $0.00 $9,000.00 100% $ - $450.00 I� 51) Waste Excavation Area 2-C.0.4 $ 48,545.00 $0.00 $48,395.00 $0.00 $48,395.00 99% $ 150.00 acj;::F ;2,9,19.75 5E Waste Excavation Area 3-C.0.4 $ 54,240.00 $0.00 $36,510.30 $0.00 $36,510.30 67% $ 17,729.70 Pb'C.6Y,825.52 F 6 Grading Material General Fill from Onsite Sources $ 108,000.00 $59,508.00 $22,719.00 $0.00 $82,227.00 76% $ 25,773.00 1♦! ��,ef0,111.35 7 Geotextile Type 1 $ 223,215.00 $0.00 $0.00 $0.00 $0.00 0% $ 223,215.00 $0.00 8 Gas venting layer from on site $ 168,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 168,000.00 $0.00 9 60 Mil textured HDPE Geomemb $ 856,560.00 $0.00 $0.00 $0.00 $0.00 090 E 856,560.00 $0.00 10 Landfill Gas Vents $ 46,176.00 $0.00 $0.00 $0.00 $0.00 090 $ 46,176.00 $0.00 11 Geocomposite $ 163,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 163,800.00 $0.00 12 Barrier Protection Layer from Onsite Sources $ 280,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 280,000.00 $0.00 4 A Vegtive Growth Med Using On Site Comp(FO1) $ 140,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 140,000.00 $0.00 Contingency Topsoil Off Site(per F01) $ 244,800.00 $0.00 . $0.00 $0.00 $0.00 0% $ 244,800.00 $0.00 4 Erosion Control Blanket $ 453,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 15 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 16 Hydroseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 Q 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $0.00 $24,000.00 $0.00 $24,000.00 9% $ 245,763.00 $1,200.00 19A 6-Foot High Fencing $ 113,062.50 $0.00 ��2G $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 19B 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 $0.00 0% IS 35,875.00 1 $0.00 $ 4,231,068.50 $538,674.00 f $197,174.30 $0.00 $735,848.30 $3,495,220.20 $36,792.42 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 3 Contractor's signed Certification is attached. APPLICATION DATE: 10/24/01 • In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 10/22/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $0.00 $0.00 $0.00 0% $ 276,250.00 $0.00 23 Guide Rail $78,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 78,000.00 $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 24B New Landfill Gas Monitoring Wells $43,320.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 58,800.00 $0.00 5B New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 W00 0% $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $0.00 $0.00 $0.00 $0.00 0% $ 65,528.00 $0.00 27 Swale Under Drains Anchor Trenches $60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren 6 Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 I� 30 Sand Pit Regrading $219,000.00 $0.00 $61,683.00 $0.00 $61,683.00 0% $ 157,317.00 $3,084.15 31 32 Test Pitting $9,600.00 $3,600.00 $6,000.00 $0.00 $9,600.00 100% $ 3,600.00 $480.00 S 33 Waste Import $75,000.00 $0.00 $64,385.75 $0.00 $64,385.75 86% $ 10,614.25 $3,219.29 >' , q6 $1,060,298.00 $3,600.00 $132,068.75 $0.00 $135,668.75 $928,229.25 $6,783.44 alit-366-60 542 274.00 $329,243.06 0.00 87 617.05 423 449.45 3 575.85 L APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 3 Distribution to: ♦ 53095 Main Road Southold Landfill Closure [ ]OWNER Southold.NY 11971 PERIOD TO: 10/22/01 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner C.O.1,C.o.2 2. Net change by Change Orders $ $75,000.00 TOTAL $0.00 $0.00 3. CONTRACT SUM TO DATE(Line 1 + 2) $ $5,291,366.50 Ap; his Month 4. TOTAL COMPLETED& STORED TO DATE $ $871,517.05 NumW Date Approved (Column G on G703) C.o.3 10/9/01 $75,000.00 $0.00 5. RETAINAGE: C.o.a $0.00 a:_5_%_of Completed Work $ $43,575.85 (Col umn D+ E on G703) b: of Stored Material $ $0.00 Net Change by Change Orders 1 $75,000.00 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ $43,575.85 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $827,941.20 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $515,160.30 8. CURRENT PAYMENT DUE $ $312,780.90 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $4,463,425.30 (Line 3 less Line 6) State of: County of: Subscribed and shown to before me this day of ,20 w1heez.1A Date: (D z _b ' Notary Public: My Commission expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 3 1 1780 YO In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: zt Date: 101744( the Contractor is entitled to payment of the AMOUNT CERTIFIED. Thisifi to is not negotiable. Th" h "I OUNT CERTIFIED is payable only t the Cont amed herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 3 Contractor's signed Certification is attached. APPLICATION DATE: 10/24/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10/22/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $124,800.00 $41,600.00 $0.00 $166,400.00 80% $ 41,600.00 $8,320.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $20,400.00 $10,200.00 $0.00 $30,600.00 30% $ 71,400.00 $1,530.00 3 Clearing and Grubbing $ 60,000.00 $12,000.00 $0.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 4 Unclassified Excay.&Relandfill(per F01)-Survey $ 370,000.00 $320,000.00 $4,750.00 $0.00 $324,750.00 86% $ 45,250.00 $16,237.50 5A Removal&Relandfilling of Buried Waste&Fill 1-Surve $ 13,560.00 $1,966.00 $0.00 $0.00 $1,966.00 15% $ 11,594.00 $98.30 5B Excavation of Gas Migration Control Trenches $ 6,072.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,072.00 $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $0.00 $9,000.00 $0.00 $9,000.00 100% $ - $450.00 SO Waste Excavation Area 2-C.0.4 $ 48,545.00 $0.00 $48,395.00 $0.00 $48,395.00 99% $ 150.00 $2,419.75 5E Waste Excavation Area 3-C.0.4 $ 54,240.00 $0.00 $36,510.30 $0.00 $36,510.30 67% $ 17,729.70 $1,825.52 6 Grading Material General Fill from Onsite Sources $ 108,000.00 $59,508.00 $22,719.00 $0.00 $82,227.00 76% $ 25,773.00 $4,111.35 7 Geotexhle Type 1 $ 223,215.00 $0.00 $0.00 $0.00 $0.00 0% $ 223,215.00 $0.00 8 Gas venting layer from on site $ 168,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 168,000.00 $0.00 9 60 Mil textured HDPE Geomemb $ 856,560.00 $0.00 $0.00 $0.00 $0.00 0% $ 856,560.00 $0.00 10 Landfill Gas Vents $ 46,176.00 $0.00 $0.00 $0.00 $0.00 0% $ 46,176.00 $0.00 11 Geocomposite $ 163,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 163,800.00 $0.00 12 Barrier Protection Layer from Onsite Sources $ 280,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 280,000.00 $0.00 0143A Vegtive Growth Med Using On Site Comp(F01) $ 140,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 140,000.00 $0.00 Contingency Topsoil Off Site(per F01) $ 244,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 244,800.00 $0.00 Erosion Control Blanket $ 453,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 1s Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 16 Hydroseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $0.00 $24,000.00 $0.00 $24,000.00 9% $ 245,763.00 $1,200.00 19A 6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 198 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 $0.00 0% Is 35,875.00 1 $0.00 $ 4,231,068.50 $538,674.00 $197,174.30 $0.00 $735,848.30 $3,495,220.20 $36,792.42 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 3 Coiitractor's signed Certification is attached. APPLICATION DATE: 10/24/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10/22/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $0.00 $0.00 $0.00 0% $ 276,250.00 $0.00 23 Guide Rail $78,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 78,000.00 $0.00 24A Abandon Existing Landfill Gas Monitoring Wells $15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 24B New Landfill Gas Monitoring Wells $43,320.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 58,800.00 $0.00 10 New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $0.00 $0.00 $0.00 $0.00 0% $ 65,528.00 $0.00 Swale Under Drains Anchor Trenches $60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren&Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $61,683.00 $0.00 $61,683.00 0% $ 157,317.00 $3,084.15 31 32 Test Pitting $9,600.00 $3,600.00 $6,000.00 $0.00 $9,600.00 100% $ 3,600.00 $480.00 33 Waste Import $75,000.00 $0.00 $64,385.75 $0.00 $64,385.75 86% $ 10,614.25 $3,219.29 $1,060,298.00 $3,600.00 $132,068.75 $0.00 $135,668.75 $928,229.25 $6,783.44 ILZ11_366.50 366.50 542 274.00 329 243.05 0.00 871 517.05 423 449.45 3 575.85 r ; Town of Southold, New York - Standard Voucher PAY TO: Payee Tax Identification Number " Payee Namey� n � �j or Social Security Number: Address: Payee Reference is 9,4/ i�.G✓'A �7' /�i Phone No.( ) Vendor Contact Invoice Number Invoice Date Purchase Order Number P.O.Date Cash Discount % Days em Number Description of Materials/Services Quantity Pnc�e Amount Total /.�/s• S Net krls!3 Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no p as bee paid,exce as therein stated,and that the balance therein stated is actually ue and owing. Signature Title 1 Dated /� Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and t at the quantities thereof have been verified with the exceptions or discrepancies noted,and payme t is approved Signature itle Dated G l APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES TO* TOWN OF SOUTHOLD PROJECT.Southoid Landfill closure APPLICATION: 2 Distribution to: [ ]OWNER PERIOD TO: 09/12/01 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 previous months by Owner 2. Net change by Change Orders $ $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $ $5,216,366.50 A d this Month 4. TOTAL COMPLETED&STORED TO DATE $ $542,274.00 Nu er Date Approved (Column G on G703) C.0.1 6/28/01 $0.00 $0.00 5. RETAINAGE: C.o.2 $0.00 a:_5_%_of Completed Work $ $27,113.70 (Col umn D+ E on G703) TOTALSI $0.001 $0.00 b: of Stored Material $ $0.00 Net Change by Change Orders 1 $0.001 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+ 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ ($27,113.70) completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $515,160.30 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $130,644.95 8. CURRENT PAYMENT DUE $ $384,515.35 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $4,701,206.20 (Line 3 less Line 6) State of: County of: Subscribed and shown to before me this day of 20 Date: Q /07 C Notary Public: My Commission expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ _3g¢j.5'/S, In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as c indicated,the quality of the Work is in accordance with the Contract Documents,and By: T Date: 97L1 the Contractor is entitled to payment of the AMOUNT CERTIFIED. This C if ate is not negotiable. The AM T CERTIFIED is payable only t/�the Contrac amed herein, Issuance,payment a d acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAG PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 2 Contractor's signed Certification is attached. APPLICATION DATE: 09/12/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/12/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 Pre-Mobilization $ 208,000.00 $83,200.00 $41,600.00 $0.00 $124,800.00 60% $ 83,200.00 $6,240.00 2 Mobil.,Maint.Demobilization $ 102,000.00 $10,200.00 $10,200.00 $0.00 $20,400.00 20% $ 81,600.00 $1,020.00 /- 3 Clearing and Grubbing $ 60,000.00 $10,800.00 $1,200.00 $0.00 $12,000.00 20% $ 48,000.00 $600.00 F 4 Unclassified Excay.&Relandfill(per F01) $ 370,000.00 $0.00 $320,000.00 $0.00 $320,000.00 86% $ 50,000.00 $16,000.00 /= 5A Removal&Relandfilling of Buried Waste&Fill 1 $ 13,560.00 $0.00 $1,966.00 $0.00 $1,966.00 15% $ 11,594.00 $98.30 5B Excavation of Gas Migration Control Trenches $ 6,072.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,072.00 $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 9,000.00 $0.00 F 6 Grading Material General Fill from Onsite Sources $ 108,000.00 $33,321.00 $26,187.00 $0.00 $59,508.00 55% $ 48,492.00 $2,975.40 7 Geotextile Type 1 $ 332,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 332,000.00 $0.00 8 Gas venting layer from on site $ 168,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 168,000.00 $0.00 9 60 Mil textured HDPE Geomemb $ 856,560.00 $0.00 10 Landfill Gas Vents $0.00 $0.00 $0.00 0% $ 856,560.00 $0.00 $ 46,176.00 $0.00 $0.00 $0.00 $0.00 0% $ 46,176.00 $0.00 11 Geocomposite $ 163,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 163,800.00 $0.00 12 Barrier Protection Layer from Onsite Sources $ 280,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 280,000.00 $0.00 13A Vegtive GrovAh Med Using On Site Comp(F01) $ 140,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 140,000.00 $0.00 13B Contingency Topsoil Off Site(per F01) $ 244,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 244,800.00 $0.00 Erosion Control Blanket $ 453,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 4 06 Hydroseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 53,200.00 $0.00 18 Rip Rap Stone Fill,Gravel& Reno Mattress $ 269,763.00 $0.00 $0.00 $0.00 $0.00 0% $ 269,763.00 $0.00 19A 6-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.50 $0.00 19B 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 0% $ 5, 00.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,6600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,875.00 $0.00 $0.00 $0.00 $0.00 I 0% le 35,875.00 $0.00 $ 4,237,068.50 $137,521.00 $401,153.00 $0.00 $538,674.00 $3,698,394.50 $26,933.70 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 2 ftntwdctbr's signed Certification is attached. APPLICATION DATE: 09/12/01 In`abulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/12/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 22 Main Access Road $276,250.00 $0.00 $0.00 $0.00 $0.00 0% $ 276,250.00 $0.00 23 Guide Rail $78,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 78,000.00 $0.00 24A Abandon ExistingLandfill Gas Monitoring Wells 9 $15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 24B New Landfill Gas Monitoring Wells $43,320.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 25A Abandon Existing Groundwater Monitoring Wells $58,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 58,800.00 $0.00 25B New Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 OM° $ 25,200.00 $0.00 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $0.00 $0.00 $0.00 $0.00 0% $ 65,528.00 $0.00 Swale Under Drains Anchor Trenches $60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 60,000.00 $0.00 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren&Electrical d Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 31 32 Test Pitting $3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ - $180.00 $979,298.00 $0.00 $3,600.00 $0.00 $3,600.00 $756,698.00 $180.00 5 216 366.50 $137,521.00 $4041753.000 0 542 274.00 0.00 455 092.50 $27,113.70 Town of Southold, New York - Standard Voucher PAY TO: Payee Tax Identification Number Payee Name: //�� JJ . or Social Security Number: l C r✓•a Lbrl�A'G�TI7•C � �,�'� Address: S�Ld ISS 1 �I � s ayee Reference 4;?G Vyi J b ffz-'� Phone No.�) Invoice NumberInvoice Date g —(� —o( Vendor Contact t Purchase Order Number P.O.Date Cash Discount % Days Im Number Description of Materials/Services Quantity price Amount Total ! 3p 6 44.1 Net Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no h s be p 'd,ex ept as therein stated,and that the balance therein stated is actually due and owing. Signature Title Dated Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted,and payment is approved Signature �t�►�yCa4 ^^ �"�"�l'Title SCl/ ��a` 44^"f"'f Dated q d I 4PPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES '0: TOWN OF SOUTHOLD PROJECT:Southold Landfill Closure APPLICATION: 1 Distribution to: [ ]OWNER PERIOD TO: 08/06/01 [ ]ARCHITECT [ ]CONTRACTOR 'ROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 01/31/01 `ONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,Is attached. "RANGE ORDER SUMMARY 'hangs Orders approved inADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM PLUS OPTION A $ $ 5,216,366.50 Drevio nths by Owner 2. Net change by Change Orders $ $0.00 IS TOTAL 3. CONTRACT SUM TO DATE(Line 1 +2) $ $5,216,366.50 Approve7this Month 4. TOTAL COMPLETED&STORED TO DATE $ $137,521.00 Number Date Approved (Column G on G703) C.0.1 6/28/01 $0.00 $0.00 5. RETAINAGE: a:-5_%—of Completed Work $ $6,876.05 (Col umn D+E on G703) TOTALS1 $0.001 $0.00 b: of Stored Material $ $0.00 Net Chane by Chan a Orders 1 $0,001 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a +5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $ $6,876.06 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $ $130,644.95 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) • issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $ $0.00 8. CURRENT PAYMENT DUE $ $130,644.95 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $ $5,085,721.55 (Line 3 less Line 6) State of: County of: Subscribed and shown to before me this day of 20 B . , Date: F 146Zo Notary Public: IV My Commission expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ /3 of g'4¢.�s� In accordance with the Contract Documents,based on on-site observations and the (Attach explanation If amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as Indicated,the quality of the Work is in accordance with the Contract Documents,and By-. -- Date. the Contractor is entitled to payment of the AMOUNT CERTIFIED. Th Cate is not negotiable. The AMO CERTIFIED is payable only o the Con ctor amed herein, Issuance,payment and acceptance of payment are with- out preJu ce to any rights of Use Owner or Contractor under this Contract. K CONTINUATION SHEET AIA DOCUMENT 6703 PAGE OF PAG PAGES kIA Document G702,APPLICATION AND CERTIFICATE FOR PXTMENT,containing APPLICATION NUMBER: 1 :ontractoes signed Certification is attached. APPLICATION DATE: 08/06/01 in tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 08/06/01 iJse Column 1 on Contracts where variable retainage for line Items may apply. ARCHITECTS PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH isAPPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DOR D+E+ 1 Pre-Mobilization $ 208,000.00 $0.00 $83,200.00 $0.00 $83,200.00 40% $ 124,800.00 $4,160.00 r 2 Mobil.,Maint Demobilization $ 102,000.00 $0.00 $10,200.00 $0.00 $10,200.00 10% $ 91,800.00 $510.00 (c 3 Clearing and Grubbing $ 60,000.00 $0.00 $10,800.00 $0.00 $10,800.00 18% $ 49,200.00 $540.00 4 Unclassified Excay.&Relandflll(per F01) $ 370,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 370,000.00 $0.00 5A Removal&Relandfilling of Burled Waste&FIII 1 $ 13,580.00 $0.00 $0.00 $0.00 $0.00 0% $ 13,560.00 $0.00 56 Excavation of Gas Migration Control Trenches $ 8,072.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,072.00 $0.00 5C Removal&Relandfilling of Buried Waste&Fill 2 $ 9,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 9,000.00 $0.00 )�6 Grading Material General FIII from Onsite Sources $ 108,000.00 $0.00 $33,321.00 $0.00 $33,321.00 31% $ 74,679.00 $1,668.05 7 Geotextile Type 1 $ 332,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 332,000.00 $0.00 8 Gas venting layer from on site $ 168,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 188,000.00 $0.00 9 60 Mil textured HDPE Geomemb $ 856,580.00 $0.00 $0.00 $0.00 $0.00 0% $ 866,560.00 $0.00 10 Landfill Gas Vents $ 46,176.00 $0.00 $0.00 $0.00 $0.00 0% $ 46,178.00 $0.00 11 Geocomposite $ 163,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 163,800.00 $0.00 12 Barrier Protection Layer from Onsite Sources $ 280,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 280,000.00 $0.00 13A Vegtive Growth Med Using On Site Comp(F01) $ 140,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 140,000.00 $0.00 lieContingency Topsoil Off Site(per F01) $ 248,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 248,400.00 $0.00 Erosion Control Blanket $ 453,800.00 $0.00 $0.00 $0.00 $0.00 0% $ 453,600.00 $0.00 16 Erosion Control Fabric $ 60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 80,000.00 $0.00 16 Hydroseeding $ 90,400.00 $0.00 $0.00 $0.00 $0.00 0% $ 90,400.00 $0.00 17 Landscaping $ 53,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 63,200.00 $0.00 18 Rip Rap Stone FRI,Gravel& Reno Mattress $ 269,783.00 $0.00 $0.00 $0.00 $0.00 0% $ 269,763.00 $0.00 19A 8-Foot High Fencing $ 113,062.50 $0.00 $0.00 $0.00 $0.00 0% $ 113,062.60 $0.00 19B 12-Foot High Fencing $ 31,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 31,600.00 $0.00 19C Gates $ 6,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 6,000.00 $0.00 20 Maintenance Road 6"Deep RCA $ 15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 21 Maintenance Road 12"Deep RCA $ 35,876.00 $0.00 $0.00 $0.00 $0.00 0°k $ 35,875.00 $0.00 $ 4,240,668.50 $0.00 $137,521.00 $0.00 $137,521.00 $4,103,147.50 $6,876.05 11A Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 1 :ontractor's signed Certification is attached. APPLICATION DATE: 08/06/01 n tabulaVons below,amounts are stated to the nearest dollar. PERIOD TO: 08/06/01 Jse Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: 2000 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DOR D+E+ 22 Main Access Road $276,250.00 $0.00 $0.00 $0.00 $0.00 0% $ 276,250.00 $0.00 23 Guide Rail $78,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 78,000.00 $0.00 24A Abandon E)dsting Landfill Gas Monitoring Wells $15,600.00 $0.00 $0.00 $0.00 $0.00 0% $ 15,600.00 $0.00 24B New Landfill Gas Monitoring Wells $43,320.00 $0.00 $0.00 $0.00 $0.00 0% $ 43,320.00 $0.00 Abandon Existing Groundwater M 00 Monitoring Wells $58,8 .00 $0.00 $0.00 $0.00 $0.00 0% $ 581800.00 $0.00 2 aw Groundwatering Monitoring Wells $25,200.00 $0.00 $0.00 $0.00 $0.00 0% $ 25,200.00 $0.00 28 Drain Pipe In/Outlet Structures,Stilling Basins MH $65,528.00 $0.00 $0.00 $0.00 $0.00 0% $ 85,528.00 $0.00 27 Swale Under Drains Anchor Trenches $60,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 50,000.00 $0.00 28 Water Supply Well and Electrical Services $42,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 42,000.00 $0.00 29 Siren&Electrical&Telephone Service. $92,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 92,000.00 $0.00 30 Sand Pit Regrading $219,000.00 $0.00 $0.00 $0.00 $0.00 0% $ 219,000.00 $0.00 $975,898.00 $0.00 $0.00 $0.00 $0.00 $975,698.00 $0.00 ma 5137,521, 1 7 21 .0 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES 10: TOWN OF SOUTHOLD PROJECT: APPLICATION: 13 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 09/30/04 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Corgracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,897,250.55 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2 ) $1,897,250.55 A.M this Month 4. TOTAL COMPLETED& STORED TO DATE $1,897,250.55 Num'Trr Date Approved (Column G on G703) 5. RETAINAGE: a:-5—%—of Completed Work $0.00 (Col umn D+ E on G703) TOTALS b: 5%_of Stored Material $0.00 Net Change by Change Orders I i (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total In Column I of G703) $0.00 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,897,250.55 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,774,593.61 8. CURRENT PAYMENT DUE / �lj4/-dn44,-Q,666.94 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE } $0.00 Terry Contracting& Materials, Inc. (Line 3 less Line 6) State of: New York County of: Suffolk '/ ERB C/ Subscribed and shown to before me this `n , T day of NOV .1 (iie.20 L)y B �' Date: �'d I Notary Public: 0 �, 629 ( -G'2-- My Commissio expires; 9- a OO EN INEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation If amount certified differs from the amount applied for.) data cor9prising the above application,the Engineer certifies to the owner that to the SOLID WASTE COORDINATOR: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: the Coll 'rbctor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-12-20� CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: 09/30/04 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/30/04 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) 0 1(D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $0.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $0.00 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 65,130.00 $65,130.00 $0.00 $0.00 $65,130.00 100% $ $0.00 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ $0.00 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ $0.00 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 100% $ $0.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ $0.00 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ $0.00 9 SURVEY $ 21,000.00 $21,000.00 $0.00 $0.00 $21,000.00 100% $ $0.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ $0.00 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $0.00 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $0.00 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $0.00 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $0.00 15 FENCE REPAIRIREPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ $0.00 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ $0.00 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ _ $0.00 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $0.00 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ $0.00 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ $0.00 21 GRADING OF 17-ACRES-CAT D6 $ 42,000.00 $38,400.00 $3,600.00 $0.00 $42,000.00 100% $ $0.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ $0.00 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $34,087.50 $0.00 $0.00 $34,087.50 100% $ $0.00 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $62,150.00 $0.00 $0.00 $62,150.00 100% $ $0.00 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $0.00 $ 1,274,348.12 $1,270,748.12 $3,600.00 $0.00 $1,274,348.12 $0.00 $0.00 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 9/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/8/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: " A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL "J BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $0.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ $0.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ $0.00 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ $0.00 30 24"CHDPE $ 63,205.00 $63,205.00 $0.00 $0.00 $63,205.00 100% $ $0.00 31 CATCH BASINS/MANHOLES $ 28,312.00 $21,000.00 $7,312.00 $0.00 $28,312.00 100% $ $0.00 9 6'HIGH FENCING $ 39,532.25 $39,532.25 $0.00 $0.00 $39,532.25 100% $ $0.00 EXCAVATION AND GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ $0.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ $0.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ $0.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ - $0.00 37 MISC.LABOR $ 5,493.64 $1,485.00 $4,008.64 $0.00 $5,493.64 100% $ 0.00 $0.00 38 SAND SCREENING-$5.67/CY $ 299,897.64 $299,897.64 $0.00 $0.00 $299,897.64 100% $ - $0.00 39 LANDSCAPING $ 57,377.64 $52,041.00 $5,336.64 $0.00 $57,377.64 100% $ $0.00 40 3-PHASE UNDERGROUND ELECTRIC W/TRANSFORMER FOR 30HP LO $ 29,400.00 $29,400.00 $0.00 $0.00 $29,400.00 100% $ - $0.00 41 BACKFILL 24"PIPES&GRADE RCA-CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $0.00 42 GRADING WOODCHIPS-CAT D6 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ $0.00 43 BACKFILL ELECTRIC TRENCH RECHARGE BASIN CAT D6/330 EXC. $ 1,525.00 $1,525.00 $0.00 $0.00 $1,525,00 100% $ $0.00 44 INSTALLED ELECTRIC FOR TRANSFORMER TO SIREN-330 EXC/416 B $ 1,725.50 $1,725.50 $0.00 $0.00 $1,725.50 100% $ - $0.00 45 GRADING TOPSOIL-416 BACKHOE $ 187.75 $187.75 $0.00 $0.00 $187.75 100% $ $0.00 46 LOAD FILL BY TRANSFORMER-TA30/972 PAYLOADE $ 675.00 $675.00 $0.00 $0.00 $675.00 100% $ $0.00 47 EXTRA FOR BLACK FENCE $ 3,956.00 $3,956.00 $0.00 $0.00 $3,956.00 100% $ $0.00 48 HEADWALL END SECTION $ 1,425.00 $1,425.00 $0.00 $0.00 $1,425.00 100% $ $0.00 49 GRADE/CURLEX/SEEDBEHIND TRANSFORMER $ 1,670.00 $1,670.00 $0.00 $0.00 $1,670.00 100% $ $0.00 GRADE WOODCHIPS ON SLOPES $ 675.00 $675.00 $0.00 $0.00 $675.00 100% $ $0.00 RCA 69 CY $ 690.00 $690.00 $0.00 $0.00 $690.00 100% $ $0.00 52 GRADING RCA-D-6 $ 4,275.00 $675.00 $3,600.00 $0.00 $4,275.00 100% $ $0.00 53 GATE WEST SIDE $ 1,725.00 $1,725.00 $0.00 $0.00 $1,725.00 100% $ $0.00 54 SETTING BLOCKS-416 C $ 1,400.00 $1,400.00 $0.00 $0.00 $1,400.00 100% $ $0.00 55 12"CHDPE PIPE $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ $0.00 56 CONSTRUCT BERMS BY COUNTY ROAD 48 $ 1,800.00 $0.00 $1,800.00 $0.00 $1,800.00 100% $ - $0.00 $ 622,902.43 $597,245.15 $25,657.28 $0.00 $622,902.43 $0.00 $0.00 $1,897.250.55 1 867 993.27 29 257.28 $O.nn tl 897 250.55 0.00 0.00 • Vendor No. Town of Southold, New York- Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Ven�orName Vendomfelephone Number '63/ Vendor Contact AZ e Invoice IzOoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 13 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing, and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. Signature '^i' Title �rC S . Signature "fi"''e ��. Company , Date '�� ATL1^vsgh *&KC APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES T0: TOWN OF SOUTHOLD PROJECT: APPLICATION: 13 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 09/30/04 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,897,250.55 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2 ) $1,897,250.55 &dlftkkve this Month 4. TOTAL COMPLETED& STORED TO DATE $1,897,250.55 er Date Approved (Column G on G703) 5. RETAINAGE: a:_5_%_of Completed Work $0.00 (Col umn D+ E on G703) TOTALS b: 5°J_of Stored Material $0.00 Net Change by Change Orders (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703) $0.00 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,897,250.55 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,774,593.61 8. CURRENT PAYMENT DUE /gyp y3y. x,656.94— CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $0.00 Terry Contracting&Materials, Inc. (Line 3 less Line 6) State of: New York County of: Suffolk Subscribed and shown to before me•this i � day of At/d4,16 ,,e6C20G�7 B � Date: I /�� Notary Public: - C( / ��t (V40— My Commission xpirrk es; INEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ �Oq y3y In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the SOLID WASTE COORDINATOR: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-1-2-20: CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: 09/30/04 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/30/04 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $0.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $0.00 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 65,130.00 $65,130.00 $0.00 $0.00 $65,130.00 100% $ $0.00 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ $0.00 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ $0.00 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 100% $ $0.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ $0.00 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ $0.00 9 SURVEY $ 21,000.00 $21,000.00 $0.00 $0.00 $21,000.00 100% $ $0.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ $0.00 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $0.00 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $0.00 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $0.00 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $0.00 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ $0.00 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ $0.00 17 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ $0.00 • WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $0.00 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ $0.00 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ $0.00 21 GRADING OF 17-ACRES-CAT D6 $ 42,000.00 $38,400.00 $3,600.00 $0.00 $42,000.00 100% $ $0.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ $0.00 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $34,087.50 $0.00 $0.00 $34,087.50 100% $ $0.00 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $62,150.00 $0.00 $0.00 $62,150.00 100% $ $0.00 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $0.00 $ 1,274,348.12 $1,270,748.12 $3,600.00 $0.00 $1,274,348.12 $0.00 $0.00 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 9/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/8/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: ' A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $0.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ $0.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $0.00 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ $0.00 30 24"CHDPE $ 63,205.00 $63,205.00 $0.00 $0.00 $63,205.00 100% $ $0.00 31 CATCH BASINSIMANHOLES $ 28,312.00 $21,000.00 $7,312.00 $0.00 $28,312.00 100% $ $0.00 6'HIGH FENCING $ 39,532.25 $39,532.25 $0.00 $0.00 $39,532.25 100% $ $0.00 EXCAVATION AND GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ $0.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ $0.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ $0.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ - $0.00 37 MISC.LABOR $ 5,493.64 $1,485.00 $4,008.64 $0.00 $5,493.64 100% $ 0.00 $0.00 38 SAND SCREENING-$5.67/CY $ 299,897.64 $299,897.64 $0.00 $0.00 $299,897.64 100% $ - $0.00 39 LANDSCAPING $ 57,377.64 $52,041.00 $5,336.64 $0.00 $57,377.64 100°% $ $0.00 40 3-PHASE UNDERGROUND ELECTRIC W/TRANSFORMER FOR 30HP LO $ 29,400.00 $29,400.00 $0.00 $0.00 $29,400.00 100°% $ - $0.00 41 BACKFILL 24"PIPES&GRADE RCA-CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $0.00 42 GRADING WOODCHIPS-CAT D6 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100°% $ $0.00 43 BACKFILL ELECTRIC TRENCH RECHARGE BASIN-CAT D6/330 EXC. $ 1,525.00 $1,525.00 $0.00 $0.00 $1,525.00 100°% $ $0.00 44 INSTALLED ELECTRIC FOR TRANSFORMER TO SIREN-330 EXC/416 B $ 1,725.50 $1,725.50 $0.00 $0.00 $1,725.50 100°% $ $0.00 45 GRADING TOPSOIL-416 BACKHOE $ 187.75 $187.75 $0.00 $0.00 $187.75 100% $ $0.00 46 LOAD FILL BY TRANSFORMER-TA30/972 PAYLOADE $ 675.00 $675.00 $0.00 $0.00 $675.00 100% $ $0.00 47 EXTRA FOR BLACK FENCE $ 3,956.00 $3,956.00 $0.00 $0.00 $3,956.00 100% $ $0.00 48 HEADWALL END SECTION $ 1,425-00 $1,425.00 $0.00 $0.00 $1,425.00 100% $ - $0.00 49 GRADE/CURLEX/SEED BEHIND TRANSFORMER $ 1,670.00 $1,670.00 $0.00 $0.00 $1,670.00 100% $ $0.00 0 GRADE WOODCHIPS ON SLOPES $ 675.00 $675.00 $0.00 $0.00 $675.00 100% $ $0.00 RCA 69 CY $ 690.00 $690.00 $0.00 $0.00 $690.00 100% $ $0.00 52 GRADING RCA-D-6 $ 4,275.00 $675.00 $3,600.00 $0.00 $4,275.00 100°% $ $0.00 53 GATE WEST SIDE $ 1,725.00 $1,725.00 $0.00 $0.00 $1,725.00 100% $ $0.00 54 SETTING BLOCKS-416 C $ 1,400.00 $1,400.00 $0.00 $0.00 $1,400.00 100% $ $0.00 55 12"CHDPE PIPE $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100°% $ $0.00 56 CONSTRUCT BERMS BY COUNTY ROAD 48 $ 1,800.00 $0.00 $1,800.00 $0.00 $1,800.00 100% $ $0.00 $ 622,902.43 $597,245.15 $25,657.28 $0.00 $622,902.43 $0.00 $0.00 11&E 250.55 $1,867,993.27 29 257.28 $0.001 $1.897.250.55 so.00 0.00 Vendor No. Town of Southold, New York- Payment Voucher Vendor Tax Number orSocial Security Number Vendor Address �� /5T Ve�QorName less ere Vendowtelephone Number ID 463/ 72 4>1-2a Vendor Contact Invoice bAoice Invoice Net Purchase order Number Date Total Discount Amount Claimed Number Descripdon of(foods or Services General Ledger Fund and Account Number `j i i ! N o /O� '� Com ut 8 $ can, .r I" Payee Certification Department Certification ��. The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me _ does hereby cert*that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions erne and owing, d that taxes Gore which the Town is exempt are excluded. or discrepancies noted,and payment is approved. Signature �'�/° Title �S • Signature461� CompanyName��ateate ! Tide DateJC —C� �1,el, 4 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 13 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 09/30/04 [ ]ARCHITECT [ )CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,897,250.55 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,897,250.55 roved this Month 4. TOTAL COMPLETED& STORED TO DATE $1,897,250.55 ber Date Approved (Column G on G703) 5. RETAINAGE: a:_5_J_ofCompleted Work $0.00 (Col umn D + E on G703) TOTALS b:-5%-of Stored Material $0.00 Net Change by Change Orders I (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703) $0.00 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,897,250.55 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,774,593.61 8. CURRENT PAYMENT DUE %��q, y3y, CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $0.00 Terry Contracting&Materials, Inc. (Line 3 less Line 6) State of: New York County of: Suffolk / Subscribed and shown o before me this / / day ofF420�tL� By: ��/ �j Date: //- �� l Notary Public '1 My Comm iss o expires; 15_11og Cf L1 WGINNEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) ' data comprising the above application,the Engineer certifies to the owner that to the SOLID WASTE COORDINATOR: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MOCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County /� �J Commissin-cynic!z na-12-20—�-_.7 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: 09/30/04 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/30/04 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORS) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $0,00 2 REMOVAL&STOCKPILING OF TOPSOIL Q LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $0.00 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 65,130.00 $65,130.00 $0.00 $0.00 $65,130.00 100% $ $0.00 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ $0.00 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ $0.00 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 100% $ $000 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ $0.00 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ $0.00 9 SURVEY $ 21,000.00 $21,000.00 $0.00 $0.00 $21,000.00 100% $ $0.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ $0.00 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $0.00 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $0.00 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $0.00 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $0.00 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ $0.00 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ $0.00 17 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ $0.00 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $0.00 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ $0.00 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ $0.00 21 GRADING OF 17-ACRES-CAT D6 $ 42,000.00 $38,400.00 $3,600.00 $0.00 $42,000.00 100% $ $0.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ $0.00 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $34,087.50 $0.00 $0.00 $34,087.50 100% $ $0.00 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $62,150.00 $0.00 $0.00 $62,150.00 100% $ $0.00 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $0.00 $ 1,274,348.12 $1,270,748.12 $3,600.00 $0.00 $1,274,348.12 $0.00 $0.00 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 9/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/8/03 U=e Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ - $0.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ - $0.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $0.00 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ - $0.00 30 24"CHDPE $ 63,205.00 $63,205.00 $0.00 $0.00 $63,205.00 100% $ - $0.00 31 CATCH BASINS/MANHOLES $ 28,312.00 $21,000.00 $7,312.00 $0.00 $28,312.00 100% $ - $0.00 2 6'HIGH FENCING $ 39,532.25 $39,532.25 $0.00 $0.00 $39,532.25 100% $ - $0.00 3 EXCAVATION AND GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ - $0.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ - $0.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ - $0.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ - $0.00 37 MISC.LABOR $ 5,493.64 $1,485.00 $4,008.64 $0.00 $5,493.64 100% $ 0.00 $0.00 38 SAND SCREENING-$5.67/CY $ 299,897.64 $299,897.64 $0.00 $0.00 $299,897.64 100% $ - $0,00 39 LANDSCAPING $ 57,377.64 $52,041.00 $5,336.64 $0.00 $57,377.64 100% $ - $0.00 40 3.PHASE UNDERGROUND ELECTRIC W/TRANSFORMER FOR 30HP LO $ 29,400.00 $29,400.00 $0.00 $0.00 $29,400.00 100% $ - $0.00 41 BACKFILL 24"PIPES&GRADE RCA-CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ - $0.00 42 GRADING WOODCHIPS-CAT D6 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $0.00 43 BACKFILL ELECTRIC TRENCH RECHARGE BASIN-CAT D6/330 EXC. $ 1,525.00 $1,525.00 $0.00 $0.00 $1,525.00 100% $ - $0.00 44 INSTALLED ELECTRIC FOR TRANSFORMER TO SIREN-330 EXC/416 B $ 1,725.50 $1,725.50 $0.00 $0.00 $1,725.50 100% $ - $0.00 45 GRADING TOPSOIL-416 BACKHOE $ 187.75 $187.75 $0.00 $0.00 $187.75 100% $ - $0.00 46 LOAD FILL BY TRANSFORMER-TA30/972 PAYLOADE $ 675.00 $675.00 $0.00 $0.00 $675.00 100% $ - $0.00 47 EXTRA FOR BLACK FENCE $ 3,956.00 $3,956.00 $0.00 $0.00 $3,956.00 100% $ - $0.00 48 HEADWALL END SECTION $ 1,425.00 $1,425.00 $0.00 $0.00 $1,425.00 100% $ - $0.00 49 GRADE/CURLEX/SEED BEHIND TRANSFORMER $ 1,670.00 $1,670.00 $0.00 $0.00 $1,670.00 100% $ - $0.00 0 GRADE WOODCHIPS ON SLOPES $ 675.00 $675.00 $0.00 $0.00 $675.00 100% $ - $0.00 1 RCA 69 CY $ 690.00 $690.00 $0.00 $0.00 $690.00 100% $ - $0.00 1552 GRADING RCA-D-6 $ 4,275.00 $675.00 $3,600.00 $0.00 $4,275.00 100% $ - $0.00 3 GATE WEST SIDE $ 1,725.00 $1,725.00 $0.00 $0.00 $1,725.00 100% $ - $0.00 4 SETTING BLOCKS-416 C $ 1,400.00 $1,400.00 $0.00 $0.00 $1,400.00 100% $ - $0.00 55 12"CHDPE PIPE $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ - $0.00 56 CONSTRUCT BERMS BY COUNTY ROAD 48 $ 1,800.00 $0.00 $1,800.00 $0.00 $1,800.00 100% $ - $0.00 $ 622,902.43 $597,245.15 $25,657.28 $0.00 $622,902.43 $0.00 $0.00 1 697 250.55 1 867 993.27 29 257.28 0.00 $1.897.250.55 0.00 0.00 s 'rLIk A I IUIV AIVU t:tK I It It;A 1 t P UK PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TOWN OF SOUTHOLD PROJECT: APPLICATION: 12 Distribution to: 53095 Main Rmd SOUTHOLD COMPOST FACILITY [ ]OWNER • Southold,NY 11971 PERIOD TO: 09/08/03 [ ]ARCHITECT [ ]CONTRACTOR A(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 1/31/01 f RACT FOR: 1NTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract Continuation Sheet,AIA Document G703,is attached. JGE ORDER SUMMARY ge Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,883,2 ous months by owner 2. Net change by Change Orders $0.00 • TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,883,267.27 :d this Month 4. TOTAL COMPLETED&STORED TO DATE $1,867,993.27 Der Date Approved (Column G on G703) 5. RETAINAGE: a:--,5—%—of Completed Work $93,399.66 (Col umn D+ E on G703) TOTALS b:---5%-of Stored Material $0.00 hangs by Change Orders I (Col umn F on G703) mdersigned Contractor certifies that to the best of the Contractors knowledge, Total Retainage(Line 5a+ 5b or nation and belief the Work covered by the Application for Payment has been Total in Column I of G703 $93,399.66 leted in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,774,593.61 >y the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) I and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR i is now due. PAYMENT(Line 6 from prior Certificate) $1,677,953.78 8. CURRENT PAYMENT DUE $96,639.83 TRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $108,673.66 Terry Contracting&Materials, Inc. Line 3 less Line 6 State of: New York County of: Suffolk • �j�yrz Subscribed and wn t before me this /2 day of ,20 6,3, Date: '!0 `✓J Notary Public: �L �� M Commission ares; GINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ ordance with the Contract Documents,based on on-*Re observations and the (Attach explanation if amount certified differs from the amount applied for.) omprising the above application,the Engineer certifies to the owner that to the SOLID WASTE COORDINATOR: f the Engineers knowledge,information and belief the Work has progressed as ted,the quality of the Work is in accordance with the Contract Documents,and By: �t�c.�.- �7g CA.�"m ate: d2 B z mtractor is entitled to payment of the AMOUNT CERTIFIED. This Ca ficate is not negotiable. The AMOUNT CERTI ED is payable only o he IF Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC60559W Certified In Suffolk County Commission Expires 0342.20 0-7 0 NTI N UATIO N SHEET AIA DOCUMENT 6703 PAGE 2 OF 3 PAGES Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 12 ltractor's signed Certification is attached. APPLICATION DATE: 09/15/03 abuiations below,amounts are stated to the nearest dollar. PERIOD TO: 09/08/03 3 Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 4 B C D E F G H I EM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE 0. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) • (D+E) (NOT IN TO DATE DORE) (D+E+ 1 REMOVAL 6 CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ - $1,020.00 2 REMOVAL 8 STOCKPILING OF TOPSOIL Q LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $84,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL d LOAM $ 65,130.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ - $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ - $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 3 RCA IMPORT 8 CONTRUCTION OF TEMPORARY P $ 16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ - $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $86,251.00 $0.00 $0.00 $88,251.00 100% $ - $4,412.55 3 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 3 SURVEY $ 21,000.00 $21,000.00 $0.00 $0.00 $21,000.00 78% $ - $1,050.00 0 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ - $17,626.76 1 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ - $656.85 2 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ - $452.40 3 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ - $1,570.50 4 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ - $201.80 5 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,787.37 $0.00 $0.00 $5,767.37 100% $ - $288.37 6 WOOD CHIP HANDLING,CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ - $403.13 7 WOOD CHIP HANDLING-CAT 07 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $236.25 9 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ - $64.69 0 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $180.00 1 GRADING OF 17-ACRES-CAT D6 $ 38,400.00 $38,400.00 $0.00 $0.00 $38,400.00 100% $ $1,920.00 2 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ - $276.56 3 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $34,087.60 $0.00 $0.00 $34,087.50 100% $ $1,704.38 4 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $62,150.00 $0.00 $0.00 $62,150.00 100% $ - $3,107.50 5 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,270,748.12 $1,270,748.12 $0.00 $0.00 $1,270,748.12 $0.00 $63,537.41 � IV{.YI/IGI�t V/vv,/'� t �.Ivn„v •r�."� ..�..... .�...� �.. . ......�..., �-..--.......� ractor'c signed Certification is attached. APPLICATION DATE: 9/15/03 bulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/8/03 Column 1 on Contracts where variable retainage for line Items may apply. ARCHITECT'S PROJECT NO: B C D E F G H I 0 DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL ,% BALANCE RETAINAGE VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORS) (D+E+ STOCKPILING OF WOOD CHIPS IN BORROW PR CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ - $30.00 STOCKPILING OF WOOD CHIPS IN BORROW PR DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ $45.00 STOCKPIIJNG OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ $30.94 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ - $22.81 24"CHDPE $ 63,205.00 $61,555.00 $1,650.00 $0.00 $63,205.00 100% $ - $3,160.25 CATCH BASINS/MANHOLES $ 21,000.00 $18,000.00 $3,000.00 $0.00 $21,000.00 100% $ - $1,050.00 Ir HIGH FENCING $ 54,806.25 $39,532.25 $0.00 $0.00 $39,532.25 100% $ 15,274.00 $1,976.61 EXCAVATION AND GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ - $600.00 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ $1,620.00 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ - $1,059.00 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ $100.00 MISC.LABOR $ 1,485.00 $561.00 $924.00 $0.00 $1,485.00 100% $ - $74.25 SAND SCREENING-$5.67/CY $ 305,715.76 $305,715.76 ($5,818.12) $0.00 $299,897.64 100% $ 5,818.12 $14,994.88 LANDSCAPING $ 52,041.00 $0.00 $52,041.00 $0.00 $62,041.00 100% $ $2,602.05 3-PHASE UNDERGROUND ELECTRIC W/TRANSFORMER FOR 30HP L $ 29,400.00 $0.00 $29,400.00 $0.00 $29,400.00 100% $ - $1,470.00 BACKFILL 24"PIPES d GRADE RCA-CAT D6 $ 600.00 $0.00 $600.00 $0.00 $600.00 100% $ - $30.00 GRADING WOODCHIPS-CAT D8 $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ - $180.00 BACKFILL ELECTRIC TRENCH RECHARGE BASIN•CAT D5/33D EXC. $ 1,525.00 $0.00 $1,525.00 $0.00 $1,525.00 100% $ $76.25 INSTALLED ELECTRIC FOR TRANSFORMER TO SIREN-330 EXC/416 B $ 1,725.50 $0.00 $1,725.60 $0.00 $1,725.50 100% $ - $86.28 GRADING TOPSOIL-416 BACKHOE $ 187.75 $0.00 $187.75 $0.00 $187.75 100% $ $9.39 LOAD FILL BY TRANSFORMER-TA30/972 PAYLOADE $ 675.00 $0.00 $675.00 $0.00 $675.00 100% $ - $33.75 EXTRA FOR BLACK FENCE $ 3,956.00 $0.00 $3,956.00 $0.00 $3,956.00 0% $ - $197.80 HEADWALL END SECTION $ 1,425.00 $0.00 $1,426.00 $0.00 $1,425.00 0% $ - $71.25 GRADE/CURLEX/SEED BEHIND TRANSFORMER $ 1,670.00 $0.00 $1,670.00 $0.00 $1,670.00 0% $ - $83.50 GRADE WOODCHIPS ON SLOPES $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ - $33.75 RCA 69 CY $ 690.00 $0.00 $690.00 $0.00 $890.00 0% $ - $34.50 GRADING RCA-D-6 $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ $33.75 GATE WEST SIDE $ 1,725.00 $0.00 $1,725.00 $0.00 $1,725.00 0% $ - $86.25 SETTING BLOCKS-416 C $ 1,400.00 $0.00 $1,400.00 $0.00 $1,400.00 0% $ - $70.00 $ 618,337.27 $495,519.02 $101,726.13 $0.00 $597,245.15 $21,092.12 $29,862.26 $1.889.089.39 0 3 00 8 1 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 12 Distribution to: 53095 Main k:�d SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 09/08/03 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,883,267.27 previous months by owner 2. Net change by Change Orders $0.00 9111111111111111, TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,883,267.27 A d this Month 4. TOTAL COMPLETED& STORED TO DATE $1,867,993.27 Number Date Approved (Column G on G703) 5. RETAINAGE: a:_5_/_of Completed Work $93,399.66 (Col umn D+ E on G703) TOTALS b: 50/-of Stored Material $0.00 Net Change by Change Orders I (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+ 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703) $93,399.66 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,774,593.61 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,677,953.78 8. CURRENT PAYMENT DUE $96,639.83 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $108,673.66 Terry Contracting&Materials, Inc. Line 3 less Line 6 State of: New York County of: Suffolk SubscribedandPpires; before me this �� day of 20 (07, Br� C_T Date /C v-� Notary Public:" My Commission -4 - 26 ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 9d, G39-S?3 In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the SOLID WASTE COORDINATOR: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: ate: Z 2- Q the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Ce Ificate is not negotiable. The AMOUNT CERTI IED is payable only to he Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County r,)mmission Expires 03.12-20 0 7 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 09/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/08/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) 0 1 (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL 6 STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $3,219.25 3 WINDROWING OF REMAINING TOPSOIL 8 LOAM $ 65,130.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ - $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY P $ 16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ - $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ - $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 21,000.00 $21,000.00 $0.00 $0.00 $21,000.00 78% $ $1,050.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ - $17,626.76 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ - $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ - $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ - $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ - $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ - $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ - $403.13 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100`Yo $ - $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ - $236.25 19 WOOD CHIP HANDLING-HAMN ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ - $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 38,400.00 $38,400.00 $0.00 $0.00 $38,400.00 100% $ - $1,920.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ - $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $34,087.50 $0.00 $0.00 $34,087.50 100% $ - $1,704.38 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $62,150.00 $0.00 $0.00 $62,150.00 100% $ - $3,107.50 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,270,748.12 $1,270,748.12 $0.00 $0.00 $1,270,748.12 $0.00 $63,537.41 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 £ontractor's signed Certification is attached. APPLICATION DATE: 9/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/8/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ $22.81 30 24"CHDPE $ 63,205A0 $61,555.00 $1,650.00 $0.00 $63,205.00 100%, $ $3,160.25 0 CATCH BASINS/MANHOLES $ 21,000.00 $18,000.00 $3,000.00 $0.00 $21,000.00 100% $ - $1,050.00 6'HIGH FENCING $ 54,806.25 $39,532.25 $0.00 $0.00 $39,532.25 100% $ 15,274.00 $1,976.61 EXCAVATION AND GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ - $600.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ $1,620.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ - $1,059.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ $100.00 37 MISC.LABOR $ 1,485.00 $561.00 $924.00 $0.00 $1,485.00 100% $ - $74.25 38 SAND SCREENING-$5.67/CY $ 305,715.76 $305,715.76 ($5,818.12) $0.00 $299,897.64 100% $ 5,818.12 $14,994.88 39 LANDSCAPING $ 52,041.00 $0.00 $52,041.00 $0.00 $52,041.00 100% $ - $2,602.05 40 3-PHASE UNDERGROUND ELECTRIC W/TRANSFORMER FOR 30HP L $ 29,400.00 $0.00 $29,400.00 $0.00 $29,400.00 100% $ - $1,470.00 41 BACKFILL 24"PIPES&GRADE RCA-CAT D6 $ 600.00 $0.00 $600.00 $0.00 $600.00 100% $ - $30.00 42 GRADING WOODCHIPS-CAT D6 $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ - $180.00 43 BACKFILL ELECTRIC TRENCH RECHARGE BASIN-CAT D6/330 EXC. $ 1,525.00 $0.00 $1,525.00 $0.00 $1,525.00 100% $ - $76.25 44 INSTALLED ELECTRIC FOR TRANSFORMER TO SIREN-330 EXC/416 B $ 1,725.50 $0.00 $1,725.50 $0.00 $1,725.50 100% $ - $86.28 45 GRADING TOPSOIL-416 BACKHOE $ 187.75 $0.00 $187.75 $0.00 $187.75 100% $ - $9.39 46 LOAD FILL BY TRANSFORMER-TA30/972 PAYLOADE $ 675.00 $0.00 $675.00 $0.00 $675.00 100% $ - $33.75 47 EXTRA FOR BLACK FENCE $ 3,956.00 $0.00 $3,956.00 $0.00 $3,956.00 0% $ - $197.80 48 HEADWALL END SECTION $ 1,425.00 $0.00 $1,425.00 $0.00 $1,425.00 0% $ - $71.25 49 GRADE/CURLEX/SEED BEHIND TRANSFORMER $ 1,670.00 $0.00 $1,670.00 $0.00 $1,670.00 0% $ - $83.50 . GRADE WOODCHIPS ON SLOPES $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ _ $33.75 RCA 69 CY $ 690.00 $0.00 $690.00 $0.00 $690.00 0% $ $34.50 52 GRADING RCA-D-6 $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ - $33.75 53 GATE WEST SIDE $ 1,725.00 $0.00 $1,725.00 $0.00 $1,725.00 0% $ - $86.25 54 SETTING BLOCKS-416 C $ 1,400.00 $0.00 $1,400.00 $0.00 $1,400.00 0% $ - $70.00 $ 618,337.27 $495,519.02 $101,726.13 $0.00 $597,245.15 $21,092.12 $29,862.26 1 889 086.39 1 766 267.14 101 726.13 0.00 1867993.27 21 092.12 93 399.66 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES Tj; TOWN OF SOUTHOLD PROJECT: APPLICATION: 12 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,9IY 11971 PERIOD TO: 09/08/03 [ ]ARCHITECT � [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,883,267.27 previous months by owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,883,267.27 A d this Month 4. TOTAL COMPLETED& STORED TO DATE $1,867,993.27 Number Date Approved (Column G on G703) 5. RETAINAGE: a:_5_%_of Completed Work $93,399.66 (Col umn D+ E on G703) TOTALS b: 5%-of Stored Material $0.00 Net Change by Change Orders I (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703) $93,399.66 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,774,593.61 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,677,953.78 8. CURRENT PAYMENT DUE $96,639.83 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $108,673.66 Terry Contracting&Materials, Inc. (Line 3 less Line 6) State of: New York County of: Suffolk G Subscribed and�/pir CHs,3 before ee)me this /F- day of 2003 VIA, .Q@ Date: ��6 6 3 Notary Public: My Commission ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 6 39.8 3 In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the SOLID WASTE COORDINATOR: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: r00�1� Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CE TIFIED is payable only o the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.Ot MC60559M Certified in Suffolk County Commission Expires 03-t2-20 07/ CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 09/15/03 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/08/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL 'J BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 65,130.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ $2,500.00 9 SURVEY $ 21,000.00 $21,000.00 $0.00 $0.00 $21,000.00 78% $ $1,050.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ $17,626.76 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ $403.13 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $236.25 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 38,400.00 $38,400.00 $0.00 $0.00 $38,400.00 100% $ $1,920.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5.531.25 100% $ $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $34,087.50 $0.00 $0.00 $34,087.50 100% $ $1,704.38 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $62,150.00 $0.00 $0.00 $62,150.00 100% $ $3,107.50 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,270,748.12 $1,270,748.12 $0.00 $0.00 $1,270,748.12 $0.00 $63,537.41 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 12 Contractor's signed Certification is attached. APPLICATION DATE: 9/15/03 1h tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/8/03 Use Column 1,on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ - $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ - $22.81 30 24"CHDPE $ 63,205.00 $61,555.00 $1,650.00 $0.00 $63,205.00 100% $ - $3.160.25 Is' CATCH BASINS/MANHOLES $ 21,000.00 $18,000.00 $3,000.00 $0.00 $21,000.00 100% $ - $1,050.00 6'HIGH FENCING $ 54,806.25 $39,532.25 $0.00 $0.00 $39,532.25 100% $ 15,274.00 $1,976.61 33 EXCAVATION AND GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ - $600.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ - $1,620.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ - $1,059.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ - $100.00 37 MISC.LABOR $ 1,485.00 $561.00 $924.00 $0.00 $1,485.00 100% $ - $74.25 38 SAND SCREENING-$5.67/CY $ 305,715.76 $305,715.76 ($5,818.12) $0.00 $299,897.64 100% $ 5,818.12 $14,994.88 39 LANDSCAPING $ 52,041.00 $0.00 $52,041.00 $0.00 $52,041.00 100% $ - $2,602.05 40 3-PHASE UNDERGROUND ELECTRIC W/TRANSFORMER FOR 30HP L $ 29,400.00 $0.00 $29,400.00 $0.00 $29,400.00 100% $ - $1,470.00 41 BACKFILL 24"PIPES&GRADE RCA-CAT D6 $ 600.00 $0.00 $600.00 $0.00 $600.00 100% $ - $30.00 42 GRADING WOODCHIPS-CAT D6 $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ - $180.00 43 BACKFILL ELECTRIC TRENCH RECHARGE BASIN-CAT D6/330 EXC. $ 1,525.00 $0.00 $1,525.00 $0.00 $1,525.00 100% $ - $76.25 44 INSTALLED ELECTRIC FOR TRANSFORMER TO SIREN-330 EXC/416 B $ 1,725.50 $0.00 $1,725.50 $0.00 $1,725.50 100% $ - $86.28 45 GRADING TOPSOIL-416 BACKHOE $ 187.75 $0.00 $187.75 $0.00 $187.75 100% $ - $9.39 46 LOAD FILL BY TRANSFORMER-TA30/972 PAYLOADE $ 675.00 $0.00 $675.00 $0.00 $675.00 100% $ - $33.75 47 EXTRA FOR BLACK FENCE $ 3,956.00 $0.00 $3,956.00 $0.00 $3,956.00 0% $ - $197.80 48 HEADWALL END SECTION $ 1,425.00 $0.00 $1,425.00 $0.00 $1,425.00 0% $ - $71.25 49 GRADE/CURLEX/SEED BEHIND TRANSFORMER $ 1,670.00 $0.00 $1,670.00 $0.00 $1,670.00 0% $ - $83.50 GRADE WOODCHIPS ON SLOPES $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ - $33.75 RCA 69 CY $ 690.00 $0.00 $690.00 $0.00 $690.00 0% $ - $34.50 52 GRADING RCA-D-6 $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ - $33.75 53 GATE WEST SIDE $ 1,725.00 $0.00 $1,725.00 $0.00 $1,725.00 0% $ - $86.25 54 SETTING BLOCKS-416 C $ 1,400.00 $0.00 $1,400.00 $0.00 $1,400.00 0% $ - $70.00 $ 618,337.27 $495,519.02 $101,726.13 $0.00 $597,245.15 $21,092.12 $29,862.26 $1,88n 085.39 1 766 267.14 $101.726.13 0.00 1 867 993.27 21 092.12 93 399.66 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 11 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 04/01/03 [ ]ARCHITECT ` % [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,841,337.14 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,841,337.14 =d this Month 4. TOTAL COMPLETED&STORED TO DATE $1,766,267.14 N er Date Approved (Column G on G703) 5. RETAINAGE: a:-5-%1—of Completed Work $88,313.36 (Col umn D+ E on G703) TOTALS b: 5%_of Stored Material $0.00 Net Change by Change Orders I i (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $88,313.36 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,677,953.78 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,434,044.62 8. CURRENT PAYMENT DUE $243,909.16 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $163,383.36 Terry Contracting&Materials, Inc. (Line 3 less Line 6) State of: New York County of: ,Suffolk Subscribed ands Ilown to before me this n - /5day of?� 2003 Date: / mac-�u-e.. Notary Public: My Commission a ires; a ' Z O O ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explana' n if amount certified Pffers from the amount applied for. data comprising the above application,the Engineer certifies to the owner that to the ENGI : S ��oy r✓,Cc best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: rl()XA� Ak-/— Date: �6 4 the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Czdlficate is not negotiable. The AMOUNT CERTIFIED is payable only to/he Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBUC STATE OF NEW YORK No.OIMC6055936 Certified in Suffolk County Commission Expires 0342.20 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF3PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 Contractor's signed Certification is attached. APPLICATION DATE: 04/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 04/01/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C.G) (D+E) (NOT IN TO DATE DORS) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ - $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ - $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 27,000.00 $0.00 $21,000.00 $0.00 $21,000.00 78% $ 6,000.00 $1,050.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ - $17,626.76 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ $403.13 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $236.25 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 38,400.00 $15,400.00 $23,000.00 $0.00 $38,400.00 100% $ $1,920.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ - $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $21,262.50 $12,825.00 $0.00 $34,087.50 100% $ - $1,704.38 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $38,637.50 $23,512.50 $0.00 $62,150.00 100% $ - $3,107.50 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,345,818.12 $1,190,410.62 $80,337.50 $0.00 $1,270,748.12 $75,070.00 $63,537.41 AIA uocument G/UZ,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 t Contractor's signed Certification is attached. APPLICATION DATE: 4/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/1/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ - $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ - $22.81 30 24"CHDPE $ 61,555.00 $30,092.00 $31,463.00 $0.00 $61,555.00 100% $ - $3,077.75 40 CATCH BASINS/MANHOLES $ 18,000.00 $11,000.00 $7,000.00 $0.00 $18,000.00 100% $ - $900.00 6'HIGH FENCING $ 39,532.25 $22,001.00 $17,531.25 $0.00 $39,532.25 100% $ $1,976.61 EXCAVATION AMD GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ - $600.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ - $1,620.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ - $1,059.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ - $100.00 37 MISC.LABOR $ 561.00 $561.00 $0.00 $0.00 $561.00 100% $ - $28.05 38 SAND SCREENING-$5.78/CY $ 305,715.76 $185,301.02 $120,414.74 $0.00 $305,715.76 100% $ - $15,285.79 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ 495,519.02 $319,110.03 $176,408.99 $0.00 $495,519.02 $0.00 $24,775.95 11,841,337.14 1 509 520.65 266 746.49 0.00 1 766 267.14175.070.00 88 313.36 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 11 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER SouXold,NY 11971 PERIOD TO: 04/01/03 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACT*R): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,841,337.14 previous months by owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,841,337.14 APW this Month 4. TOTAL COMPLETED& STORED TO DATE $1,766,267.14 Number Date Approved (Column G on G703) 5. RETAINAGE: a:_5_-of Completed Work $88,313.36 (Col umn D+ E on G703) TOTALS b: 517o_of Stored Material $0.00 Net Change by Change Orders I I (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+ 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $88,313.36 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,677,953.78 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,434,044.62 8. CURRENT PAYMENT DUE $243,909.16 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $163,383.36 Terry Contracting&Materials, Inc. (Line 3 less Line 6) State of: New York County of: Suffolk Subscribed and show to before metes_ /S day of 20 () 3 B Date: Notary Publidtr% My CommissioIexpires; 3' o� - f Q-7 ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-t2-20_� CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 Contractor's signed Certification is attached. APPLICATION DATE: 04/15/03 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 04/01/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ - $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY P $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ - $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 27,000.00 $0.00 $21,000.00 $0.00 $21,000.00 78% $ 6,000.00 $1,050.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ - $17,626.76 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ - $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ - $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ - $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ - $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ - $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ - $403.13 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ _ $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $236.25 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ - $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 38,400.00 $15,400.00 $23,000.00 $0.00 $38,400.00 100% $ - $1,920.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ - $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $21,262.50 $12,825.00 $0.00 $34,087.50 100% $ - $1,704.38 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $38,637.50 $23,512.50 $0.00 $62,150.00 100% $ - $3,107.50 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,345,818.12 $1,190,410.62 $80,337.50 $0.00 $1,270,748.12 $75,070.00 $63,537.41 AIA Uocument G/UL,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 Contractor's signed Certification is attached. APPLICATION DATE: 4/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/1/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIP4ION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %u BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ - $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ - $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ - $22.81 30 24"CHDPE $ 61,555.00 $30,092.00 $31,463.00 $0.00 $61,555.00 100% $ - $3,077.75 CATCH BASINS/MANHOLES $ 18,000.00 $11,000.00 $7,000.00 $0.00 $18,000.00 100% $ - $900.00 6'HIGH FENCING $ 39,532.25 $22,001.00 $17,531.25 $0.00 $39,532.25 100% $ - $1,976.61 33 EXCAVATION AMD GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ - $600.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ - $1,620.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ - $1,059.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ - $100.00 37 MISC.LABOR $ 561.00 $561.00 $0.00 $0.00 $561.00 100% $ - $28.05 38 SAND SCREENING-$5.78/CY $ 305,715.76 $185,301.02 $120,414.74 $0.00 $305,715.76 100% $ - $15,285.79 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ 495,519.02 $319,110.03 $176,408.99 $0.00 $495,519.02 $0.00 $24,775.95 1 841 337.14 $1,509,620.65 $256.746.49 0.00 $1.766.267.14 $75,070.00 &88.313. PAGE ONE OF 2 PAGES tnbutior tc Town of Southold, New;York - Standard Voucher Dis[ ]owNtR PAI'TO: , Payee Tax Identification Number t3 [ J ARCHITECT Payee N JJ or Social Security Number: yfy- >.✓y ALj iyvC 113,-�6o // [ )CONTRACTOR Address: Ce Payee Reference V f � 11f 0 Z Phone No.(6123 Z `� �r,,/7 a �1 Vendor Contact Invoice Number Invoice Date Purchase Order Number P.O.Date Cash Discount % Days on with the Contract. Item Number Description of Materials/Services Quantity �ce Amount $ 1,841,337.14 1 , $0.60— $1,841,337.14 $1,766,267.14 �f G 01 It ��i�SG!!� a y3 ��qi5 $88,313.36 $0.00 $88,313.36 $1,677,953.78 Total $1,434,044.62 $243,909.16 $163,383.36 Net 3 qay /6 .Suffolk n Payee Certification day of ~.CX, 20 Q� The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no p been paid,exce therein stated,and that the balance therein stated is actually due owing. / Signature s Title / S. Dated y �s $ Department Certification applied for.) Z I herebv certifv that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted,and payment is approved Signature A.1 ( . Title Dated AIIJIIe on tot 6 nent are with- act. JULIA A.MCCLAVt NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 CertifW in&Mc&County D Commission Expires 0342.20.____2 Check Town of Southold BILL OF Vendor No. Invoice No. W . . . . . . . . . . Invoice Date : -�.�? Amount Claimed $ Purchase Order No. . . . . . . . . . For Services and Disbursements as �OfM�/cd 0E.c�-Cl'��t�cct Fund and Account H Entered by . . . . . . . . . . . . . . . Allowed, $ . . . . . . . . . . . . . . . Audited . . . . . . . . . . , 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . Town Clerk APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO: TOWN OF4�SOUTHOLD PROJECT: APPLICATION: 11 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 04/01/03 [ ]ARCHITECT a FROM(CONTRACTOR): VIA(ENGINEERS): [ ]CONTRACTOR Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,841,337.14 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2 ) $1,841,337.14 ed this Month 4. TOTAL COMPLETED& STORED TO DATE $1,766,267.14 Number Date Approved (Column G on G703) 5. RETAINAGE: 2a:_5_%—of Completed Work $88,313.36 (Col umn D+ E on G703) TOTALS b: 50/.-ofStored Material $0.00 Net Change by Change Orders I i (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+ 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $88,313.36 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,677,953.78 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,434,044.62 8. CURRENT PAYMENT DUE $243,909.16 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $163,383.36 Terry Contracting&Materials, Inc. (Line 3 less Line 6) State of: New York County of: Suffolk ^Z Subscribed and 0 to before me this /,j day of 20 0 '3 Date: O� Notary Public: V//` 75 My Commis sio xp're', ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK NO.01MC6055936 Certified in Suffolk County Commission Expires 03-t2-20_4 • CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 Contractor's signed Certification is attached. APPLICATION DATE: 04/15/03 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 04/01/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ - $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ - $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 27,000.00 $0.00 $21,000.00 $0.00 $21,000.00 78% $ 6,000.00 $1,050.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ - $17,626.76 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ - $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ - $403.13 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ - $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ - $236.25 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ - $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 38,400.00 $15,400.00 $23,000.00 $0.00 $38,400.00 100% $ - $1,920.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ - $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $21,262.50 $12,825.00 $0.00 $34,087.50 100% $ - $1,704.38 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $38,637.50 $23,512.50 $0.00 $62,150.00 100% $ - $3,107.50 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,345,818.12 $1,190,410.62 $80,337.50 $0.00 $1,270,748.12 $75,070.00 $63,537.41 AIA Uocument G/UZ,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 11 Contractor's signed Certification is attached. APPLICATION DATE: 4/15/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/1/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL uJ BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PR CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ $22.81 30 24"CHDPE $ 61,555.00 $30,092.00 $31,463.00 $0.00 $61,555.00 100% $ $3,077.75 CATCH BASINS/MANHOLES $ 18,000.00 $11,000.00 $7,000.00 $0.00 $18,000.00 100% $ $900.00 V HIGH FENCING $ 39,532.25 $22,001.00 $17,531.25 $0.00 $39,532.25 100% $ $1,976.61 33 EXCAVATION AMD GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ $600.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ $1,620.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ $1,059.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ $100.00 37 MISC.LABOR $ 561.00 $561.00 $0.00 $0.00 $561.00 100% $ $28.05 38 SAND SCREENING-$5.78/CY $ 305,715.76 $185,301.02 $120,414.74 $0.00 $305,715.76 100% $ $15,285.79 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 1 0% $ - $0.00 $ 495,519.02 $319,110.03 $176,408.99 $0.00 $495,519.02 $0.00 $24,775.95 1 841 337.14 1 509 620.65 266 746.49 0.00 $1.766.267.14 75 070.00 88 313.36 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES T0: TOWN OF SOUTHOLD PROJECT: APPLICATION: 10 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 01/10/03 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead, NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,586,090.65 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,586,090.65 AF d this Month 4. TOTAL COMPLETED& STORED TO DATE $1,509,520.65 Num er Date Approved (Column G on G703) 5. RETAINAGE: a:-5—%—of Completed Work $74,817.43 _ (Col umn D+ E on G703) TOTALS b: 5%_of Stored Material $658.60 Net Change by Change Orders I (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractors knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $75,476.03 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,434,044.62 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,036,979.56 8. CURRENT PAYMENT DUE $397,065.06 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $152,046.03 Terry Contracting&Materials, Inc. (Line 3 less Line 6) _ State of: New York County of: Suffolk l/ Subscribed ands own t before this�/� a day of 20 ©3 B � Date: -a/'C3 Notary Public: r '�" "�"-v�- My Commission a ires; �'�a7 -03 ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ ;?y 7 0,1� S In accordance with the Contract Documents,based on on-site observations and the (AN�G�R: n if amount certified differs from the,(p inount applied for.)'� data comprising the above application,the Engineer certifies to the owner that to the E best of the Engineer's knowledge,information and belief the Work has progressed as ll indicated,the quality of the Work is in accordance with the Contract Documents,and By: / "LP�� Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Nritificate is not negotiable. The AMOUN RTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-12-20 0--5_ n CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 10 Contractor's signed Certification is attached. APPLICATION DATE: 01/10/03 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 01/10/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ - $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ - $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 7,500.00 $0.00 $0.00 $0.00 $0.00 0% $ 7,500.00 $0.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $273,994.55 $78,540.70 $0.00 $352,535.25 100% $ - $17,626.76 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ - $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ - $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ - $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ - $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ - $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ - $403.13 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ - $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ - $236.25 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ - $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 15,400.00 $11,300.00 $4,100.00 $0.00 $15,400.00 100% $ - $770.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ - $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 21,262.50 $12,375.00 $8,887.50 $0.00 $21,262.50 100% $ - $1,063.13 24 GRADING OF 17-ACRES-TEREX TA 40 $ 38,637.50 $28,737.50 $9,900.00 $0.00 $38,637.50 100% $ - $1,931.88 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,266,980.62 $1,088,982.42 $101,428.20 $0.00 $1,190,410.62 $76,570.00 $59,520.53 AJA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 10 Contractor's signed Certification is attached. APPLICATION DATE: 1/10/03 In,-tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 1/10/03 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ - $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ - $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ - $22.81 30 24"CHDPE $ 30,092.00 $0.00 $18,920.00 $11,172.00 $30,092.00 100% $ - $1,504.60 CATCH BASINS/MANHOLES $ 11,000.00 $0.00 $9,000.00 $2,000.00 $11,000.00 100% $ - $550.00 6'HIGH FENCING $ 22,001.00 $0.00 $22,001.00 $0.00 $22,001.00 100% $ - $1,100.05 3 EXCAVATION AMD GRADING OF ACCESS ROAD $ 12,000.00 $0.00 $12,000.00 $0.00 $12,000.00 100% $ - $600.00 34 RCA AND PAVE ACCESS $ 32,400.00 $0.00 $32,400.00 $0.00 $32,400.00 100% $ - $1,620.00 35 RETAINING WALL 1 $ 21,180.00 $0.00 $21,180.00 $0.00 $21,180.00 100% $ - $1,059.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $0.00 $2,000.00 $0.00 $2,000.00 100% $ - $100.00 37 MISC.LABOR $ 561.00 $0.00 $561.00 $0.00 $561.00 100% $ - $28.05 38 SAND SCREENING-$5.78/CY $ 185,301.02 $0.00 $185,301.02 $0.00 $185,301.02 100% $ - $9,265.05 $ - $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ 319,110.03 $2,575.01 $303,363.02 $13,172.00 $319,110.03 $0.00 $15,955.50 $1,586.090.65 $1.091.557.43 5404.791.22 13 172.00 $1.509.520.65 76 570.00 75 476.03 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 767i__TOWN OF SOUTHOLD PROJECT: APPLICATION: 9 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 09/09/02 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,159,961.43 previous months by owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,159,961.43 A this Month 4. TOTAL COMPLETED& STORED TO DATE $1,091,557.43 Nu r Date Approved (Column G on G703) 5. RETAINAGE: _T a:_5_%_of Completed Work $54,577.87 (Col umn D + Eon G703) TOTALS b: of Stored Material $0.00 Net Change by Change Orders (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractors knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total In Column I of G703 $54,577.87 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,036,979.56 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $991,464.23 8. CURRENT PAYMENT DUE $45,515.33 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $122,981.87 Line 3 less Line 6) County of: State of: Subscribed and shownn/ before met 1 d 20d B Date: q' J�- Z Notary Public: 9" cru C( l (C�liL^a� My Commissio expires; 3' 7,— 'Ut 3 ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified difters from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the EN best of the Engineers knowledge,information and belief the Work has progressed as /� indicated,the quality of the Work is in accordance with the Contract Documents,and By: C 1�-�-'--`-fit /` ,,,rim.� Date: >W_o the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNTCERTIFIED is payable onI to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A. LAV NOTARY PUBLIC STATE OF NEW YORK No.OIMC6055936 Certified In Su"Courtly Cmnmfssion Expires 0342-20„¢x_ CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 9 Contractor's signed Certification is attached. APPLICATION DATE: 09/13/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/09/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED � (C-G) (D+ *I (NOTIN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 319,245.00 $319,245.00 $1,566.00 $0.00 $320,811.00 100% $ (1,566.00) $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PA $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ - $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 7,500.00 $0.00 $0.00 $0.00 $0.00 0% $ 7,500.00 $0.00 10 SAND SCREENING-$3.65/CY $ 273,994.55 $273,994.55 $0.00 $0.00 $273,994.55 100% $ - $13,699.73 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $3,197.51 $2,569.86 $0.00 $5,767.37 100% $ $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ - $403.13 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ _ $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $236.25 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ - $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 11,300.00 $4,500.00 $6,800.00 $0.00 $11,300.00 100% $ - $565.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $2,625.00 $2,906.25 $0.00 $5,531.25 100% $ - $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 12,375.00 $900.00 $11,475.00 $0.00 $12,375.00 100% $ - $618.75 24 GRADING OF 17-ACRES-TEREX TA 40 $ 22,137.50 $6,600.00 $22,137.50 $0.00 $28,737.50 100% $ (6,600.00) $1,436.88 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ $112.50 $ 1,157,386.42 $1,041,527.81 $47,454.61 $0.00 $1,088,982.42 $68,404.00 $54,449.12 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 9 Cantraetor's signed Certification is attached. APPLICATION DATE: 9/13/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/9/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $0.00 $456.26 $0.00 $456.26 100% $ $22.81 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ _ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 1 $0.00 1 $0.00 1 0% $ - $2,575.01 $2,118.75 $456.26 $0.00 $2,575.01 $0.00 $128.75 $-1159,961.43 $1.043.646.56 7 910.87 0.00 1 091 557.43 0.00 68 404.00 S4 577.87 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION 8 Distribution to'. 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER `_'outhold, NY 11971 PERIOD TO: 07/24/02 [ ]ARCHITECT ( ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials.Inc. Dvirka&Bartilucci PROJECT NO 2000 840 West Main Street 330 Crossways Park Drive Riverhead, NY 11901 Woodbury,New York 11797-2015 CONTRACT IMTE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,120,216.56 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 +2) $1,120,216.56 JMWved this Month $0.00 4. TOTAL COMPLETED& STORED TO DATE $1,043,646.56 Wer Date Approved $0.00 (Column G on G703) $0.00 $0.00 5. RETAINAGE: $0.00 a:_5 of Completed Work $52,182.33 $0.00 (Col umn D+ E on G703) TOTALS $0.001 $0.00 b: of Stored Material $0.00 Net Change by Change Orders $0.001 $0.00 (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $52,182.33 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $991,464.23 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $836,045.37 8. CURRENT PAYMENT DUE $155,418.86 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $128,752.33 Line 3 less Line 6 State of County of: / Subscribed andslho to before me this ,3 d,4 df ,20612 B s Date: C (/ Notary Public ten' My Comm isso expires: 3 ' /a '7ev INEER'S CERTfrFCATE FOR PAYMENT AMOUNT CERTIFIED $ /_S 5s In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certifiQd'diff ersffom toe amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEEl��1 best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: t.��'-'�� tZi k�4,A-1 c C_ Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor nand herein, Issuance,payment andacceptance of payment are with- out prejudice b any rights of the Owner or Contradbr under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.OIMC6055936 CeiMed in Suffolk County r',KnrN4L ,n F,mires 03-12-2p /''Z CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 8 Contractor's signed Certification is attached. APPLICATION DATE: 07/24/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/24/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY CONPLETED (G C) TO FINISH APPLICATION STORED ANDSTORED (C-G) 0 1 (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL S CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL Q LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385,00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35070.00 $3,256.50 4 LOADOUT,XPORTRLACEMENT&COMP LOAM T/S $ 319,245.00 $319,245.00 $0.00 $0.00 $319,245.00 100% $ - $15,962.25 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY P $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $58,584.00 $29,667.00 $0.00 $88,251.00 100% $ - $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 7,500.00 $0.00 $0.00 $0.00 $0.00 0% $ 7.500.00 $0.00 10 SAND SCREENING-$3.65/CY $ 273,994.55 $143,481.50 $130,513.05 $0.00 $273,994.55 100% $ - $13,699.73 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $656.85 12 RCA TRANSPORT-$3ICY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ $201.80 15 FENCE REPAIR/REPLACEMENT $ 3,197.51 $3,197.51 $0.00 $0.00 $3,197.51 100% $ $159.88 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ $403.13 7 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ $624.38 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ $236.25 19 WOOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ $64.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 4,500.00 $3,200.00 $1,300.00 $0.00 $4,500.00 100% $ $225.00 22 GRADING OF 17-ACRES-CAT 322 $ 2,625.00 $2,625.00 $0.00 $0.00 $2,625.00 100% $ $131.25 23 GRADING OF 17-ACRES-DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ $45.00 24 GRADING OF 17-ACRES-TEREX TA 40 $ 6,600.00 $6,600.00 $0.00 $0.00 $6,600.00 100% $ $330.00 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ $112.50 $52,076.39 $ 1,118,097.81 $880,047.76 $161,480.05 $0.00 $1,041,527.81 $76,570.00 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 8 Contractor's signed Certification is attached. APPLICATION DATE: 7/24/02 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 7/24/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TOFINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PIT GAT D6 $ 600.00 $0.00 $600.00 $0.00 $600.00 100% $ $30.00 27 STOCKPILING OF WOOD CHIPS IN BORROW PIT DAEWOO 330 $ 900.00 $0.00 $900.00 $0.00 $900.00 100% $ $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $0.00 $618.75 $0.00 $618.75 100% $ $30.94 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ - $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ $0.00 $ - $0.00 $0.00 $0.00 $0.00 0% $ - tr __y $2,118.75 $0.00 $2,118.75 $0.00 $2,118.75 $0.00 $105.94 1 120 16.56SM.047.76 163 598.80 .00 11.043."6.56 R.,G0 UM70.00 $52J82.33 Town oouthotd, New York - Standard Vo cher • PAY TO: Payee Tax Identificatio ber Payee Name:.r or Social Security Num rig 6, Address: Payee Reference Ig IlD S4 IAC 1 V et D F nl Y 9o/ Phone No.( (^ 31 Vendor Contact n � Invoice Number Invoice Date 'Sn Purehara Qtdrr Number-P.O. Date Cash Discount % - ...__q Days Item Number Description of Materials/Services Quantity Pricte Amount if PA q r F +SPO Total �s. �8�$ Net Payee Certification The undefeigned(Clatmant)(Aettng on hohalf of the above named claimant)doer+hereby certify that the ford¢oinp claim ipi true and vorrort and that no part has been paid,except /as�therein stated,and that the balance therein stated is actually due and owing. - Title .2 Signature Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that -the quantities hereof have been verified with the exceptions or discrepancies noted,and payment is approved Signature tle S �� Dated - ��-P-- t� 1 �V Southold,NY 11971 JV V"'vLVvJ' '~y1L1" P4r 7, L Juvviltm ERIOD TO: 05/31/02 [ ]ARCHITECT [ J CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): i Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 956,617.76 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $9§6,617.76 Approved this Month $0.00 4. TOTAL COMPLETED&STORED TO DATE $880,047.76 Number Date Approved $0.00 (Column G on G703) $0.00 $0.00 5. RETAINAGE: $0.00 a:_5_%_of Completed Work $44,002.39 $0.00 1 (Col umn D+ E on G703) TOTALSI $0.001 $0.00 b: of Stored Material $0.00 Net Change by Change Orders 1 $0.001 $0.00 1 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $44,002.39 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $836,045.37 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $766,821.82 8. CURRENT PAYMENT DUE $69,223.55 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $120,572.39 (Line 3 less Line 6) State of: EW '90,C4- County of: rOL k /��J Subscribed and shown to before me this //� �o day of 20 2— By: iG./ Date: 6 l tc i5 No Public:C l CA_ fw lsL/t.c�.a� o My Commission pares; 3-/a -Q'j ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In ance with the Contract Documents,based on on-site observations and the (Attach explan amounl certified differs from the alpount ap ied for.) da prising the above application,the Engineer certifies to the owner that to the ENGI wk""_ C e�y(�,�r C� best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: �- 1— /`p>•-+•« '�` Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.McCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC6055936 Certified in Suffolk County Commission Expires 03-t2-20_111 O NTI N UATI O N SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 7 (tractor's signed Certification is attached. APPLICATION DATE: 06/05/02 abulations below, amounts are stated to the nearest dollar. PERIOD TO: 05/31/02 Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H i EM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE ,O. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 ofVAL 6 CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ - $1,020.00 2 IWVAL 3 STOCKPILING OF TOPSOIL®LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 319,245.00 $319,245.00 $0.00 $0.00 $319,245.00 100% $ - $15,962.25 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT S CONTRUCTION OF TEMPORARY P $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 58,584.00 $58,584.00 $0.00 $0.00 $58,584.00 100% $ - $2,929.20 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 7,500.00 $0.00 $0.00 $0.00 $0.00 0% $ 7,500.00 $0.00 10 SAND SCREENING-$3.65/CY $ 143,481.50 $116,358.35 $27,123.15 $0.00 $143,481.50 100% $ - $7,174.08 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ - $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ - $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ - $201.80 15 FENCE REPAIRIREPLACEMENT $ 3,197.51 $3,197.51 $0.00 $0.00 $3,197.51 100% $ - $159.88 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $0.00 $8,062.50 $0.00 $8,062.50 100% $ - $403.13 17 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $0.00 $12,487.50 $0.00 $12,487.50 100% $ - $624.38 18 IWOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $0.00 $4,725.00 $0.00 $4,725.00 100% $ - $236.25 19OD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $0.00 $1,293.75 $0.00 $1,293.75 100% $ - $64.69 20 ING OF 17-ACRES-CAT D7 $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ - $180.00 21 ING OF 17-ACRES-CAT D6 $ 3,200.00 $0.00 $3,200.00 $0.00 $3,200.00 100% $ - $160.00 22 GRADING OF 17-ACRES-CAT 322 $ 2,625.00 $0.00 $2,625.00 $0.00 $2,625.00 100% $ - $131.25 23 GRADING OF 17-ACRES-DAEWOO 330 $ 900.00 $0.00 $900.00 $0.00 $900.00 100% $ - $45.00 24 GRADING OF 17-ACRES-TEREX TA 40 $ 6,600.00 $0.00 $6,600.00 $0.00 $6,600.00 100% $ - $330.00 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $0.00 $2,250.00 $0.00 $2,250.00 100% $ - $112.50 $ 956,617.76 $807,180.86 $72,866.90 $0.00 $880,047.76 $76,570.00 $44,002.39 APPLICATION AND CER I It II:A It Curt rATmtn 1 TO AOWN OF SOUTHOLD PROJECT: APPLICATION: 7 Distribution to: ` 513095 Main Road SOUTHOL.D COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 05/31/02 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR). VIA(ENGINEERS). Terry Contracting&Materials,Inc Ovirka&Bartiluca PROJECT NO: 2000 a40 West Main Street 330 Crossways Park Dr ve Riverhead,NY 11901 Woodbury.New York 11797 2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below, in connection with the Contract. Continuation Sheet.AIA Document G703, is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 956,617.76 previous months by Owner 2. Net change by Change Orders $0.00 -TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2 ) $956,617.76 AppIIIIIIIII,this Month $0 00 4. TOTAL COMPLETED&STORED TO DATE $880,047.76 Nu ate Approved $000 (Column G on G703) $0.00 $0.00 5. RETAINAGE: $4-00 a:_5_%_of Completed Work $44,002.39 $0.00 (Col umn D+ E on G703) TOTALS $000 $000 b: of Stored Material $0.00 Net Change by Chane Orders 1 $0.001 $0.00 (Col umn F on G703) -the undersigned Contractor certifies that to the gest of the Contractors knowledge, Total Retainage(Line 5a+5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $44,002.39 completed in accordance with the Contract Documents,that all amowrts have been 6. TOTAL EARNED LESS RETAINAGE $836,045.37 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $766,821.82 8. CURRENT PAYMENT DUE $69,223.55 CONTRACTOR: 9. BALANCE TO FINISH. PLUS RETAINAGE $120,572.39 (Line 3 less Line 6) State of. C GSI County of: FdG k ( Subscr+bed and shown?o belore ms tMs to -t& day of �C�L-�. 20 Date. 6! is Notary Public My Commission&PIres, ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from tale amount applied for) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicted,the quality of the Work is in accordance with the Contract Documents,and By: Date: the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.01 MC605WA Certified in Suffolk County Commission Expires 03-t2-20�1�_ CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES 41A Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 7 Contractor's signed Certification is attached. APPLICATION DATE: 06/05/02 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 05/31/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO, VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) 4 (D+E) (NOT iN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL 0 LANDFILL $ 64,385.00 $64.385.00 $0.00 $0.00 $61.385.00 100% $ - $3219.25 3 WINDROWING OF REMAINING TOPSOIL 3 LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENTBCOMP LOAM TiS $ 319,245.00 $319,245.00 $0.00 $0.00 $319,245.00 100% $ - $15.962.25 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% s - $1,812-50 6 RCA IMPORT A CONTRUCTION OF TEMPORARY P $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 58,584.00 $58.584.00 $0.00 $0.00 $58,584.00 100% 3 - $2,929.20 8 SAND SCREENING-$2.501CY $ 50.000.00 $50,000.00 $0-00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 7,500.00 $0.00 $0.00 $0.00 $0.00 0% $ 7.500.00 $0.00 10 SAND SCREENING-$3.65/CY s 143,481.50 $116,358.35 $27,123.15 $0.00 $143,481.50 100% $ $7.174.08 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% s $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 1D0% $ $1,570.51) 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,035.00 $4.036.00 $0.00 $0.00 $4,036-00 100% $ $201.80 15 FENCE REPAiR/REPLACEMENT $ 3,197.51 $3,197.51 $0.00 $0.00 $3,197.51 100% $ $159.88 16 WOOD CHIP MANDLING-CAT 322 $ 8,062.50 $0.00 $8,062.50 $0.00 $8,062.50 100% $ - $403.13 WOOD CIDP HANDLING-CAT 1)7 $ 12.487.50 $0.00 $12.487.50 $0.00 $12,487.50 100% $ - $624.38 WOOD CHIP HANDLING-DAEWOO 370 s 4,725.00 $0.00 $4,725-00 $0.00 $4,725.00 100% $ - $236.25 19 WOOD CHIP HANDLING-HAMA ROLLER $ 1 293.75 $0.00 $1.293.75 $0.00 $1,293.75 100% is - 564.69 20 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $ORO $3,600.00 $0.00 $3,600-00 100% I$ - $180.00 21 GRADi NG OF 17-ACRES-CAT D6 $ 3,200.00 $0.00 $3.200.00 $0-00 $3,200.00 100% $ - $160-00 22 GRADING OF 17-ACRES-CAT 322 $ 2,625.00 $0.00 $2,625.00 $0-00 $2,625.00 100% $ - $131.25 23 GRADING OF 17-ACRES-DAEWOO 330 $ 900.00 SO.00 $900.00 $0.00 I $900.00 100% $ - $45.00 24 GRADING OF 17-ACRES-TEREX TA 40 $ 6,600.00 $0.00 $6,600.00 $0.00 $6.600.00 100% $ - $330-00 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $0.00 $2.250.00 $0.00 $2,250.00 100% $ - $11250 $ 956,617.76 $807,180.86 $72,866.90 $0.00 $880,047.7 $$76,570.00 544,002.39 [ ]ARCHITECT town of Southold,New York . Standard Voucher [ ]CONTRACTOR PAY TO: Payee Name: Payee Tax Identification Number 4 � or Social Security Number: G Payee Reference Phone No.c 63�, 7.?7— Dl7U vith the Contract. Vendor Contact Invoice Number Invoice Date Purchase Order Number P.O.Date Cash Discount % Days $ 956,617.76 Nuem 0.00 mber Description of Materials/Services Quantity Price Amount $9§6,6$7.76 $880,047.76 $44,002.39 • $0.00 $44,002.39 $836,045.37 $766,821.82 $69,223.55 Total $120,572.39 Fay k Net 6p S day of 20 6 Z- Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct q and that no p been paid,except therein stated,and that the balance therein stated is actually due and owing. $ 6 ip led for.) Signature . Title res Dated G �2 A Z Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly a only to the performed and that the quantities thereof have been verified with the exceptions or discrepancies noted,and payment is approved (� n lent are with- Signature / ^ � Title Dated fa— / D —d'a_ act. Certified in Suffolk County Commission Expires 03-t2-20 1 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO: TOWN OF SOUTHOLD PROIECF: APPLICATIO01: 6 voritmiiion to,- 53M Main Road SOUTHOLD WUPOST FACIIJTY `I ]OWWR / Southold,NY 11971 PERM TO: 03/25/02 r [ ]ARCHITECT ( j WNTRACTOR F00AI(CONTRACTOR): VA(ENGINEERSI: Tony CotdradfeK&Neleriais,bw. tnt m&a artituaci PROJECT MD. 2000 SW West Main Sired 330 OM33 "Part[Drive ttrerhea4 NY 11901 WnOft ry,NewYcrk 11797-2015 CONTRACT DATE: 1/31101 CONTRACT FOR; CONTRACTORS APPUCATION FOR PAYMENT Application ir:made for Paytrnent;as shown below,in raonnocfon will fie contract. Calimraion S mek AIA Dommi#GM,Is Attached. ORDER SUMMWV Changs OTders aWovedin TIONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM ;-- x83,790.86 prerims months by0wher 2. Net change by Change Orders 50.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 +2) $683,750.86 , Approved thn Monlh $0.00 4 TOTAL COMPLETED&STORED TO DATE 3807,180.66 Number Date AWroved 30-00 (Cohsm G on G703) i $0.00 90.00 5. RETA NAGE: i so-im a of Comp!eted Work $40,359.04__ $0 (Col urnn D+E on G703) TOTALS ;0.00 50.00 b: of Stored Material 50.00 Net ChanpbyChange O'de's $Om -Do (Cal urm F on G703) r The wldembrod Co wm*r owfka that to the bed of the Cenbe ctm knoledfle, Total Rdainage(Line 5a+5b or i de n alloo and babel t o llitfark oor Brad bytha Appkafm for pyyaleut has beanTotal In Column t of G703 $40$59,04 i oar 0abdln momrdsnee wMhow Caanret tDomenw+ts,**Wjwwwr fs haae bmn 6. TOTAL EARNED LESS RETAINAGE $7®B,x2t-x2 PW by the Caatractor for Wm*for rlfrieh pnNoua Csltoatea of Payment hsata au issued snd paynlerlts rmehed tom!se omwr,and that ment (Line 4 Vest Line 5 Total) �eha�wm 7. LESS PREVIOUS CERTIFICATES FOR tl.rai"ie"0N1due PAYMENT(Line 6 from prior Certificate) _ 3665,524.35 8. CURRENT PAYMENT DINE $101 297.47 CONTRACTOR 9. BALANCE TO FIMStt,PLUS RETAINAGE it1-B,fNQe-04 Line 3less Line 6 Staler Courtly of: 20 i= Subscribed and shown taf NRS _ L .21 B V • Owe: � 2 �! Noiay Pubiir � AllI M COrnmisS es; ENGINEE 'S ERTIFICATE O PAYMENT AMOUW CERTFI£d s In accordance vwNh tie Contract DxuArahk, on-mile observa6orm and the (Atbch avlenebon if amour#carti3ed dWera from the amount applied for.) dabo mWlairlpthembamelpNafYtal OwEnobver btheamerlhdtotlre ENGINEER: beet of Nle Enik"WN twv4 0P.WOneak n and b*W the Work has proommed as lrlydceted,the Waft of the Work is In momWence wfth Nva Corp Doctxm ts,and By, Daae: to Cantrador fs emWed to payment of the AMOUNT CERTIFIED. This CMINtcale is trot►letotabla. The AMOUNT CERTWfED is PGVabk any ftr the cw*&tui,w comm, lawisrroe pegnlert ashA acoeptarwtis of P afe hMltr ass pr*atloe bow doff of tse cimm orca treotor under this Corltrart VE NOTARY PUBLIC STATiE t4EW%VpW no,01AICS05mm Corr**dw Ekpiras(0-1-2-20 .14 a r - CONTINUATION SHEET AIA DOCUMENT G703 PAIGE 2o zPMES ZIA anient 6702,APPLICATION W CER'TFICATE FOR PAY ,cmu mft Appy _ 6 Cmtracter's sipied Certification is attached, APPUCATiON DATE: 03/Z6/02 In tabulations below,aRIo ob are slated to the mold dWkr. PERIOD TO: 03/26102 Use Coiww 1 o11 Contracts whore variable retainage for Noe item ms7 sPPIl►- ARCHITECT'S PROJECT NO: A S C D E F G N 1 ITEM OESCRIt'Tmm OF low SCHEDULED WOW ODMPLETBD MATEMALS TOTAL $ SALA= RETANAGE • VALUE rRNA PRNIOUS THIS PERM PRESENTLY COMPLETED (a L) TO FINISH APPLICATION STORED AND$TORE- (D-G t (D+E) (NOT IN TO DATE CORE) (0+E+ 111 CQ0.00 { 1 8 CONSOLIDATION OF VEGETATION 5 20.400.00 $20,40080 $0.00 $0.00 ;20,40000 100% S 2 MOWAL 8 STOCKPIL*IG OF TOPSOIL 6 L0040ML i 643115.00 $60.365 O0 $3,219.25 � $0.00 SO.OD 484.306.- 100% i s 3 WRIRNMAWOOFR TOPSMiLOAA1 $ IM20D.00 $65.13D;00 $0-00 56.00 $85,130.0D as% $ 35Q70a0 $3,25650 4 .)GKw PLAGGamEJ WONIP L0m TJ3 $ 3194245.0 3315.1m.00 $4.0E9-00 50.00 3319 m ou 10096 S $15,06225 5 k0C:ESSROAD ! 36$250.00 $38.25-00 $000 $000 $36,250.00 "m $ $1,612.50 6 RC1k@VCRT s OONTRUCTIOM OF TEMvp12%RY pAI $ GROW.00 $18J00D00 $000 SO.D $16,00000 3294 $ 34,000.00 $60000 7 V4000 CHIPS-$3fM $ 56.564-W SMAK D $41,M.90 11010 i66.6p.OD 10096 $ $ SAND SCREENING-SISNCY $ 90.00000 $50,000.012.50000 30.00 $0.00 55-,000.00 160!6 i 9 SLIRWY $ 7,50-00 '000 $0-00 SOHO $0.00 0% $ T.500.00 $O.D 10 SMD3C -$3e51CY $ 116,366,35 $66.775,95 $573112-40 $0.00 $143511.35 100% S - R5l17,92 11 TRANSPORT $ 13,13700 $13,137.00 $ONO $0.00 513`13700 100% f - $656.85 12 CA TRANSPORT-$31CY 0 SCM.00 $9,OIe.00 $0.80 $0.1N $6„048.00 100% $ - $4u.4e 13 ONGTRUCT1014OFA�PAD AND AOCE=ROAD $ 31,410.00 131,410.[10 10.86 $0.00 $31,410.00 100% i - 31,57050 14 LOCATION OF TEM PORMRY ACCESS ROAD 1 J,036.00 54,W6.00 $0.00 $0.00 $4,036-60 100% $ - 11201.80 15 ENCS T $ 3,tg7,Sf $ONO $3.187.51 $O.OD $3,197.51 10046 i $139 611 $ 883.75034 5700551.06 $1e"26.91 $D-OD $1107,180.86 $?6570.00 $40x 9• APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TC TCrvti 0:SOUTi-iO:.D PPCJE:T, APPL!Cr"TION 6 D!Strlt)Ubon t:� 53095 Main Road SOUTHOLD COMPOS'FACILITY [ )OWNEP Southold, NY 11971 PERIOD TO: 03/26/02 [ j ARCHITECT ( )CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartiluca PROJECT NO: .2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 883,750.86 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 1 3. CONTRACT SUM TO DATE(Line 1 + 2) $883,750.86 App ,his Month $0.00 4. TOTAL COMPLETED&STORED TO DATE $807,180.86 Number Date Approved $000 (Column G on G703) $0.00 $0.00 5. RETAINAGE: $0.00 a:-5–%_of Completed Work $40.359.04 $0.00 (Col umn D+ E on G703) TOTALS $0.00 $0.00 b: of Stored Material $0.00 Net Change by Change Orders so-001 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractors knowledge, Total Retainage(Line 5a+ 5b or information and belief the Work covered by the Application for Payment has been Total in Column 1 of G703 $40,359.04 completed in accordance with the Contact Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $766,821.82 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $665,524.35 8. CURRENT PAYMENT DUE $101,297.47 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $116,929.04 Line 3 less Line 6 State of County of r w ' Subscribed and shown to before me thi3 � � a da .h s f p 20 0 �- �J . Date: Z G NotaryPublic�4 My Commissio xprces; ENGINEE 'S 9ERTIFICATE2'1 PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Docurnerits, on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) r data comprising the above application,the Engineer ceffifies to the owner that to the ENGINEER: best of the Engineers knowledge,information and belief the Work has progressed as _ indicated,the quality of the Work is in accordance with the Contract Documents,and B Date: rJ Z the Contractor is entitled to payment of the AMOUNT CERTIFIED. This CaKcate is not nepotiabk_ The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Corrtra under this Contract. AXIA A. NOTARY POSL STATEF NEW YORK No.OIW-605WM Cel W in Suffolk mon Expires 03-12-20 .? r �✓" r CONTINUATION SHEET AIA DOCUMENT 6703 PAGE 2 OF 2 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 6 Contractor's signed Certification is attached. APPLICATION DATE: 03/26/02 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 03/26/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: A B C 0 E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL �(, BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORS) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ - $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL 0 LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 319245.00 $315,156.00 $4,089.00 $0.00 $319,245.00 100% $ - $15,96125 5 ACCESS ROAD $ 36,250.00 536,250.00 $0.00 $0.00 536250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY P $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 58,584.0 $16,824.00 $41,760.00 $0.00 $58,584.00 100% $ - $2.92920 8 SAND SCREENING-$2.50/CY $ 50,000.00 5501000.00 $0.00 $0.00 $50,000.00 100% $ - $2.500.0 9 SURVEY $ 7,500.00 $0.00 $0.00 $0.00 $0.00 0% $ 7,500.00 $0.00 10 SAND SCREENING-$3.65/CY $ 116,358.35 $58,775.95 $57,582.40 $0.00 $116,358.35 100% $ - $5,817.92 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ - $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.01) 100% $ - $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ - $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ - $201.80 15 FENCE REPAIR/REPLACEMENT $ 3,197.51 $0.00 $3,197.51 $0.00 $3,197.51 100% $ - $159.88 $ 883,750.86 $700,551.95 $106,628.91 $0.00 $807,180.86 $76,570.00 $40,359.04 r � PAY TO: - Towntouthold New York - - Standard fucher Payee Name: Payee Tax Identification Number y jtQ , or Social Security Nb 'r'Q rr•/ �„ n M 1�triGl SrtL umer: 1130 Address: �y0 Payee Reference J[/P f 1t c1 /U Phone No.C6 L) 7 7— 0/ 7 O Invoice Number Invoice Date Vendor Contact '0 /yo- •ti—rr Purchase Order Number P.O.Date Cash Discount % Days Item Number Description of Materials/Services Quantity Unit Price Amount Total Net O m79 Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no part has been paid,except as therein stated,and that the balance therein stated is actually duF and owing. Signature %— —' mss-t�� Title Dated Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted,and payment is approved Signature /^l`K ti.� Title v Dated S/- 17—."),— r, APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 5 Distribution to: i 53095 Main Road SOUTHOLD COMPOST FACILITY I ]OWNER Southold,NY 11971 PERIOD TO: 01/28/02 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/2001 CONTRACT FOR: _ CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM $ 790,297.95 previ anths by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 +2) $790,297.95 ApprMthis Month $0.00 4. TOTAL COMPLETED&STORED TO DATE $700,551.95_ Number Date Approved $0.00 (Column G on G703) $0.00 $0.00 5. RETAINAGE: $0.00 a:_5_%—of Completed Work $35,027.60 $0.00 (Col umn D+E on G703) TOTALS1 $0.001 $0.00 b: 'of Stored Material $0.00 Net Chane by Change Orders 1 $0.001 $0.00 (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a+5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $35,027.60 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $665,524.35__ paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner, and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $403,089.75_ 8. CURRENT PAYMENT DUE $262,434.60_ CONTRACTOR C y �,r�i��j� ��,yy ,.,� 3 �jC 9. BALANCE TO FINISH,PLUS RETAINAGE $124,773.60_ / � 4 (Line 3 less Line 6) _ State County of: Subscribed and shown to before me this day of ,20 B Date: S Notary Public: My Commissionexpires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents, based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents, and By: KII: ;// Date: IS-10 2— the the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702,APPUCAT10N AND CERTIFICATE FOR PAYMENT,containing APPUCATION NUMBER: 5 Contractor's signed Certification is attached. APPLICATION DATE: 01/28/02 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 01/28/02 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H 1 ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FMJISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.21.9 3 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 315,156.00 $199,893.00 $115,263.00 $0.00 $315,156.00 100% $ - $15,757.80 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 6 RCA IMPORT&CONTRUCTION OF TEMPORARY PAD $ 50,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ 34,000.00 $800.00 7 WOOD CHIPS-$3/CY $ 30,000.00 $9,777.00 $7,047.00 $0.00 $16,824.00 56% $ 13,176.00 $841.20 8 SAND SCREENING-$2.50/CY $ 50,000.00 $12,500.00 $37,500.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 7,500.00 $0.00 $0.00 $0.00 0% $ 7,500.00 $0.00 10 SAND SCREENING-$3.65/CY $ 58,775.95 $0.00 $58,775.95 $0.00 $58,775.95 100% $ - $2,938.80 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $0.00 $13,137.00 $0.00 $13,137.00 100% $ $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $0.00 $9,048.00 $0.00 $9,048.00 100% $ $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $0.00 $31,410.00 $0.00 $31,410.00 100% $ $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $0.00 $4,036.00 $0.00 $4,036.00 100% $ $201.80 $ 790,297.95 $424,335.00 $276,216.95 $0.00 $700,551.95 $89,746.00 $35,027.60 APPLICATrN AND CERTIFICATE FOR PAYMENT _ AU+QOCu1ENT G7D2 _ PAGE QC r PAGES r TO: -IMS—W,4 ,4 Ttt0LD PRO1LM" �. APPLICAILON: 4 oistributionto: SOU T KOLD COMPOST FA1;N ITY [ )DWr4FR o 53095 Main iToad u Southold.NY 11911 PERIOD TO: 11/28/01 ( )ARCHITECT r� ( ]CONTRACTOR r FROM(CONTRACTOR}. VIA(ENr.IFIEERS): ea Te"Conlrecting&(Materials,Inc Ovirka&Barliluccr PROJECT NO. 2000 0 840 West Main Street 330 Crossways Park Drive Riverhead.NY 11901 Viuucbury,New York 11797.2015 CONTRACT DATE: 1131/01 a- CONTRACT FOR. 't1 CONTRACTORS APPLICATION FOR PAYMENT Application is made for PaWwnt,as shown below,in calneiWon with the Contract. Continuation Sheet,ALA Document G703,is attached_ CHANGE ORDER SUMIAARY __ Change Orders approved in ThL ADDffiONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM S 474,312.00 . previous maths byOwNcr 2_ Net change by Change Orders $0.00 TO3. CONTRACT SUM TO DATE(Line 1 + 2) $474,312.00 a rnvad this Month $000 4. TOTAL COMPLETED&STORED TO DATE __$424,305.00_ Number OaleApproved $0.00 (Column G on G703) $0.00 $0.00 5. RETAI NAGE: $0.00 a: 5_',�of Completed Work $21,215.25 $0.00 (Col umn D+ E on 6 703) TDTALS $0.00 $0-00 b: _of Stored Material $0.0o Nei Change by Change Drders 1 30.00 $om (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Lint:5a t 5b or informafton and belief the Work covered by the Application for Payrrrerd has been Total in Column i of G703 $21,215.25 completed In accordance with the Cuntrad Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $403,089.75 paid by the Corrtractnr for Wort for which previous CerMfieales of payment were (Line 4 less Line 5 Total) issued and payments received from the owner•and that current payment shown 7, LESS PREVIOUS CERTIFICATES FOR herein is now due; PAYMENT(Line 6 from prior Certificate) $311,302.65 8. CURRENT PAYMENT DUE $91,787.10 CONTRACTOR------" 9. BALANCE TO FINISH, PLUS RETAINAGE $71,222.25 (Line 3 less Line 6) —•� F � '� ' State ot: CourAy of: Subscribed and shown to before me ibis day of ,20 By: Date: /l c7-___--Notary Public: Aly Commission expires; ENGINEER'S C RTIFICATE FOR PAYMENT AMOU14TCERT11FIED $ ��#797, 10 to accordance with the Contract Documents,based on on-eke observations and the (Attach explanation It amount cerified differs from the amount applied for.) date comprising he above application,the Engineer cerifftes to the owner that to the ENGINEER: best of the Engineer's kn&Medge,inforrnalion and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and B . , Dale. // •^tr D t the Contractor is enticed to payment of the AMOUNT CE RTI 1=IIED. This ert(icate is trot negoli able. The/1M l ITCERTIF IED Is payable to tfie Corikao named herein, Issuance,payment rid ac elriance of payment are vAth- out prejudice to any rights of the Owner or Contractor under this Contract. 0 0 N 1 - w N G CONTINUATION SHEET AiA DOCUMENT G703 PACE Or PAC PAGES 0 AIA Document x702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION!NUMBER: 4 Contraclur s signed Certification is attached- _APPLICATION DATE: 11/29/01 U In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 11/28/01 Use Column 1 an Corltracis where variable retainage for line items nuy apply. ARCHITECTS PROJECT NO. A �8 C D E F jG H 1 ITEM DESCRIPTION OF WORK SCHEDULED 1YORK OOMPLEFED MATEMALS TOTAL a/, BALANCE RETAINAGE NO. VALUE FNOM PREVIOUS THIS PERK}D PRESENTLY COBAPLEFED (C (� TO FINISH APPLICATION STORED AND STORED (C-G) (D+F) (NUT IN TO DATE 1 0ORE) (D+E+F) 1 REMOVAL d CONSOLIDATION Or VEGETATION = 20,40090 $20,400.00 $0.00 $11.00 $20.419300 100% ; - 31020.W 2 REMOVAL 3 STOCKPIL O OF TOPSOIL®LANDFILL $ 64,385.00 $04,365-OD $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINEIROWING OF REMNN"G TOPSOIL h LOAM L 100,200.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ 355 C70A0 $3,256.50 4 LOADOUT,XPORT,PIAC EMENT&COW LOAM TIS $ 214.3W.0U 3:41.492.00 $58.37190 ;0.00 $199,663.00 93% $ 14,937.00 $9,4911.15 5 ACCESS ROAD $ 36,250-00 $36,250-00 $0.00 $0.00 $36,250.00 1011% $ - $1,81250 U RCA WORT $ 46,000.00 $OAO $16,000.00 !10.00 $16,000.00 19015 $ $301190 7 WOOD C HPS-$3tCY $ 9,777.00 $000 $9,777.00 (0-00 $1-,777.00 100% $ $46695 a 'ArdDSCREE14IING(2.kY) 3 12,500.00 $0.00 $12,500.00 56.110 $12,500.00 100% $ $625.00 $ 474,312.00 3327,652.00 1105JAS-00 10.90 3421003-00 $50,007.00 621,21525 0 0 U Armlll%.A 1 IVIM AMU L t.K I It II,A It 1-UK f ATIVILIM I AIA DOCUMENT G702 PAGG ONE OF PACES TO; TOh' :SOUTHOLD � PROJECT � - -— - - -� APfrJCA11014: 4 Distribution to. I.- 530t ..rainitoad SOUTHOLDCOMPOS T rACI LIIy [ ]OMER � C Southold,NY 119;1 PERIOD TO: 11/28/01 [ IA.RC"IT`CT a [ ]CONTRACTOR N TROM/ODNTRACTOR)• VIA(ENGINEERS): ra. Terry Coni racting&Materials.Inc_ Dvirke&Barlducci PROJECT NO. 2000 940 West Main Strcct 330 Crossways Park Drive o a Riverhead.NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE- 1131101 N CONTRACT FOR. ro CONTRACTORS APPLICATION FOR PAYMENT Applical1ion is made for Payment,as shown below,in comection with the Contract_ Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS MDUCTIONS 1.ORIGINAL CONTRACT SUM S 474,312-DO previous months by Owner 2. Net charge by Change Orders $0.00 • _ TOTAL 3. CONTRACT SUM TO DATE(Line I + 2) $474,31ZOG Approved this btrnih 50.00 4. TOTAL COMPLETED&STORED TO DATE $424,305.DG Number Date Approved $000 (Column G on G703) WOO $0.00 S. RETAINAGE: of Completed Work $21,215.25 30.00 (Call umn D t E un G703) TOTALS $0.00 $0.00 b: --of Stored Material $D.00 Net Chane by Change Orders yo.o0 $0-001 (Cal umn F on G703) The undersigned Contractor certifies that to the hest of the Contractors knawledge, Total Retainage(Line 5a+ 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $21,215.25 completed in accordance w 1h the Contract Documents,Drat all amounts have been 6_ TOTAL EARNED LESS RETAINAGE $403,08975 paid by Uro Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments mcefved from the Owner,and that current payment shown 7_ LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $311,302.65 8. CURRENT PAYMENT DUE $91,787.10 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $71,222.25 (Line 3 less Line 6) State all: County 01- Subscribed fSubscribed and shown to before me this day of ,2D • BT Date: Public: on expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED � In acemdanee with the Contracl Documents,based on on-site obsermfions and the (Attach explanation if amount certified differs from the arnuunt applied for.) date comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's krnvadge,infohma on and belief the Work has progressed as indicated,the quality of the Work Is In accordance vAth the Contract Oocufnents,and 6y: Date: _ the Contractor is entitled to payment of the AMOUNT CERTIFIED- This Ced ificate is not negotiable. The AMOUNT CERTIFIED is peyebfe onlyto Ute Contractor named herein, Issuance,payment and acceptance of payment are with- _ out prejudice to any rights of the Owner or Contractor under this Contract. l� 0 0 ry r IJ 0 w a CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAcPAGES 4 AIA Documlent G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION(NUMBER: 4 Conlractar's signed Certification Is attached. APPLICATION DATE: 11/29/01 ^' m In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 11/28/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO. R B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL gt; BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D t E) (NOT[N TO DATE DOBE) (D+Es F) 1 REMOVAL&CONSOLIDATION OF VEGETATM $ 20.400.00 $20,400.00 $0.00 $000 520,400.00 100% $ $1,020.00 2 REMOVAL&STOCXPtLING OF TOPSOIL 0 LANDFILL $ 64,38 6.00 $64,385.00 $0.00 $O.00 $64,385.00 100:0 $ - $3,219.25 3 VWNDROWM OF REMAINING TOPSOIL&LOAM $ 100,200.00 $55,130.00 $0.00 $0.00 $65,130.00 66% $ 35.070.00 $3,256.50 4 LOADOUT,XPORT,PLACU ENT&COMP LOAM TIS $ 214,800.00 $141,492.00 558,371.00 $0.00 $19903.00 93% $ 14 937.00 $9.993.15 5 IAOMSS ROAD $ 35,250.00 $36,250.00 $0.00 $0.00 $36,230.00 100% $ $1,812.50 6 RCA IMPORT $ 16,000.00 $D_OD $18,000.00 $0.00 $16,000.00 tou% S $800.00 7 WOOD CHIPS-13ICY $ 9,777.00 $0.00 $9,777.00 $0.00 $9,777.00 100% $ $488.85 8 SAND SCREENING(2.5CY) $ 121500.00 $0-00 $12,50000 $0.00 $12.500.00 100% S $025.00 $ 474,312.00 $327,657.00 $96,54600 $0.OD $424,305.00 350,007.00 $21.21S25 0 0 w ,APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES TO: ' TOWN OF SOUTHOLD PROJECT: APPLICATION: 3 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 10/22/01 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797-2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below,in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 436,035.00 previous months by owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $436,035.00 ADhis Month $0.00 4.� TOTAL COMPLETED& STORED TO DATE $327,687.00 Number Date Approved $0.00 (Column G on G703) $0.00 $0.00 5. RETAINAGE: $0.00 a:_5_%_of Completed Work $16,384.35 $0.00 (COI umn D+ E on G703) TOTALS1 $0.00 $0.00 b: of Stored Material $0.00 Net Change by Change Orders 1 $0.001 $0.00 (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $16,384.35 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $311,302.65 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $228,538.65 8. CURRENT PAYMENT DUE $82,764.00 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $124,732.35 (Line 3 less Line 6) State of: County of: /I Subscribed and shown to before me this day of ,20 S Date: id Z D Notary Public: My Commission expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as _ indicated,the quality of the Work is in accordance with the Contract Documents,and By: Date: t10 7-s alf the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Ce c e is not negotiable. The Al"T CERTIFIED is payable only to the Contrac r med herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAC PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 3 Contractor's signed Certification is attached. APPLICATION DATE: 10/24/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10/22/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) REMOVAL&CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 752 REMOVAL&STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 WINDROWING OF REMAINING TOPSOIL&LOAM $ 100,200.00 $38,040.00 $27,090.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 214,800.00 $81,492.00 $60,030.00 $0.00 $141,522.00 65% $ 73,278.00 $7,076.10 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 $ 436,035.00 $240,567.00 $87,120.00 $0.00 $327,687.00 $108,348.00 $16,384.35 • •Town of Southold, New York- Standard Voucher PAY TO: Payee Tax Identification Number • Payee Name or Social Security Number: 49e. 3o Vof�0 IJ Address: Payee Reference r }riYG✓if[,o� /Yr� 4190 J Phone No.(All—) 7Z47 c7/7 O Vendor Contact — r .z Invoice Number Invoice Date •�o� /G.- r.-if Purchase Order Number P.O.Date Cash Discount % Days Item Number Description of Materials/Services Quantity Prig Amount Total Net y, Payee Certification The undersigned(Claimant)(Acting on behalf of the above named claimant)does hereby certify that the foregoing claim is true and correct and that no part has been paid,exec s therein stated,and that the balance therein stated is actually due and owing. Signature True UgoffS- Dated Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution,the services properly performed and that the quantiti thereof have been verified with the exceptions or discrepancies noted,and payment is approved Signature / Title Dated le APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES TO: TOWN OF SOUTHOLD PROJECT: APPLICATION: 3 Distribution to: 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Southold,NY 11971 PERIOD TO: 10/22/01 [ ]ARCHITECT [ ]CONTRACTOR FROM(CONTRACTOR): VIA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 436,035.00 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2 ) ` $436,035.00 A this Month $0.00 4.� TOTAL COMPLETED&STORED TO DATE $327,687.00 Number Date Approved $0.00 (Column G on G703) $0.00 $0.00 5. RETAINAGE: $0.00 a:_5_%—of Completed Work $16,384.35 $0.00 (Col umn D + E on G703) TOTALSI $0.00 $o.00 b: of Stored Material $0.00 Net Change by Change Orders 1 $0.001 $0.00 1 (COI umn F on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703 $16,384.35 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $311,302.65 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $228,538.65 8. CURRENT PAYMENT DUE $82,764.00 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $124,732.35 (Line 3 less Line 6) State of: County of: / Subscribed and shown to before me this day of ,20 Date: G Z�b / Notary Public: My Commission expires; ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the ENGINEER: best of the Engineer's knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and By: --#'= Date: 101Zr � the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Cert! cat is not negotiable. The A NT CERTIFIED is payable only to the Contractor n ed herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAC PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 3 Contractor's signed Certification is attached. APPLICATION DATE: 10/24/01 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 10/22/01 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED` (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 1 REMOVAL h CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL&STOCKPILING OF TOPSOIL Q LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ - $3,219.25 3 WINDROWING OF REMAINING TOPSOIL h LOAM $ 100,200.00 $38,040.00 $27,090.00 $0.00 $65,130.00 65% $ 35,070.00 $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 214,800.00 $81,492.00 $60,030.00 $0.00 $141,522.00 65% $ 73,278.00 $7,076.10 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ - $1,812.50 $ 436,035.00 $240,567.00 $87,120.00 $0.00 $327,687.00 $108,348.00 $16,384.35 r ,-PVLICA N AND CERTIFICATE FOR PAYMENT ALA,00GUMLNTG702 PAGEOt C PAGES --- — — — -- -- � —` abtibubon ta: TOWN i_q ._{ri?ItiOlp? —PkOJEC7:Sr.:uTnprr•`_rA'I APPICATIDN 2 ( pm4ER o PERIOD TO: 09!32!01 1 )ARCHITECT o ( ]CDNTRA.0 OR �fiOkl;CONTRACTGR). 4tA(t[n[;IPtt FifSk Terry Corlradmg&Matem Is,Inc- 6vuka&oartilucci PHO IECT NCI: 840 West Main Street 330 Crossways Park Drive Riverhead,HT 31901 Woodbury,New'Wk 13797.2015 CONTRACT DATE: :1N I HAC I h01t: :ONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection with the Contract. Gontimintion Sheet,AIA Document 0,703,is attached- HANG E ttached_HANGE ORDER SUMMARY T hangs Orders approved in ADDITIONS DEDUCTIONS 1.ORIGINAL CONTRACT SUM — $ 436,035.00 'eviths by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line i t 2) $436,033.00 :)proved this Month 5o_tMt 4. TOTAL.COMPLETED&STORED TO DATE $240,567.00 umber Date Approved T, $0.00 (,Column G on G703) $0-00 $O.co 5. RETAINAGE: $0.00 a:___,5_%_of Completed Work $12,U28.35 $0.00 (Col umn D+E on G703) TOTALS $0-00 $0.00 b: —of Stored Material $0.00 el Change by[:mange Orders $0.001 E0.00 (Col umn F on G743) he undersigned Contractor certifies that to the best of the Cantrador's knowledge, Tntat Retainage(Line 5a+5b ur iformation and belief the Work covered by the Application for Payment has been Total in Column I of G703 _ $12,02$.35 ompieted in accordance wiltr lie Conlract Documents,that all arneunts have been 6. TOTAL EARNED LESS RETAINAGE $_228,538 65 aid Ivy the Curittaclix for Work fro Which previous Certificates of Payment were (L.i ne 4 less Line 5 Total) sued and payments retched Fran the Owner,and that current paynieid shown 7. LESS PREVIOUS CERTIFICATES FOR Brain is now drle. PAYMENT(Line 6 from prior Certificate) _ $368,245.00 B. CURRENT PAYMENT DILE $60,293.65 :ONTRACTOR: 9. RAIANCE TO FINISH, Pi it; RETAINAGE —_$_207,496.35 (Line 3 less Line b) _ State of- County ot. �J Subscribed and shown to bciore me this day of 20 Date: — W Notary Public: My Comm,ssion expires: — NGINEER'S CERTif LATE FOR PAYMENT AMOUNTCERTIFED $ 464-143-4 t acccfdance wtlti Nie Ctxitrac.-I Orxuments,leased on un-site observations and the (Attach explanation 4 amourtt certified differs from the amount applied for.) afa emiprising the above application,the Engineer certifies to the owner that to the ENGINEER: est of the£ngineWs.knowrledge,infomrisi on and belief the Work has piNgessr7d as _ 1 � andicated,the quality of the Work is maccordance with the Contracl bocumenls,and 31: tr t' !]ate c( 1-1 lot Wie Contractor is entitled to paymerrl ill the AMOUNT CERTIFIED_ T e i@c?Ae is nal negotiable. Th DUArr CERTIFIED is payable only o the h ,n Con ar mined hersin, Issuance.fibyment and acceptance of payment are vrith out ptejuwue to any r hls of the Owner ar Coritraclor trader this Contract_ N _ _ C'J O N O .-i 7 0 Q ;ONTINUATION SHEET AIA DOCUMENT G71313 PAGE OF PA(PAGES IA Dotum-ent G702,APPLICKDON AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER. ontractor's signed Certification is attached. APPLICATION DATE: 09/12/01 1 tabulations below,amounts are stated to the nearest doliar. PERIOD TO: 09/12/01 se Cotumn 1 on Contracts where variable retainage liar line items may apply. ARCHITECT'S PROJECT NO: A S C D E -F G -- - H ITER DESCRIPTION OF WORT( SCHEDULED WORK COMPLETED MATERIALS TOTAL y6 BALANCE RETAINAGE W VALUE FROM PREVIOUS HIS PERIOD PRESENTLY COMPLETED (G C} TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) JNOT IM TO DATE DORE) (D+E+F) _ 1 REMOVAL A CONSOLIOAT011 OF VEGETATION 5 20.400 OD $19,390.00 51,020.00 $0.00 $20,400.00 100% $ $51013 2 REMOVAL 8 STOCKPILING OF TOPSOIL 0 LANDF ILL L 64,385.00 744,385.00 $0.00 $000 364.3&5 00 10076 3 - 3000 3 WINORO ING OF RELIAININGTOPSON &LOAM S 100,200.00 $20,00.00 $18,000-00 30.00 536,040.00 3b% 7 62,10000 S90000 4 LOADOUT,XPORTYLACGMENT&COMP LOAM TI�SJ S 214,800 Go $.434,440 DO 517,052.00 $0.00 381..'492.00 38% 5 733,308.00 3851 o0 5 .�C��S ri R� t, y f 36,250.011 5000 $36,250.00 $0011 $36,2511.00 100% 3 S1,8t250 Jia d w N S 436,035.00 1163.245.00 372.322 00 1 $000 5240.561 110 5195.08 OO 6.1,616]O CJ O N r-1 r APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOC UMENTG702 PAGE ONE OF PAGES TO_ TOWN OF SOUTHOLD PROJECTssoumomcam Po APPLICATION: 1 Distribution ta: [ ]OWNER o PERIOD TO: 08/06/01 [ ]ARCHITECT c [ ]CONTRACTOR f ROM(CONTRACTOn VA(ENGINEERS): Terry Contracting&Materials,Inc. Dvirka&Bartilucci PROJECT NO: 84D West Main Streak 330 Crossways Park Drive Riverhead,NY 11941 Woodbury,New York 11797-2015 CONTRACT DATE: 3ONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application Is rna&for Payment,as shown below,In connectlon with the Contract. Conlinuation Sheet,AW Doctanent 6703,Is attached. :RANGE ORDER SUMMARY :hen a Orders approved in RDDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 3 ,785.00 �r rttrs by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 +2) $399,785.00 %Waved this Month 30.00 4, TOTAL COMPLETED&STORED TO DATE $168,245,00 number Date Approved $0.00 (Column G on G703) 30.00 $4.00 5. RETAINAGE: $0.00 a:._._5_%_of Completed Work $a.412.25 10-00 (Cd umn D+E an G703) _ TOTALS $0.00 $0.00 b: of Stared Material $D.00 vet Charge by Chane Orders $0.001 $4.00 (Col umn F on G703) rhe w0crslWred Contactor certifies that to the best of the Contracts knowledge. Totai Retainage(Line 5a+5b or nfermagtnn and belief the Work cared by ere Application for Payment has been Total in Column I-of 13703 $8,112.25 :ompleledin accordance With the Cormact rMements,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $159,832.75 weld by the Contractor for Work for which previous Certificates of Paymentvere (Line 4 less Line 5 Total) asued and poyraents recahrod iron the Owner,and that current payment shaven 7. LESS PREVIOUS CERTIFICATES FOR wain Is now du& PAYMENT(Line 6 from prior Certificate) $0.000 8. CURRENT PAYMENT DUE $159,83275 30NTRAGTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE J $239,952.25 (Line 3 less Line 6) Sate of: County at: Subscribed and shown to before me this day of ,20 3ya Dale: Notary Public: Naw My Commission exphes; -- ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNTCERTIFIED $ _ n accordancewYh Vie Contract Dmurnents based on on-alte ohserva lwa and tile (Attach explanation I amount cerliried difkm frarn the amount applied for.) Jake comprising the aboae application,the Engineer certifies to the owner gist to the ENGINEER: gest of the EngtneePs knowledge,infmnalon and belief the Work has progressed as enatceled,ere quality of the Work Is In accordance vAh the Con1mat Docurnenls,and By: Dale_ she Conlractor is entitled to payment of the AMOUNT GERTWIED. This Certificate is not negotiable. The AMOUNT CERTIFED Is payable only to the e, Conlrackx named herein, Issuance,payment and acceptance of payment are ww out prejudice to any rights of ghe Owner or Corrtraclor under this Conkaot. N N ,i O N 'V• N rl 0 a CONTINUATION SHEET Au DOCUMENT 0703 PAGE OF PAI PAGES AIA Document ,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NW # Contractor's signed Certification Is attached. APPLICATION DATE: 08/06/01 In tabulations below,amounts aro stated to the nearest dollar. PERIOD TO: 08/06/01 Use Column 1 on Contracts when variable retainage for line Items anay apply. ARCHITECTS PROJECT NO: A 0 C D E F a H 1 ITEM DESCR4PTION OF YORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % 8ALA14Cf RETAINAGE VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G Q TO FINISH APPLICATION STORED AND STORED (C-6) (D+E) (NOT IN TO DATE DOR D+E+ 1 REMOVAL&CONSOLIDATION OF VEGETATION 8 20,400.90 E11.00 $19,380.00 39.00 819,380.00 95% S 1,020,00 se".00 2 REMOVAL&STOCKPILING OF TOPSOIL O LANDFILL S 84.366.60 $0.00 884,395.00 $000 384,305-01) IWO% 3 - 53,219.25 3 WINDROWING OF REMAJININ i TOPSOIL&LOAM S 100.200.60 $0.00 520,040.00 #0.00 820,040.00 2056 S 80,160.00 51,002.00 4 LOADOUT,XPORT,PLACEAENT&COMP LOAM TJS 8 214.800.00 $1).00 884,440.00 $0-00 884,460.01) 80% $ 151),360.o0 $3,222.00 GQ e? N $ 399,793,00 x1).00 8168,245,00 50.00 8188,245.00 5231,540 00 ;8.412.23 r 0 e PA -tn CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING &MATERIALS, INC. �95 MAIN ROAD 205 MARCY AVENUE Payroll No rom OUTHOLD„ NY 11971 RIVERHEAD, N 1190 36 9/8/03 TO 9/14/03 rolec on rac o. 2000 Name, ress, SSN ot Employee With. Exemp. HoursWorked EachDay TOTAL RATE ross- FICA STATE OF Task OTHER Net-Task Chec_k__# ------------ Mon Tue Wed Thu Fri Sat Sun --------- ------------ ----------------- L- ------------- Task - Race/Gender 9/8 9/9 19/10 9/11 9/12 9/13 HOURS PAY Check DED. 9/14 Gross- FED W/H 401 K Net-Check ED. JUAN C. COLLAZOS6.0 0.0 0.00 0.0 0.00 0.0 0.0 6.00 34.89 209.34 (96.13) (63.33) (0.60) 163.37 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969__________ ______ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 -------- --------------------- ------------- 084-64-3878 8326 --------------------------------------- Allbw D 0.00 0.00 0.00 0.0 0.00 0.00 0.00 0.00 0.00 1256.61 (115.90) 0.00 (275.96) 980.65 ILCAR GARCIA 4.00 S 6.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 25.54 153.24 (77.18) (47.01) (0.60) 116.22 1069 WEST MAIN STREET RIVERHEAD„ NY 119.0.1 O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ___________ ___________ ______________________ _____________ 013-68-9451 8.3.35 D 0.0 0.0 0.00 0.00 0.00 0.0 0.0 0.00 0.00 1008.83 (118.94) 0.00 (243.73) 765.10 age: 1 9ATEMENT OF COMPLIANCE 1, ROBERT G. TERRY, PRESIDENT do hereby state: (1) That I pay or supervise the payment of the persons employed by Co Y NTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period' �' 6�to �y�3 ,all persons employed on said project have been paid the full weekly wages earned,that no re ales ha�e been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise underthis contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefrts as listed in the contract, except as noted in Section 4(c) below. Exception implanation Name and Title 9ignatung ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE'18 AND SECTION 231 OF HTE UNITED STATES CODE. A C CertPay Wizard Certified Payroll Report Name Of Contractor X Subcontractor roject Location ress TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No rom OUTHOLD„ NY 11971 RIVERHEAD, N 1190 37 9/15/03 TO 9/21/03 rojec on rac o. 2000 Name, ress, SSN OT Employee With. Exemp. Hours Worked Each Day TOTAL RATE TOSS- FICA STATE OF Task OTHER Net-Task heck ------------------ Mon Tue Wed Thu Fri Sat Sun -- --- Race/Gender HOURS PAY Gross FED W/H 401 K TOTAL Net-Check Task 9/15 9/16 9/17 9/18 9/19 9/20 9/21 cneck DED. JUAN C. COLLAZOS S 6.00 0.00 0.00 0.00 0.00 0.00 0.00' 6.00 34.89 209.34 (82.64) (51.25) (0.60) 165.95 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969 ------ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ___________ ___________ ------------------ --- _____________ 084-64-3878 8366 --------------------------------- 0 ----------------- ------------- D 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 1080.34 (89.45) 0.00 (223.94) 856.40 IER GARCIAS 7.00 0.00 0.00 0.00 0.00 0.00 0.00 7.00 25.54 178.78 (27.44) (5.91) (0.60) 158.40 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901--------------- ------ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ___________ ___________ __________ ___________ _____________ ---- 011-69-8573 8374 -------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 358.78 (6.94) 0.00 (40.89) 317.89 AMILCAR GARCIA S 7.0 0.00 0.00 0.0 0.00 0.0 0.0 7.00 25.54 178.78 (56.88) (28.84) (0.60) 143.28 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 ------ O 0.0 0.00 0.00 0.00 0.00 0.00 0.0 0.00 0.00 ------___ ___________ _____________ ------------------- -- ----------- ---------- 013-68-9451 8375 -------------------'------------------- D 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 743.58 (61.34) 0.00 (147.66) 595.92 MANUEL GARCIA S 6.5 0.00 0.00 0.00 0.00 0.0 0.00 6.50 25.54 166.01 (41.62) (13.96) (0.60) 146.06 40 PHILLIPS AVENUE 5.00 RIVERHEAD„ NY 11901 ______ O 0.0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 __________ _____________ ------------------- -- ----------- ---------- - 129-78-9523 8376 --------------------------------------- D 0.0 0.0 0.00 0.00 0.00 0.0 0.0 0.00 0.00 544.01 (9.21) 0.00 (65.39) 478.62 MES J. HORAN S 0.0 0.00 0.00 4.0 0.00 0.0 0.0 4.00 38.83 155.32 (106.38) (72.50) (0.60) 120.08 BERT STREET 4.00 REHAM„ NY 11786 -__--- O 0.00 0.0 0.00 0.00 0.00 0.0 0.00 0.00 0.00 ----------------------- ___________ _____________ ------- ---------- 052-74-1323 8377 -------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1390.59 (135.99) 0.00 (315.47) 1075.12 JAMES J. HORAN 4.00 S 8.00 8.00 8.00 4.00 0.00 0.00 0.00 28.00 36.21 1013.88 (106.38) (72.50) (0.60) 783.87 6 ALBERT STREET SHOREHAM„ NY 11786--------------- ------ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ___________ ___________ ______________________ _____________ ---- 052-74-13238377 --------------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1390.59 (135.99) 0.00 (315.47) 1075.12 age: 1 CertPay Wizard Certified Payroll Report Name Of Contractor X Subcontractor roject Location ress TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No rom OUTHOLD„ NY 11971 RIVERHEAD, N 1190 37 9/15/03 TO 9/21/03 ro�ec on rac o. 2000 Name, Address, 6,9N-OT Employee With. Exemp. Hours Worked Each Day 101AL RATEross- oF Task FICA STATE OTHER Net-Task _-------Chec_k_# -- ------------ Mon Tue Wed Thu Fri Sat Sun --Task---- ---------- ---------- --------- -------------- Gross Task Race/Gender 9/15 9/16 9/17 9/18 9/1919/20 9/21 HOURS PAY Check FED W/H 401 K TD oAL Net-Check ROBERT TERRY8.0 8.00 8.00 0.00 0.00 0.0 0.0 24.00 38.83 931.92 (71.29) (41.09) (0.60) 751.75 57 FOSTER AVENUE 4.00 HAMPTON BAYS„ NY 11946 ------ 0 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 --____-_ __________ --------------- ------ ------------- 071-28-9247 8394 --------------------------------------- Idahk D 0.0 0.00 0.00 0.09 0.00 0.0 0.0 0.00 0.00 931.92 (67.19) 0.00 (180.17) 751.75 ISTOPHER L. ZITO S 7.0 8.0 8.00 8.0 0.00 0.00 0.00 31.00 38.83 1203.73 (119.87) (89.85) (0.60) 865.17 101 COLIN DRIVE o.00 SHIRLEY,, NY 11967------------------ O 0.00 0.0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------- ----------- ---------- ----------- ------------- 108-64-2931 8398 ---------------------------------------- D 0.00 0.0 0.00 0.00 0.00 0.00 0.001 0.00 0.00 1566.87 (230.37) 0.00 (440.69) 1126.18 • age: 2 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Co r R Y N RACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll periodb 63 to �./ Q all persons employed on said project have been paid the full weekly wages earned,that n bates av been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Slat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise underthis contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)Thad any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer ormechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basichourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. cep ion pan Ion Name and I itle Signatur ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 239 OF HTE UNITED STATES CODE J!� ✓. CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No rom OUTHOLD„ NY 11971 RIVERHEAD, N 1190 3s 9/22/03 TO 9/28/03 rojec on rac o. 2000 Name, ress, o mpoyee With. Exem ours ore Each ay RATES- FICA STATE P OF Task OTHER Net-Task heck# - Mon Tue Wed Thu Fri Sat Sun ---------- ------------------------------------------------- C_ --------- ---------- --------- -------------- Task ----- Race/Gender 9/2219/2319/24 9/25 9/26 9/27 9/28 HOURS PAY MOSS FED W/H 401 K TOTAL Net-Check Check DED. JUAN C. COLLAZOS 0.0 0.0 0.00 8.0 8.00 0.0 0.0 16.00 34.89 558.24 (89.48) (57.37) (0.60) 438.78 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969___________ ______ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- ----------------------- ------------- 084-64-3878 8403 D 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 1169.60 (102.84) 0.00 (250.29) 919.31 VIEWR GARCIA S 0.0 0.0 0.00 8.0 8.00 0.0 0.0 16.00 25.54 408.64 (60.02) (31.65) (0.60) 325.43 1069 EST MAIN STREET 4.00 RIVERHEAD„ NY 11901 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------- ----------- ------------- ------------------- 011-69-85738410 D 0.00 0.00.00 0.00. 0.00 0.00 0.00 0.00 0.00 784.58 (67.49) 0.00 (159.76) 624.82 AMILCAR GARCIA S 0.0 0.0 0.00 8.0 8.00 0.0 0.0 16.00 25.54 408.64 (68.95) (39.64) (0.60) 317.40 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 _ ______ O 0.0 0.0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------- ----------- ---------- ----------- -- 013-68-9451 8411 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 901.26 (92.05) 0.00 (201.24) 700.02 MANUEL GARCIA S 0.0 0.0 0.00 8.0 8.00 0.0 0.00 16.00 25.54 408.64 (71.29) (39.77) (0.60) 334.14 40 PHILLIPS AVENUE 5.00 RIVERHEAD„ NY 11901______________ 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------- ----------- ---------- ----------- ------------- 129-78-95238412 D 0.00 0.0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 931.93 (58.25) 0.00 (169.91) 762.02 0 age: 1 �ATEMENT OF COMPLIANCE • I, ROBERT G. TERRY, PRESIDENT do hereby state: (1) That I pay or supervise the payment of the persons employed byCo Y NTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period7� to d3 all pentons employed on said project have been paid the full weekly wages earned,that n rebates have. been orwill be made either directly or indirectly to oron behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Slat,548.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise underthis contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer ormechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs forthe benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic fisted in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basichourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. cep Ion txplanation Name and Title 6ignatur ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 10D1 OF TITLE'18 AND SECTION 231 OF HTE UNITED STATES CODE. �i CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING & MATERIALS, INC. 95 MAIN ROAD 205 MARCY AVENUE Payroll No rom OUTHOLD„ NY 11971 RIVERHEAD, N 1190 39 9/29/03 TO 10/5/03 rojec on rac o. 2000 ame, Address, o Employee With. Exemp. ours Worked Each ay RATE ask FICA STATE OTHER Net-Task ------ - OF Task Check_#_-_---_ ----------- Mon Tue Wed Thu Fri Sat Sun - -- -------------------------------------------- ----------------- TOTAL Race/Gender HOURS PAY MOSS FED W/H 401 K . Net-Check ask 9/29 9/30 10/1 10/2 10/3 10/4 10/5 Check DED. JUAN C. COLLAZOS 3.0 0.0 0.00 0.0 0.00 0.0 0.0 3.00 34.89 104.67 (86.80) (54.97) (0.60) 82.53 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 119.69------------------ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------- ----------- ---------- ----------- ------------- 084-64-3878 8440 -------------------'------------------- D 0.0 0.00 0.00 0.00 0.001 0.00 0.00 0.001 0.00 1134.60 (97.59) 0.00 (239.96)1 894.64 AN C. COLLAZOS 4.00 S 2.00 0.00 0.00 0.00 0.00 0.00 0.00 2.00 25.54 51.08 (86.80) (54.97) (0.60) 40.28 P.O. BOX 2786 SOUTHAMPTON„ NY 11969 ------ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- --------- ----------- ------------- 084-64-3878 - - 8440- ------------------ '------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1134.60 (97.59) 0.00 (239.96) 894.64 AMILCAR GARCIA S 5.0 0.0 0.00 0.0 0.00 0.0 0.0 5.00 25.54 127.70 (35.93) (11.28) (0.60) 109.19 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 -_---- O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------- - ------------------- ---------- - --------- ----------- ------------- 0.13-68-94.51 8448 D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 469.70 (20.26) 0.00 (68.07) 401.63 age: 1 ATEMENT OF COMPLIANCE • I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by ontract rTERRY CONTRACTING 8. MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll periodQ 62toj0 6 l)3 ail persons employed on said project have been paid the full weekly wages earned,that n rebates h ve been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Slat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: WI addition to the basic hourly wage rates paid to each laborer ormechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basichourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception pan Ion Name an It aIgnatur ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1OD1 OF TITLE'18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 40 1 10/6/03 TO 10/12/03 roject/Contract No. 2000 Name, ress, bbN OT Employee With. Exemp. Hours Worked Each Day TOTAL RAT Task FICA STATE OTHER Net-Task _ C_h_ec_k__# ----------- Mon Tue Wed Thu Fri Sat Sun Task---- --------- ---------- --------- ------------- --------------- Race/Gender HOURS PAY Gross- FED W/H 401 K TOTAL Net-Check Task 10/6 10/7 10/8 10/9 10/1010/1110/12 Check DED. JUAN C. COLLAZOS2.0 0.0 0.00 0.0 0.00 0.0 0.00 2.00 34.89 69.78 (72.10) (41.81) (0.60) 56.21 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 1-1969- ----------- -__--_ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- ---------- ----------- ------------- --- --- 084-64-3878 8475 D 0.01 0.0 0.00 0.00 0.00 0.0 0.00 0.00 0.00 942.46 (68.77) 0.00 (183.28) 759.18 .O. BN C.OX 2786 4.00 COLLAZOS S 4.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 25.54 102.16 (72.10) (41.81) (0.60) 82.29 SOUTHAMPTON„ NY 1- ----------- 1969 __-___ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ___________ ___________ __________ ___________ _____________ --- ---- 084-64-3878 8475 ----------------- -'------------------ D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 942.46 (68.77) 0.00 (183.28) 759.18 RENE S. CONTRERAS S 6.0 0.0 0.00 0.0 0.00 0.0 0.0 6.00 25.54 153.24 (13.78) (0.69) (0.60) 140.43 424 OSBORNE AVENUE 1.00 RIVERHEAD„ NY 11901 ------ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------- ----------- ---------- ---------- ------------ ------------------- 080-92-7276 8478 ------------------------------------ D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 180.24 0.00 0.00 (15.07) 165.17 JAVIER GARCIA S 6.0 0.0 0.00 0.0 0.00 0.0 0.0 6.00 25.54 153.24 (40.03) (14.44) (0.60) 128.83 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 __-___ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----- ------------------- ----------------------- ---------- ----------- ------- ------ 011-69-8573 8482 -------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 523.24 (28.29) 0.00 (83.36) 439.88 age: 1 GATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed byCo r RY N RACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period)6/ &6,-Sto) �,Pall persons employed on said project have been paid the full weekly wages earned,that no es h v been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Slat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise underthis contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborerormechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basichourty wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception Lxplanation Name and TitleSi gnatur ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS ,WM THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 1a AND SECTION 231 OF HTE UNITED STATES CODE. TERRY CONTRACTING& ERIALS, INC. 840 WEST MAIN ET RIVERHEAD,NEW YORK 11901 Date: 9-18-03 Job No. Attention: Mr. James Bunchuck PHONE: (631) 727-0170 FAX: (631) 727-0410 Re: Southold Landfill Closure To: Southold Town Solid Waste District P.O. Box 962 Cutchogue,NY 11935-0962 WE ARE SENDING YOU ❑ Attached ❑Under separate cover Via the following items: ❑ Shop Drawings ❑ Prints ❑Plans ❑ Samples ❑Specifications ❑Copy of Letter ❑ Change Order ❑Compact Disc COPIES DATE NO. DESCRIPTION 4 9-8-03 12 Application 12 Southold Compost Facility 1 Multiple Certified Payroll for Application 13 Southold Landfill Closure THESE ARE TRANSMITTED as checked below: ❑For approval ❑ Approved as submitted ❑ Resubmit copies for approval 0 For your use ❑Approved as noted ❑Submit copies for distribution ❑As requested ❑Returned for corrections ❑Return corrected prints ❑For review and comment ❑ ❑FOR BIDS DUE ❑PRINTS RETURNED AFTER LOAN TO US REMARKS: Copies To: Southold File Signed: Julie McClave If enclosures are not as noted, kindly notify CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ J OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 103 June 15,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/9 6/10 6/I 1 6/12 6/13 6/14 6/IS HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JUAN C.COLLAZOS WX 2786 BACKHOE O 7 6 5.5 4 22.5 36.19 814.28 HAMPTON,NY 11969 LABORER 1 2 3 25.23 75.69 CK.#7691 084.64-3878 4 DOZER S 1 1 2 33.67 67.34 73.23 78.26 42.83 0.60 194.92 762.39 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 CK.#7704 013-68-9451 4 LABORER S 8 8 8 5 29 25.23 731.67 55.97 61.24 28.03 0.60 145.84 585.83 MANUEL GARCIA 40 PHILLIPS AVENUE O RIVERHEAD,NY 11901 CK.#7711 129-78-9523 5 LABORER S 5 5 25.23 126.15 9.65 0.00 0 0.601 10.25 115.9 JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY11968 CK.#7724 070-64-2225 0 EXCAVATOR S 4 4 36.19 144.76 11.08 2.07 0.04 0.60 13.79 130.97 J.OUDEANS x305 O EAST QUOGUE,NY 11942 LABORER 7 8 5 20 25.23 504.60 CK.#7723 075-74-5407 1 DRIVER S 1 1 29.41 29.41 40.85 57.99 18.48 0.60 117.92 416.09 O S O S 0 S THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date 6/1-7 �� r ' (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanlo listed In the above-referenced payroll has been paid,as indicated on the payroll,an amount not less Ilton the sum of the do hereby state: applicable basic hourly wage rete plus the amount of the required fringe benefits X1(1))That I pay or supervlseMthe paJyment of the persons employed 6y [� /� as listed In the contract,except as noted In Section 4(c)below. 1v��L,L 1�� /7L—f / � /1v�.��i7.�1.( �v1 .• � ./i (a)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the _ i day of ,20p3 and ending the /'S day of 20 d all pers s employed on said project have been paid the full week( ages earned,that no rebates have boon or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION / + from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submllted for Ilia above period are correct and complete;Dial The wage rates for laborers,workers,or mechanics contained therein are not less(Ilan Ilia applicable wage rates contained In any wage determination Incorporated Into Ilse contract,that the classifications set forth therein for each laborer,worker or mechanic conform with the work halshe performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeshlp program registered with a Slate apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,or If no such recognized agency exists In a Slate,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanlo listed r ff <In the above referenced payroll,payments of fringe benefits as listed In the contract have bean or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY q THE APF STA11EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 103 lune 15,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/9 6/10 6i11 6/12 6/13 6/14 6/15 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK E N Y.BANEGAS 16VIW.MAIN STREET O RIVERHEAD,NY 11901 CK.#7688 129-66-5523 5 LABORER S 8 8 8 5 29 25.23 731.67 55.97 35.62 26.05 0.60 118.24 613.43 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7707 011-69-8573 4 LABORER S 8 8 8 5 29 25.23 731.67 55.97 61.24 28.03 0.60 145.84 585.83 CHRISTOPHER L.ZITO DRIVER 6 6 36.19 217.14 101 COLIN DRIVE DOZER O 2 2 21 6 36.19 217.14 SHIRLEY,NY 11967 EXCAVATOR 4 7 4 15 36.19 542.85 CK.#7736 108-64-2931 0 PAYLOADER S 2 1 2 5 36.19 180.95 88.59 161.73 61.85 0.60 312.77 845.31 ANIBAL A.DIAZ 1069 WEST MAIN STREET O RIVERHEAD,NY 11901 LABORER 6.5 6.5 25.23 164.00 CK.#7698 126-88-2636 1 DRIVER S 1.5 1.5 29.41 44.12 15.92 9.85 2.19 0.60 28.56 179.56 WLB J.HORANRT STREET PAYLOADER S 4.5 4.5 33.67 151.52 SHOREHAM,NY 11786 DRIVER 0.5 0.5 29.41 14.71 CK.#7713 052-74-1323 4 EXCAVATOR O 3 3 36.19 108.57 21.02 0 2.17 0.61 23.79 251.01 S O S IT O S IlUE I L0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR L) Date 1112 1 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH 1 v i (Name of signatory party) (Title) p -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state.- apald,as Indicated on the payroll,an amount not less Ilion the sum of tike pplicable basic hourly wage rate plus Ilse amount of the required fringe benefits _lt)That I pay or supervIss-e the payment of the persons employed by /I as listed In the contract,except as noted In Section 4(c)below. 1�v17 $ �.• �� ./ (c)EXCEPTIONS (Contractor or Sub tractor) Cf that during the payroll peri d com ncing on tlhc� day of . 2u03,and ending the payroll 20� all persons employed on said project have been paid the full weekly wages earned,fihat no rebates have been orwill be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles n and 9 and described below.- (2) elow:(2)That any payrolls submitted for file above period era correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than Ilia applicable wage rates contained In any wage determination Incorporated Into the contract,that the classifications set forth therein for each laborer,worker or mechanic conform with the work halshe performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,or if no such recognized agency exlsts In a Stets,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or machanlc listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for Ilia THE WILLFUL FALSIFICATION OF ANY Of THE 4MAMIEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ) OR SUBCONTRACTOR[ J ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 104 June 22,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/16 6/17 6/18 6/19 6/20 6/21 6/22 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JUAN C.COLLAZOS BACKHOE 6 6 7 4 3 26 36.19 940.94 X 2786 DOZER O 2 2 33.67 67.34 SO HAMPTON,NY 11969 LABORER 2 1 3 2 8 25.23 201.84 DRIVER 2 2 29.41 58.82 CK.#7750 084-64-3878 4 PAYLOADER S 1 1 2 33.67 67.34 102.23 146.50 68.78 0.60 318.11 1018.17 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 CK.#7759 013-68-9451 4 LABORER S 8 8 7 8 8 39 25.23 983.97 75.28 119.55 45.31 0.60 240.74 743.23 MANUEL GARCIA 40 PHILLIPS AVENUE O RIVERHEAD,NY 11901 CK.#7761 129-78-9523 5 LABORER S 8 8 7.5 8 31.5 25.23 794.75 60.79 45.08 30.37 0.60 136.84 657.91 JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY 11968 DOZER 8 3 4 15 33.67 505.05 CK.#7774 Aldlbk-2225 0 DRIVER S 5 1 5 29.41 147.05 49.89 67.67 27.19 0.60 145.35 506.75 O S 0.00 O S O S 0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Dat4-61e y ° � tt ��t K. {f , (b) HERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ .Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as Indicated on Ilia payroll,an amount not less than the sum of the applicable basic hourly wage rete plus the amount of the required fringe benefits (t)That I pay or supervlse the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. ('7C (a)EXCEPTIONS (Contractor or Sub tractor) ,��,77that during the payroll period commencing on thg_ Z day or.I 20d p and ending the other day of tial 3 all pore employed on said project have been paid the full week wages eamed,fltat no rebates have been or will be made elther directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period ere correct and complete:that The wage rates for laborers,workers,or mechanics contained therein are not less than Ilia applicable wage rates contained In any wage determination Incorporated Into lata contrect;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,ere registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,Worker or mechanic listed r // In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for Ilia THE WILLFUL FALSIFICATION OF ANY Of THEA EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT i NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 493 June 22,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) 16) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 1 6/16 6/17 6118 6/19 6/20 6/21 6/22 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK ELVIN Y.BANEGAS IWMAIN STREET O EAD,NY 11901 CK.#7749 129-66-5523 5 LABORER S 1-8 6 8 8 32 25.23 807.36 61.77 46.97 31.24 0.60 140.58 666.78 JAVIER GARCIA 1069 W.MAIN STREET Oji RIVERHEAD,NY 11901 CK.#7760 011-69-8573 4 LABORER S 8 8 7 8 8 39 25.23 983.97 75.28 119.551 45.311 0.60 240.74 743.23 CHRISTOPHER L.ZITO PAYLOADER 4 3 3 10 36.19 361.90 101 COLIN DRIVE DOZER O 4 4 2 10 36.19 361.90 SHIRLEY,NY 11967 EXCAVATOR 5 6 11 36.19 398.09 CK.#7787 108-64-2931 0 BACKHOE S 1 1 36.19 36.19 88.59 161.73 61.85 0.60 312.77 845.31 RENES.CONTRERAS 424 OSBORNE AVENUE 0 RIVERHEAD,NY 11901 CK.#7753 080-92-7276 - 1 LABORER S 8 81 81 24 25.23 605.52 46.32 51.89 22.68 0.60 121.49 484.03 S O S 0 S 0 S F-I ITE THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date a V 03 , C1A�K ny4l 4 Je4� (b)WHERE FRINGE BENEFITS ARE PAID IN CASH v (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanlo listed In the above-referenced payroll has been do hereby state, aid,as Indicated on the payroll,an amount not less than(lie sum of the applicable basic hourly wage rale plus tine amount of the required fringe benefits _(1)That I pay or supervise the payment of the persons employed by _ as listed In the contract,except as noted In Section 4(c)below. • A' (c)EXCEPTIONS �•. (Contractor or Sub tractor) ,that during the payroll period commencing on ilia dayof��20�and ending the dayof_I 20 d J all pars s employed on sold project have been paid the full weekly ages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for(lie above period ere correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not lose than Ilia applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with tike work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a Slate apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (o)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addluon to the basic hourly wage rates paid to each laborer,worker or mechanlo listed r In the above referenced payroll,payments of fringe benefits as listed In Ilia contract have boon or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEA EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location Address , TERRY CONTRACTING & MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 32 8/11/03 TO 8/17/03 roject/Contract No. 2000 Name, AddreS-STSSN ot Employee With. Exemp. Hours Worked-Each Day RATE Gross- FICA STATE OTHER Net-Task - OF Task check_ # ---------- Mon Tue Wed Thu Fri Sat Sun -------- ---------- ------------------------------------ Gross-Task --- Race/Gender 8/11 8/12 8/13 8/14 8/15 8/16 8/17 HOURS PAY FED W/H 401 K TOTAL Net-Check Check DED. ELVIN Y. BANEGAS 5.00 0.0 0.0 0.00 4.5 0.00 0.0 0.0 4.50 25.54 114.93 (30.13) (6.16) (0.60) 104.17 1069 WEST MAIN STREET RIVERHEAD„ NY 11901--------------- ______ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ___________ ___________ __________ ___________ _____________ ---- 129-66-5523 8133 --------------------------------------- D 0.09 0.00 0.00 0.00 0.001 0.00 0.00 0.00 0.00 393.93 0.00 0.00 (36.89) 357.04 'JUM" C. COLLAZOS S 0.0 0.0 0.00 4.5 0.00 0.0 0.0 4.50 34.89 157.01 (83.31) (51.85) (0.60) 124.35 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 1-1969- ----------- _-____ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ___________ ___________ ---------------------- ------------- --- --- 084-64-3878 8134 D 0.00. 0.0 0.00 0.00 0.00 0.01 0.00, 0.00 0.00 1088.99 (90.75) 0.00 (226.51) 862.48 AMILCAR GARCIA S 0.0 0.0 0.00 4.50 0.00 0.0 0.0 4.50 25.54 114.93 (35.30) (10.79) (0.60) 98.56 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 119.0.1_--------------- ______ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- ---------------------- ------------- 013-68-9451 8142 --------------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 461.4319.02 ( ) 0.00 (65.71) 395.72 ag e: 1 STATEMENT OF COMPLIANCE r I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period 8/4/03 to 8/10/03; all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING &MATERIALS, INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Stat, 948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: A7, 0/ 7/03 a WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS FUNDS OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception Explanation Name an It aIgn lure ROBERT G. TERRY PRESIDENT C , THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS CT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 100 OF TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report Name Of Contractor X Subcontractor roject Location Address TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 25 1 6/23/03 TO 6/29/03 roject/Contract No. 2000 Name, Addr5ss, 56N OT Employee With. ExemP Hours Worked Each Day TOTAL RATEGross- FICA STATE OF Task OTHER Net-Task h__e_c_k_# ------------ Mon Tue Wed Thu Fri Sat Sun ---------- ---------- ---------- --------- -------------- Task - Race/Gender 6/23 6/24 6/25 6/26 6/27 6/28 6/29 HOURS PAY check FED W/H 401 K TOTALNet-Check JUAN C. COLLAZOS 4.00 4.50 0.00 0.00 0.00 0.00 0.00 0.00 4.50 25.23 113.54 (82.45) (51.08) (0.60) 89.26 P.O. BOX 2786 SOUTHAMPTON„ NY 11969 -_____ O 0.0 0.00 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- ---------- ---------- ------------- 084-64-3878 7802 D 0.0 0.0 0.00 0.00 0.00 0.0 0.0 0.00 0.00 1077.79 (96.33) 0.00 (230.46) 847.33 AN C. COLLAZOS S 3.0 0.0 0.00 0.0 0.00 0.0 0.0 3.00 33.67 101.01 (82.45) (51.08) (0.60) 79.41 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969 ______ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 --------- ------------------- 084-64-3878 7802 -------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1077.79 (96.33) 0.00 (230.46) 847.33 JAVIER GARCIA S 7.5 6.5 0.00 0.0 0.00 0.0 0.00 14.00 25.23 353.22 (73.69) (43.89) (0.60) 268.10 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ___________ ___________ __________ ___________ _____________ 011-69-8573 7810- --------------------'---------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 963.28 (113.96) 0.00 (232.14) 731.14 AMILCAR GARCIA S 7.5 6.5 0.00 0.00 0.00 0.0 0.0 14.00 25.23 353.22 (73.27) (43.52) (0.60) 268.45 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 ______ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ------------------------ ---------- ----------- ------------- 013-68-9451 -- 7809- ------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 957.78 (112.48) 0.00 (229.87) 727.91 CHRISTOPHER L. ZITO S 0.0 0.0 0.00 5.5 0.00 0.0 0.0 5.50 36.19 199.05 (111.71) (82.55) (0.60) 139.32 O01 COLIN DRIVE 0.00 HIRLEY„ NY 11967 ____ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 _ ___________ __________ ___________ _____________ 108-64-2931 -- 7829- --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1460.34 (243.34) 0.00 (438.20) 1022.14 age.- 1 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That 1 pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period 7/21/03 to 7/27/03;all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laboreror mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor,or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship andel Training, United States Department of Labor. (4)That: p' i!t�P� /� 91�1 (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: &In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in Section 4(c) below. Exception p ana Ion Name and Title Signature ROBERT G. TERRY PRESIDENT oes THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MA'rSUDXCT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 100 TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. • i CertPay Wizard Certified Payroll Report -� Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 26 6/30/03 TO 7/6/03 rotec OUT; rac o. 2000 Name, ress, o mpoyee With. Exemp. Hours orke Each ay TOTAL RATEGross- FICA STATE Check# ------ ---- Mon Tue Wed Thu Fri Sat Sun OF OTHER Net-Task _Task------- ---------- -------------- ---------- Race/Gender Gross- FED W/H 401 K TOTAL Net-Check Task 6130 711 7/2 7/3 7/4 7/5 7/6 HOURS PAY Check DED. JUAN C. COLLAZOS0.0 2.0 8.00 0.0 0.00 0.0 0.0 10.00 25.23 271.23 (67.49) (37.68) (0.60) 220.35 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969 _ ------ O 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.50 37.86 ----------------------- ---------- ----------- ------------- 084-64-38787840 -------------------- ----------- AdIlk D 0.01 0.00 0.001 0.09 0.00 0.09 0.00 0.00 0.00 882.24 (59.74) 0.00 (165.51) 716.73 ANUEL GARCIA S 0.0 0.0 0.00 6.5 0.00 0.0 0.0 6.50 25.23 164.00 (59.79) (29.48) (0.60) 137.65 40 PHILLIPS AVENUE 5.00 RIVERHEAD,, NY 11901---------------------- O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- ---------- ----------- ------------- 129-78-9523 7850 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 781.69 (35.72) 0.00 (125.59) 656.10 CHRISTOPHER L. ZITO S 0.0 0.0 0.00 4.0 0.00 0.0 0.0 4.00 36.19 144.76 (112.12) (82.92) (0.60) 105.18 101 COLIN DRIVE o.00 SHIRLEY„ NY 11967------------------ ------ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------- ----------- ------------- - 108-64-2931 7875 ------------------ '------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1465.70 (205.08) 0.00 (400.72) 1064.98 CHRISTOPHER L.ZITO S 0.0 0.0 0.00 2.0 0.00 0.0 0.0 2.00 36.19 72.38 (112.12) (82.92) (0.60) 52.59 101 COLIN DRIVE o.00 SHIRLEY„ NY 11967------------------ ______ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------- ----------- ------------- - 108-64-2931 7875 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1465.70 (205.08) 0.00 (400.72) 1064.98 CHRISTOPHER L. ZITO S 0.00 0.00 0.00 0.00 8.00 0.00 0.00 8.00 36.19 289.52 (112.12) (82.92) (0.60) 210.37 WIRLEY,,COLIN DRIVEo.00 NY 11967------------------ __--_- O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------- ----------- ---------- ----------- ------------- - 108-64-2931 7875 PAID-HO LTDAY------------------------ D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1465.70 (205.08) 0.00 (400.72) 1064.98 CHRISTOPHER L. ZITO 0.00 S 0.00 0.0 0.00 1.00 0.00 0.00 0.0 1.00 36.19 36.19 (112.12) (82.92) (0.60) 26.30 101 COLIN DRIVE SHIRLEY„ NY 11967 ------ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------- ----------- ---------- ----------- ------------- ------------------- 108-64-2931 7875 D 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 1465.70 (205.08) 0.00 (400.72) 1064.98 ag e: 1 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period 7/21/03 to 7/27/03; all persons employed on said project have been paid the full weekly wages earned, that no rebates have been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING 8 MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 2760, and described below: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications therein for each laboreror mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor,or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. 1 / (4)That: �.�,'a .Q�u-c� 1 �' ( 6 (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception Lxplanation Name and Titlenature ROBERT G. TERRY PRESIDENT , fi4 It . THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS BJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report • Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 27 7/7/03 TO 7/13/03 ro�ec on rac o. 2000 Name, ress, o Employee With. Exemp. Hours orked Each Day T 7Ar RATEGross- FICA STATE OTHER Net-Task r----- --- ------------------ OF Task Check# Mon Tue Wed Thu Fri Sat Sun --- - - - --------------- Race/Gender HOURS PAY Gross- FED W/H 401 K TOTAL Net-Check Task 7/7 7/8 7/9 7/10 7/11 17/1217/13 check DED. ELVIN Y. BANEGAS 5.00 8.00 8.00 0.00 8.00 0.00 0.00 0.0 1 24.00 25.23 605.52 (68.32) (37.11) (0.60) 498.09 1069 WEST MAIN STREET RIVERHEAD„ NY 11901 _-____ O 0.0 0.0 0.00 0.0 0.00 0.00 0.0 0.00 0.00 ___________ ___________ __________ ___________ _____________ 129-66-5523 7881 - D O.Oq 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 893.11 (52.43) 0.00 (158.46) 734.65 JUAN C. COLLAZOS 4.00 S 3.00 0.00 0.00 7.00 0.00 0.00 0.0 )10.00 36.19 361.90 (88.46) (56.45) (0.60) 284.79 P.O. BOX 2786 SOUTHAMPTON„ NY 1-1969- ----------- -_____ O 0.0 0.0 0.00 0.0 0.00 0.00 0.0 0.00 0.00 ___________ ___________ __________ ___________ _____________ --- --- 084-64-3878 7882 '------------------- ------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1156.24 (100.84) 0.00 (246.35) 909.89 JUAN C. COLLAZOS 4.00 S 5.00 5.50 0.00 1.00 0.00 0.00 O.00 11.50 25.23 290.15 (88.46) (56.45) (0.60) 228.33 P.O. BOX 2786 SOUTHAMPTON„ NY 11969 _-____ O 0.0 0.0 0.00 0.0 0.0 0.0 0.0 0.00 0.00 ___________ ___________ __________ ___________ _____________ 084-64-3878 7882 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1156.24 (100.84) 0.00 (246.35) 909.89 JUAN C. COLLAZOS S 0.0 2.0 0.00 0.0 0.00 0.0 0.0 2.00 33.67 67.34 (88.46) (56.45) (0.60) 52.99 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969 _____- O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ___ ___________ __________ ___________ _____________ 084-64-3878 7882 ---------------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1156.24 (100.84) 0.00 (246.35) 909.89 RENE S. CONTRERAS S 0.00 8.00 0.00 8.00 0.00 0.00 0.00 X16.00 25.23 403.68 (64.32) (38.80) (0.60) 315.31 424 OSBORNE AVENUE 1.00 IVERHEAD„ NY 11901 ______ O 0.0 0.0 0.00 0.0 0.00 0.00 0.0 0.00 0.00 ----------------------- ---------- ----------- ------------- ------------------- 080-92-7276 7885 -------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 840.80 (80.35) 0.00 (184.07) 656.73 AMILCAR GARCIA 4.00 S 8.00 8.00 0.00 8.00 0.00 0.00 0.00 24.00 25.23 605.52 (68.31) (39.07) (0.60) 471.29 1069 WEST MAIN STREET RIVERHEAD„ NY 11901 _____- O 0.0 0.0 0.00 0.0 0.00 0.0 0.00 0.00 0.00 -__-_____ ------------------- ----------------------- ---------- ----------- --- 013-68-9451 7891 '------------------- ------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 892.86 (89.95) 0.00 (197.93) 694.93 age: 1 f CertPay Wizard Certified Payroll Report Name Of Contractor X Subcontractor J3095 oject Location Address TERRY CONTRACTING &MATERIALS, INC. MAIN ROAD 205 MARCY AVENUE Payroll No rom OUTHOLD„ NY 11971 RIVERHEAD, N 1190 27 7/7/03 TO 7/13/03ojec on rac o. 2000 Name, Address, o Employee With. Exemp. ours orked ach Day RATE Gross- FICA STATE OTHER Net-Task OF Task check# - - Mon Tue Wed Thu Fri Sat Sun - ------ --------- - Task Race/Gender 7/7 7/8 7/9 7/10 7/11 17/12 7/13 HOURS PAY Gross FED W!H ao1 K DEDTOTANet-Check MANUEL GARCIA 5.00 0.00 8.00 0.00 1.50 0.00 0.00 0.00 9.50 25.23 239.69 (54.66) (24.88) (0.60) 204.00 40 PHILLIPS AVENUE RIVERHEAD,, NY 11901 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- 129-78-9523 7892 D 0.00 0.00 0.00 0.00 0.00 0.09 0.00 0.00 0.00 714.53 (26.26) 0.00 (106.40) 608.13 RAIG T. OUDEANS 1.00 S 8.00 8.00 0.00 0.00 0.00 0.00 0.00 16.00 25.23 403.68 (88.79) (60.71) (0.60) 306.84 7 WEST SIDE AVENUE EAST QUOGUE„ NY 11942 ___ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- ---------- ----------- ------------- 131-68-1974 7901 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1160.64 (128.33) 0.00 (278.43) 882.21 CHRISTOPHER L. ZITO S 0.0 4.0 0.00 0.0 0.00 0.0 0.0 4.00 36.19 144.76 (101.66) (73.55) (0.60) 106.99 101 COLIN DRIVE o.00 SHIRLEY„ NY 11967 _____ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ---------- - ---------- ---------- ----------- ------------- 108-64-29317916 ------------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1328.88 (170.87) 0.00 (346.68) 982.20 CHRISTOPHER L. ZITO S 5.0 0.0 0.00 0.0 0.00 0.0 0.0 5.00 36.19 180.95 (101.66) (73.55) (0.60) 133.74 101 COLIN DRIVE o.00 SHIRLEY„ NY 11967 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------- ----------- ------------- 108-64-2931 7916 ---------------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1328.88 (170.87) 0.00 (346.68) 982.20 CHRISTOPHER L. ZITO 0.00 S 3.00 4.00 0.00 0.00 1.00 0.00 0.00 8.00 36.19 289.52 (101.66) (73.55) (0.60) 213.99 1 COLIN DRIVE HIRLEY„ NY 11967 _ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------- ---------- ------------- 108-64-2931 7916 - ------------------ '------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1328.88 (170.87) 0.00 (346.68) 982.20 age: 2 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period 7/21/03 to 7/27/03;all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: Al� f/3 A) � (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: �ln addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs forthe benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception txplanation Name an It aIgna re ROBERT G. TERRY PRESIDENT /06t,Z THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY B TI-Ir-CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report Name Of Contractor X Subcontractor roject Location rens TERRY CONTRACTING & MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 28 7/14/03 TO 7/20/03 ro�ec on rac o. 2000 Name, Address, o Employee With. Exemp. ours orke Each ay RATE Gmss- FICA STATE OTHER Net-Task - - OF Task he_c_k__#----- ------------ Mon Tue Wed Thu Fri Sat Sun -----------_ - -- - Task ---- Race/Gender 7/14 7/15 7/16 7/17 7/18 7/19 7/20 HOURS PAY Gross FED W/H 401 K TOTAL Net-Check Check DED. ELVIN Y. BANEGAS0.0 8.0 6.50 0.0 0.00 0.0 0.0 14.50 25.54 370.33 (45.00) (16.57) (0.60) 322.61 1069 WEST MAIN STREET 5.00 RIVERHEAD„ NY 11901 ______ O 0.0 0.0 0.0 0.0 0.00 0.0 0.0 0.00 0.00 --------- ------------------- -- ----------- ---------- ----------- ------------- 129-66-5523 7957 --------------------------------------- 0.0 0.0 0.00 0.0 0.00 0.0 0.00 0.00 0.00 588.15 (13.62) 0.00 (75.79) 512.36 JUAN C. COLLAZOS S 0.0 8.0 1.50 0.0 0.00 0.0 0.0 9.50 38.83 368.89 (59.31) (30.36) (0.60) 305.14 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969 ______ O 0.0 0.0 0.0 0.0 0.00 0.0 0.0 0.00 0.00 ----------- ---------- ----------- ------------- ------------------- --------- 084-64-3878 7958 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 775.28 (43.70) 0.00 (133.97) 641.31 JUAN C. COLLAZOS S 0.0 0.0 3.50 0.0 0.00 0.0 0.0 3.50 25.54 89.39 (59.31) (30.36) (0.60) 73.94 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 1-1969- ----------- ______ O 0.0 0.0 0.0 0.0 0.00 0.0 0.0 0.00 0.00 ___________ ___________ __________ ___________ ____________ --- --- 084-64-3878 7958 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 775.28 (43.70) 0.00 (133.97) 641.31 RENE S. CONTRERAS S 0.0 8.0 0.00 0.0 0.00 0.0 0.0 8.00 25.54 204.32 (42.86) (19.58) (0.60) 167.37 424 OSBORNE AVENUE 1.00 RIVERHEAD„ NY 11901 O0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------- - ------------------- ---------- ---------- ----------- ------------- 080-92-7276 7961 D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 560.30 (38.28) 0.00 (101.32) 458.98 AMILCAR GARCIA S 0.0 8.0 6.50 0.0 0.00 0.0 0.0 14.50 25.54 370.33 (45.00) (18.27) (0.60) 306.17 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 _ __ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ------------------- ----------------------- ---------- ----------- ------------- 013-68-9451 7966 --------------------------------------- - ------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 588.15 (38.03) 0.00 (101.90) 486.25 MANUEL GARCIA S 0.00 8.0 0.00 0.0 0.00 0.0 0.0 8.00 25.54 204.32 (42.73) (14.82) (0.60) 179.15 40 PHILLIPS AVENUE 5.00 RIVERHEAD„ NY 11901 _____- O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 __________ ___________ __________ ___________ _____________ 129- ----- '----------- ---- ----------- 78-9523 ----7967 129- --- ------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 558.48 (10.66) 0.00 (68.81) 489.67 age: 1 CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location ress TERRY CONTRACTING &MATERIALS, INC. 95 MAIN ROAD 205 MARCY AVENUE OUTHOLD„ NY 11971 RIVERHEAD, N 1190 Payroll No 7/14/03 TO 7!20/03 ro�ec on rac o. 2000 28 Name, cess, o Employee With. Exemp. Hours or ed Each ay RATE mss- FICA STATE --- OF Task OTHER Net-Task Check# - ------------ Mon Tue Wed Thu Fri Sat Sun -- ----Gross--- ----------- .............. --- ------------- Task ----- Race/Gender 7/14 7/15 7/16 7/17 7/18 7/19 7/20 HOURS PAY Check FED W/H 401 K TOTALENet-Check CHRISTOPHER L. ZITO0.0 0.0 4.50 0.0 0.00 0.0 0.0 4.50 38.83 174.74 (98.40) (70.63) (0.60) 129.93 101 COLIN DRIVE o.00 SHIRLEY„ NY 11967 -____- O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------------------- ----------- ------------- ---------- ---------- ------------------- 108-64-2931 7991 -------------------------------------- D 0.0 0.00 0.001 0.00 0.00 0.00 0.00 0.00 0.00 1286.35 (160.24) 0.00 1 (329.87) 956.48 iCHRISTOPHER L. ZITO 0.00 S 0.00 4.00 0.00 0.00 0.00 0.00 0.00 4.00 38.83 155.32 (98.40) (70.63) (0.60) 115.49 101 COLIN DRIVE SHIRLEY„ NY 11967 _ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------- ---- - -- - 108-64-2931 - ----7991 - - D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1286.35 (160.24) 0.00 (329.87) 956.48 • age: 2 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period 7/21/03 to 7/27/03;all persons employed on said project have been paid the full weekly wages earned, that no rebates have been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: ( -26, d /0 3 (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: "eIn addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above " eferenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs forthe benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception tXplanation Name and Title I nature ROBERT G. TERRY PRESIDENT aes. THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS ECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1 F TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report r Name Of Contractor El Subcontractor jcject/Contract ject Location Address TERRY CONTRACTING &MATERIALS, INC. 95 MAIN ROAD 205 MARCY AVENUE Payroll No From UTHOLD„ NY 11971 RIVERHEAD, N 1190 29 7/21/03 TO 7/27/03o. 2000 Gross- Name, Address, o mpoyee WithExemp. Hours Worked Each Day ROTE cask FICA STATE OTHER Net-Task Check# ----------- ------- Task Race/Gender 7/21 7/22 7/2---------------No---H-P- D 3 7/24 7/25 7/26 7/27 HOURS PAY Check FED W/H 401 K DED Net-Check EMP-7-1-41 r ---EE=' K---- ag e: 1 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1) That I pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period 7/14/03 to 7/20/03; all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor,or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor (4)That: P.- Ct-4-f tx) "7 1� '7/d '> (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in Section 4(c) below. Exception tXplanation Name an It ature ROBERT G. TERRY PRESIDENT1Z—Z.&4e5 - THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS S CT 1AE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report 1 Name Of Contractor El Subcontractor 3roject Location Address + TERRY CONTRACTING & MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 30 7/28/03 TO 8/3/03 3roject/Contract No. 2000 Name, Address, bbN ot Employee With. Exemp. Hours Worked Each Day RATEGross- FICA STATE OTHER Net-Task OF Task heck_ # ------- - _ -_----- ---------------------------TD. _0_T_ - ------------- Task Race/Gender 7/28 7/29 7/30 7/31 8/1 8/2 8/3 HOURS PAY check FED W/H 401 KD — Net-Check NO---H- _-T--_ _ -1- --- ---- -- --E - __D • age: 1 STATEMENT OF COMPLIANCE �1"ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period 7/21/03 to 7/27/03; all persons employed on said project have been paid the full weeklywages earned, that no rebates have been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise underthis contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of bor. (4)That: /-� 0 "�. � 3/Q, (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: ❑ In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs forthe benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception Explanation Name and Title Signature ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MA S T CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report Name Of Contractor X Subcontractor roject Location Address TERRY CONTRACTING &MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 31 8/4/03 TO 8/10/03 ro�ec on rac o. 2000 Name, ress, o mpoyee With. Exemp. Hours Worked Each Day TAL RATE mss- FICA STATE OF Task OTHER Net-Task __h_e_c_k__#____ ----------- Mon Tue Wed Thu Fri Sat Sun -------_--- ---------- ---------- --------- -------------- ' ------------- Race/Gender HOURS PAY Gross FED W/H 401 K TOTAL Net-Check Task 8/4 8/5 8/6 8/7 8/8 8/9 8/10 Check DED. ELVIN Y. BANEGAS4.0 0.0 0.00 0.0 0.00 0.0 0.0 4.00 25.54 102.16 (26.40) (4.21) (0.60) 92.92 1069 WEST MAIN STREET 5.00 RIVERHEAD„ NY 119.0.1_--------------- ______ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------------------- ____ 129-66-5523 8093 ------------------ '------------------- D 0.0 0.00 0.00 0.0 0.00 0.00 0.00 0.00 0.00 345.16 0.00 0.00 (31.21) 313.95 JUAN C. COLLAZOS 4.00 S 4.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 38.83 155.32 (79.82) (48.72) (0.60) 123.61 P.O. BOX 2786 SOUTHAMPTON„ NY 11969 ------ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ___ ___________ __________ ___________ _____________ 084-64-3878 8094 -------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1043.34 (83.90) 0.00 (213.04) 830.30 JAVIER GARCIA 4.00 S 4.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 25.54 102.16 (31.14) (8.06) (0.60) 89.22 1069 WEST MAIN STREET RIVERHEAD„ NY 119.0.1_---------------------- O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 __ ___________ __________ ___________ _____________ 011-69-85738102 -------------------'------------ D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 407.16 (11.77) 0.00 (51.57) 355.59 • age: 1 ♦` STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Contractor TERRY CONTRACTING & MATERIALS, INC. on TOWN OF SOUTHOLD; that during the payroll period 7/28/03 to 8/3/03; all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract; that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. f (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: 'c-oln addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs forthe benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception Explanation Name and Titlebignat ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAYT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 100 ITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor 13095 ect Location Address TERRY CONTRACTING & MATERIALS, INC. MAIN ROAD 205 MARCY AVENUE Payroll No rom THOLD„ NY 11971 RIVERHEAD, N 1190 33 8/18/03 TO 8/24/03ec on rac o. 2000 Name, ress, o mp oyes With. Exemp. Hours Wo Each ay TOTAL ROTE Gross- Task FICA STATE OTHER Net-Task heck ------------ Mon Tue Wed Thu Fri Sat Sun ---------- ----------- ------------------------------------- ------ Gross- Task - - Race/Gender 8/18 8/19 8/20 8/21 8/22 8/23 8/24 HOURS PAY Check FED W/H 401 K TOTAL TED. Net-Check JUAN C. COLLAZOS0.0 8.0 7.50 0.0 0.00 0.0 0.0 15.50 34.89 540.80 (81.46) (50.19) (0.60) 429.38 P.O. BOX 2786 4.00 SOUTHAMPTON„ NY 11969 ------ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ------------------------ ---------------------- ------------- 084-64-3878 8172 D 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 1064.87 (87.13) 0.00 (219.38) 845.49 ENE S. CONTRERAS 1.00 S 0.00 8.00 7.50 0.00 0.00 0.00 0.00 15.50 25.54 395.87 (63.78) (38.31) (0.60) 309.47 424 OSBORNE AVENUE RIVERHEAD„ NY 11901 -_--- O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------- ----------- ------------- 080-92-7276 8175 - - -------------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 833.76 (79.29) 0.00 (181.98) 651.78 AMILCAR GARCIA 4.00 S 0.00 8.00 7.50 0.00 0.00 0.00 0.00 15.50 25.54 395.87 (68.08) (38.87) (0.60) 308.34 1069 WEST MAIN STREET RIVERHEAD„ NY 11901 ------ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------------------- ------------- ------------------- 013-68-9451 8180 D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 889.95 (89.22) 0.00 (196.77) 693.18 ag e: 1 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That 1 pay or supervise the payment of the persons employed by Co r RRTRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD;that during the payroll period' / Q3to r9/03all persons employed on said project have been paid the full weekly wages earned,that no rebates have been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise underthis contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in Section 4(c) below. Exception tExplanation Name an It aIgnatur ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS s_ THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING & MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 34 8/25/03 TO 8/31/03 rotec on rac o. 2000 Name, ress, o mp oyes With. Exemp. ours Worked Each Day RATE Task- FICA STATE OTHER Net-Task - ----- - C_h_e_c_k_# ----------- Mon Tue W Thu Fri at un Gross- ------ ---- ---------- - Race/Gender HOURS PAY Ch,c FED W/H 401 K DEo Net-Check Task 8/25 8/26 8/27 8/28 8/29 8/30 8/31 cne�k JUAN C. COLLAZOS 4.00 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 34.89 279.12 (90.08) (57.91) (0.60) 219.24 P.O. BOX 2786 SOUTHAMPTON„ NY 11969 __--__ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ---- ----------- ---_ ------------------- ----------- ----------- ------ --------- 084-64-3878 8214 D 0.00 0.00 0.00 0.00 0.00 0.0 0.00 0.00 0.00 1177.57 (104.04) 0.00 (252.63) 924.94 ENE S. CONTRERAS 1.00 S 0.00 8.00 0.00 0.00 0.00 0.00 0.00 8.00 25.54 204.32 (36.63) (14.65) (0.60) 170.86 424 OSBORNE AVENUE RIVERHEAD„ NY 11901--------------- ______ 0 0.00 0.00 0.00 0.00 0.00 0.00 0.0 0.00 0.00 ----------------------- --------------- ------ ------------- ---- 080-92-7276 8217 -------------------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.0 0.00 0.00 478.82 (26.54) 0.00 (78.42) 400.40 AMILCAR GARCIA S 0.0 8.00 0.00 0.0 0.00 0.0 0.0 8.00 25.54 204.32 (50.96) (23.54) (0.60) 166.03 1069 WEST MAIN STREET 4.00 RIVERHEAD„ NY 11901 O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------- - ------------------- 013-68-9451 8222 --------------------------------------- -------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 666.11 (49.72) 0.00 (124.82) 541.29 age: 1 STATEMENT OF COMPLIANCE m I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by Co r RY N RACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll riodYAS03 to �3t3, all persons employed on said project have been paid the full weekly wages earned,that no rebates hvbeen or will be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor underthe Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each laborer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic listed in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception t=xplanation Name and Title 5ignatur ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS $.. THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. CertPay Wizard Certified Payroll Report Name Of Contractor El Subcontractor roject Location Address TERRY CONTRACTING & MATERIALS, INC. 3095 MAIN ROAD 205 MARCY AVENUE Payroll No From OUTHOLD„ NY 11971 RIVERHEAD, N 1190 35 9/1/03 TO 9/7/03 rojec on rac o. 2000 Name, Address, o mp oyee With. Exemp. ours Worked Each ay RATES- FICA STATE ----- of Task OTHER Net-Task ------ heck# Mon Tue Wed Thu Fri Sat Sun --------- - Task Race/Gender 9/1 9/2 9/3 9/4 9/5 9/6 9/7 HOURS PAY check FED W/H 401 K DED Net-Check MANUEL GARCIA0.0 0.0 5.00 4.0 0.00 0.0 0.0 9.00 25.54 229.86 (50.18) (20.87) (0.60) 197.60 40 PHILLIPS AVENUE 5.00 RIVERHEAD„ NY 11901 ______ O 0.0 0.0 0.00 0.0 0.00 0.0 0.0 0.00 0.00 ----------- ----------- ---------------------- ------------- 129-78-9523 � 8293 --- -------------------'------------------- D 0.0 0.00 0.00 0.0 0.00 0.0 0.0 0.00 0.00 655.98 (20.41) 0.00 (92.06) 563.92 CHRISTOPHER L. ZITO S 0.0 0.0 6.00 5.0 0.00 0.0 0.00 11.00 38.83 427.13 (116.82) (87.12) (0.60) 308.26 101 COLIN DRIVE o.00 SHIRLEY,, NY 11967_____ _______ ______ O 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ----------------------- ---------------------- __-__-_____-_ 108-64-29318315 --------------------'------------------- D 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1527.05 (220.42) 0.00 (424.96) 1102.09 IIS age: 1 STATEMENT OF COMPLIANCE I, ROBERT G. TERRY, PRESIDENT do hereby state: (1)That I pay or supervise the payment of the persons employed by C_ooh T RRY O TRACTING & MATERIALS. INC. on TOWN OF SOUTHOLD; that during the payroll period (3 to � /Q3 all persons employed on said project have been paid the full weekly wages earned,that no bates h v been orwill be made either directly or indirectly to or on behalf of said Contractor TERRY CONTRACTING & MATERIALS. INC. from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations, Part 3(29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act(48 Stat,948.63 Stat, 108.72 Stat, 967.76 Stat, 357; 40 U.S.C. 276c), and described below: (2)That any payrolls otherwise underthis contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications therein for each la borer or mechanic conform with the work performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training, United States Department of Labor, or if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS: In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted in Section 4(c) below. (b)WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ Each laborer or mechanic fisted in the above references payroll has been paid as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. Exception txplanation Name an I eIgnatur ROBERT G. TERRY PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS $_ T THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF HTE UNITED STATES CODE. i i APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 3 PAGES T:. .TOWN OF SOUTHOLD PROJECT: APPLICATION: 12 Distribution to. 53095 Main Road SOUTHOLD COMPOST FACILITY [ ]OWNER Squthold.NY 11971 PERIOD TO: 09/08/03 [ )ARCHITECT FROM(CONTI kTOR): VIA(ENGINEERS): [ ]CONTRACTOR Terry Contracting&Materiais.Inc. Dvirka&Bartiiucci PROJECT NO: 2000 840 West Main Street 330 Crossways Park Drive Riverhead,NY 11901 Woodbury,New York 11797.2015 CONTRACT DATE: 1/31/01 CONTRACT FOR: CONTRACTORS APPLICATION FOR PAYMENT Application is made for Payment,as shown below, in connection with the Contract. Continuation Sheet,AIA Document G703,is attached. CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $ 1,883,267.27 previous months by Owner 2. Net change by Change Orders $0.00 TOTAL 3. CONTRACT SUM TO DATE(Line 1 + 2) $1,883,267.27 ApproyAMs Month 4. TOTAL COMPLETED& STORED TO DATE $1,867,993.27 Numb eApproved (Column G on G703) 5. RETAINAGE: a:_5_%_of Completed Work $93,399.66 (Col umn D+ E on G703) TOTALS b: 5%_of Stored Material $0.00 Net Change by Change Orders I (Col umn F on G703) The undersigned Contractor certifies that to the best of the Contractors knowledge, Total Retainage(Line 5a + 5b or information and belief the Work covered by the Application for Payment has been Total in Column I of G703) $93,399.66 completed in accordance with the Contract Documents,that all amounts have been 6. TOTAL EARNED LESS RETAINAGE $1,774,593.61 paid by the Contractor for Work for which previous Certificates of Payment were (Line 4 less Line 5 Total) issued and payments received from the Owner,and that current payment shown 7. LESS PREVIOUS CERTIFICATES FOR herein is now due. PAYMENT(Line 6 from prior Certificate) $1,677,953.78 8. CURRENT PAYMENT DUE $96,639.83 CONTRACTOR: 9. BALANCE TO FINISH, PLUS RETAINAGE $108,673.66 Terry Contracting&Materials, Inc. (Line 3 less Line 6) State of: New York County of: Suffolk =" Subscribed and shown to before me this day of ,20 d 5 By: o �� Date: Notary Public<_Z nCQ a. �� CIC4 My Commissidr/expires: EN EER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ In accordance with the Contract Documents,based on on-site observations and the (Attach explanation if amount certified differs from the amount applied for.) data comprising the above application,the Engineer certifies to the owner that to the SOLID WASTE COORDINATOR: best of the Engineers knowledge,information and belief the Work has progressed as n p indicated,the quality of the Work is in accordance with the Contract Documents,and By: f,�. '`f� ",—,x Z— Date: / O the Contractor is entitled to payment of the AMOUNT CERTIFIED. This dificate is not negotiable. The AMOUNT CERTIFIED is payable onlyAto the Contractor named herein, Issuance,payment and acceptance of payment are with- out prejudice to any rights of the Owner or Contractor under this Contract. JULIA A.MCCLAVE NOTARY PUBLIC STATE OF NEW YORK No.OIMCW559M Certified in Suffolk County Commission Pvires 0342-20_(0 A1 N UATIO N SHEET AIA DOCUMENT G703 PAGE 2 OF 3 PAGES ,ocument G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 12 Aractor's signed Certification is attached. APPLICATION DATE: 09/15/03 4n tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 09/08/03 '�►' Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL °X, BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE AIIIIIIIIi DORE) (D+E+F) EMOVAL h CONSOLIDATION OF VEGETATION $ 20,400.00 $20,400.00 $0.00 $0.00 $20,400.00 100% $ $1,020.00 2 REMOVAL b STOCKPILING OF TOPSOIL @ LANDFILL $ 64,385.00 $64,385.00 $0.00 $0.00 $64,385.00 100% $ $3,219.25 3 WINDROWING OF REMAINING TOPSOIL d LOAM $ 65,130.00 $65,130.00 $0.00 $0.00 $65,130.00 65% $ $3,256.50 4 LOADOUT,XPORT,PLACEMENT&COMP LOAM T/S $ 320,811.00 $320,811.00 $0.00 $0.00 $320,811.00 100% $ $16,040.55 5 ACCESS ROAD $ 36,250.00 $36,250.00 $0.00 $0.00 $36,250.00 100% $ $1.812.50 6 RCA IMPORT&CONTRUC11ON OF TEMPORARY P $ 16,000.00 $16,000.00 $0.00 $0.00 $16,000.00 32% $ $800.00 7 WOOD CHIPS-$3/CY $ 88,251.00 $88,251.00 $0.00 $0.00 $88,251.00 100% $ $4,412.55 8 SAND SCREENING-$2.50/CY $ 50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $ - $2,500.00 9 SURVEY $ 21,000.00 $21,000.00 $0.00 $0.00 $21,000.00 78% $ - $1,050.00 10 SAND SCREENING-$3.65/CY $ 352,535.25 $352,535.25 $0.00 $0.00 $352,535.25 100% $ - $17,626.76 11 LEAF/BRUSH TRANSPORT $ 13,137.00 $13,137.00 $0.00 $0.00 $13,137.00 100% $ - $656.85 12 RCA TRANSPORT-$3/CY $ 9,048.00 $9,048.00 $0.00 $0.00 $9,048.00 100% $ - $452.40 13 CONSTRUCTION OF ACRE PAD AND ACCESS ROAD $ 31,410.00 $31,410.00 $0.00 $0.00 $31,410.00 100% $ - $1,570.50 14 RELOCATION OF TEMPORARY ACCESS ROAD $ 4,036.00 $4,036.00 $0.00 $0.00 $4,036.00 100% $ - $201.80 15 FENCE REPAIR/REPLACEMENT $ 5,767.37 $5,767.37 $0.00 $0.00 $5,767.37 100% $ - $288.37 16 WOOD CHIP HANDLING-CAT 322 $ 8,062.50 $8,062.50 $0.00 $0.00 $8,062.50 100% $ - $403.13 17 WOOD CHIP HANDLING-CAT D7 $ 12,487.50 $12,487.50 $0.00 $0.00 $12,487.50 100% $ - $624.38 18 WOOD CHIP HANDLING-DAEWOO 330 $ 4,725.00 $4,725.00 $0.00 $0.00 $4,725.00 100% $ - $236.25 OOD CHIP HANDLING-HAMM ROLLER $ 1,293.75 $1,293.75 $0.00 $0.00 $1,293.75 100% $ - $64.69 GRADING OF 17-ACRES-CAT D7 $ 3,600.00 $3,600.00 $0.00 $0.00 $3,600.00 100% $ - $180.00 21 GRADING OF 17-ACRES-CAT D6 $ 38,400.00 $38,400.00 $0.00 $0.00 $38,400.00 100% $ - $1,920.00 22 GRADING OF 17-ACRES-CAT 322 $ 5,531.25 $5,531.25 $0.00 $0.00 $5,531.25 100% $ - $276.56 23 GRADING OF 17-ACRES-DAEWOO 330 $ 34,087.50 $34.087.50 $0.00 $0.00 $34,087.50 100% $ - $1.704.38 24 GRADING OF 17-ACRES-TEREX TA 40 $ 62,150.00 $62,150.00 $0.00 $0.00 $62,150.00 100% $ - $3,107.50 25 GRADING OF 17-ACRES-HAMM ROLLER $ 2,250.00 $2,250.00 $0.00 $0.00 $2,250.00 100% $ - $112.50 $ 1,270,748.12 $1,270,748.12 $0.00 $0.00 $1,270,748.12 $0.00 $63,537.41 S• ,efCATION AND CERTIFICATE FOR PAYMENT, containing APPLICA U � :k r. ,. ..b 'cation is attached. APPLICATION DATE: 9/15/03 amounts are stated to the nearest dollar. PERIOD TO: 9/8/03 .;ontracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: B C D E F G H I .SCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE DORE) (D+E+F) 26 STOCKPILING OF WOOD CHIPS IN BORROW PR CAT D6 $ 600.00 $600.00 $0.00 $0.00 $600.00 100% $ - $30.00 27 STOCKPILING OF WOOD GIPS IN BORROW PR DAEWOO 330 $ 900.00 $900.00 $0.00 $0.00 $900.00 100% $ - $45.00 28 STOCKPILING OF WOOD CHIPS IN BORROW PIT CAT 972 $ 618.75 $618.75 $0.00 $0.00 $618.75 100% $ - $30.94 29 GRADING OF 17-ACRES-CAT 980 $ 456.26 $456.26 $0.00 $0.00 $456.26 100% $ - $22.81 30 24"CHDPE $ 63,205.00 $61,555.00 $1,650.00 $0.00 563,205.00 100% $ - $3,160.25 3 TCH BASINSTMNHOLES $ 21,000.00 $18,000.00 $3,000.00 $0.00 $21,000.00 100% $ - $1,050.00 3 HIGH FENCING $ 54,806.25 $39,532.25 $0.00 $0.00 $39,532.25 100% $ 15,274.00 $1,976.61 33 EXCAVATION AND GRADING OF ACCESS ROAD $ 12,000.00 $12,000.00 $0.00 $0.00 $12,000.00 100% $ - $600.00 34 RCA AND PAVE ACCESS $ 32,400.00 $32,400.00 $0.00 $0.00 $32,400.00 100% $ - $1,620.00 35 RETAINING WALL 1 $ 21,180.00 $21,180.00 $0.00 $0.00 $21,180.00 100% $ - $1,059.00 36 GRADING OF 17-ACRES-CAT 972 $ 2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100% $ - $100.00 37 MISC.LABOR $ 1,485.00 $561.00 $924.00 $0.00 $1,485.00 100% $ - $74.25 38 SAND SCREENING-S5.67/CY $ 305,715.76 $305,715.76 ($5,818.12) $0.00 $299,897.64 100% $ 5,818.12 $14,994.88 39 LANDSCAPING $ 52,041.00 $0.00 $52,041.00 $0.00 $52,041.00 100% $ - $2,602.05 40 3-PHASE UNDERGROUND ELECTRIC W/TRANSFORMER FOR 30HP L $ 29,400.00 $0.00 $29,400.00 $0.00 $29,400.00 100% $ - $1,470.00 41 BACKFILL 24"PIPES 8 GRADE RCA-CAT D6 $ 600.00 $0.00 $600.00 $0.00 $600.00 100% $ - $30.00 42 GRADING WOODCHIPS-CAT D6 $ 3,600.00 $0.00 $3,600.00 $0.00 $3,600.00 100% $ - $180.00 43 BACKFILL ELECTRIC TRENCH RECHARGE BASIN-CAT D6/330 EXC. $ 1,525.00 $0.00 $1,525.00 $0.00 $1,525.00 100% $ - $76.25 44 INSTALLED ELECTRIC FOR TRANSFORMER TO SIREN-330 EXC/416 B $ 1,725.50 $0.00 $1,725.50 $0.00 $1,725,50 100% $ - $66.28 45 GRADING TOPSOIL-416 BACKHOE $ 187.75 $0.00 $187.75 $0.00 $187.75 100% $ - $9.39 46 LOAD FILL BY TRANSFORMER-TA30/972 PAYLOADE $ 675.00 $0.00 $675.00 $0.00 $675.00 100% $ - $33.75 47 EXTRA FOR BLACK FENCE $ 3,956.00 $0.00 $3,956.00 $0.00 $3,956.00 0% $ - $197.80 48 HEADWALL END SECTION $ 1,425.00 $0.00 $1,425.00 $0.00 $1,425.00 0% $ - $71.25 GRADE/CURLEX/SEED BEHIND TRANSFORMER $ 1,670.00 $0.00 $1,670.00 $0.00 $1,670.00 0% $ - $83.50 GRADE WOODCHIPS ON SLOPES $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ - $33.75 RCA 69 CY $ 690.00 $0.00 $690.00 $0.00 $690.00 0% $ $34.50 52 GRADING RCA-D-6 $ 675.00 $0.00 $675.00 $0.00 $675.00 0% $ $33.75 53 GATE WEST SIDE $ 1,725.00 $0.00 $1.725.00 $0.00 $1,725.00 0% $ $86.25 54 SETTING BLOCKS-416 C $ 1,400.00 $0.00 $1,400.00 $0.00 $1,400.00 0% $ $70.00 $ 618,337.27 $495,519.02 $101,726.13 $0.00 $597,245.15 $21,092.12 $29,862.26 1 01 72 889 085.39 1 766 267.14 16.13 0.00 $1.867.993.27 121.092.12 93 399.66 i Vendor No. 11cC1c Nb�. Town of Southold, New York - Payment Vouchers 70 •r. Vendor Tax ID Number or Social Security Number Vendor Address q0 weS4 Vendor Name . , , T �� /f�G✓ �' ,t z t� Vendor Telephone Number 7a-7-0/70 1 Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services ; G 3%8 bppd- 3' "` .' .,r'• ^*+ .,". Y`,.a..: 9 WE �. — �i� `y-y% ..z..:,'y. R t _ Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid.except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing.and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. n Signature lG+ Title '< Signature Ole'3 Company Name j " , . �'T wr Date — Title ate /n'71( el. /• vn CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 92 April 6,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED T14U FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 3/31 4/1 4/2 4/3 4/4 4/5 4/6 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK TOPHER ZITO ILO AVENUE O SHIRLEY,NY 11967 DOZER 8 8 8 1.5 25.5 36.19 922.85 CK.#7200 108-64-2931 0 PAYLOADER S 8 8 36.19 289.52 92.75 176.39 65.57 0.60 335.31 877.06 AMILCAR GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7181 013-68-9451 4 LABORER S 7.51 7.51 15 25.23 378.45 28.951 9.29 6.761 0.60 45.60 332.85 ANDREW M.FLEMING 11 BEATRICE STREET O SHIRLEY,NY 11967 DRIVER 4 7.5 11.5 29.41 338.22 CK.#7178 069-68-1419 3 LABORER S 0.5 0.5 25.23 12.62 26.84 5.08 5.98 0.60 38.50 312.34 JAMES L.NICHOL 430 AMITY STREET O WOODBRIDGE CT.06525 CK.#7190 042- 8-0638 2 PAYLOADER S 8 1 1 8 33.67 269.36 20.61 2.8 0.29 23.70 245.66 paTERRY 57 FOSTER AVENUE S HAMPTON BAYS,NY 11946 41'33.86 #7197 071-28-9247 4 EXCAVATOR O 8 8 8 24 36.19 868.56 66.44 64.95 36.75 0.60 699.82 SEAN TERRY #7310 57 FOSTER AVENUE ERROR CORR. DRIVER S 4 4 29.41 117.64 9.00 0.80 0.00 0.59 107.25 HAMPTON BAYS,NY 11946 #7198 050-76-6251 1 DRIVER O 4 8 8 20 29.41 588.20 45.00 66.11 22.15 0.60 454.34 S S 0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date q - 3 f� i 1 ' (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) p .Each laborer,worker,or mechanlo listed In the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. (a)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the / day of 't l atzt,20 Oland ending the � day 0 �of 2 3 all persons employed on said pro)ect have been paid the tali weekly ages earned,that no rebates have been or will be made elther directly or indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION 7L ` ' from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 6 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;gist the wage rates for laborers,workers,or mechanics contained therein are not less than[lie applicable wage rates contained In any wage determination Incorporated Into the contract;[list the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the THE WILLFUL FALSIFICATION OF ANY a THE EMENT9 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR contract have been or will be made to appropriate programs for the benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ J ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 93 April 6,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MONH411 THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 3/314/2 4/3 4/4 4.!5 4/6 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK S J.OUDEANS P. 305 O EAST QUOGUE,NY 11942 LABORER OR 0.5 1.5 2 37.85 75.70 CK.#7192 075-74-5407 1 LABORER S 8 8 8 8 8 40 25.23 1009.20 82.99 194.31 56.18 0.60 334.08 750.82 ELVIN Y.BANEGAS 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7165 129-66-5523 5 LABORER S 7 7.5 14.5 25.23 365.84 27.981 0.00 5.041 0.60 33.62 332.22 JAY A.POREMBA PAYLOADER 8 6 8 8 30 33.67 1010.10 49 PELLETREAU STREET DRIVERO 2 2 29.41 58.82 SOUTHAMPTON,NY 11968 EXCAVATOR 1 I 36.19 36.19 CK.#7193 070-64-2225 5 LABORER S 2 2 25.23 50.46 88.41 161.05 61.68 0.60 311.74 843.83 ANIBAL A.DIAZ 1069 WEST MAIN STREET O RIVERHEAD,NY 11901 CK.#7173 12 36 1 LABORER S 1 7.5 7.5 15 25.23 378.45 28.95 34.65 9.46 0.60 73.66 304.79 JA HORAN 6 ALBERT STREET O SHOREHAM,NY 11786 CK.#7184 052-74-1323 4 PAYLOADER S 8 8 8 8 8 40 33.67 1346.80 103.03 149.34 69.51 0.60 322.48 1024.32 JUAN C.COLLAZOS P.O.BOX 2786 O SOUTHAMPTON,NY 11969 ASV 6.5 6.5 32.4 210.60 CK.#7169 084-64-3878 4 DOZER S 1 1 1 33.67 33.67 18.68 0.00 0.94 0.60 20.221 224.05 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7183 011-69-8573 4 LABORER S 8 7.5 15.5 25.23 391.07 29.92 10.55 7.33 0.60 48.40 342.67 CRAIG T.OUDEANS 7 WEST SIDE AVENUE LABORER O/T 0 2.5 1.5 4 37.851 151.40 EAST QUOGUE,NY 11942 LABORER 8 2.5 8 8 8 1 34.5 25.23 870.44 CK.#7191 DRIVER S 5.5 5.5 29.41 161.76 90.54 152.781 62.28 0.60 306.20 877.40 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date y- - 43 It �ij -� (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (71119) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: apald,as Indicated on the payroll,an amount not lass than the sum of the pplicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (t)That 1 pay or supervise the payment of the persons employed by !J,, n alLt��l /7�-6 i �✓�—�CS�-!l.[a'f-C/1 -� /c./ (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the / day ofy�� =-- 206 and ending the 16 day of,� 2063, 0 6 3 all pentons employed on said project have been paid the full weekly ages earned,that no rebates have been or will be made sillier directly or indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and g and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into His contract;that the classifications sat forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE -In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of hinge benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEA EMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICL58 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ J OR SUBCONTRACTOR[ J ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 94 April 13,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. E4/7 TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/8 4/9 4/10 1/ 4/12 4/13 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK SHAWN J.OUDEANS 0 305 O EAST QUOGUE,NY 11942 CK.#7235 075-74-5407 1 LABORER S 4 4 25.23 100.92 7.72 0.00 0.00 0.50 8.22 92.70 MICHAEL N.JONES P.O.BOX 191 0 EAST QUOGUE,NY 11942 CK.#7225 090-68-2853 0 EXCAVATOR S 3 3 36.19 108.57 8.301 5.76 0.0010.54 14.60 93.97 JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY 11968 PAYLOADER 6 6 33.67 202.02 CK.#7238 070-64-2225 5 LABORER S 5.75 5.75 25.23 145.07 26.55 22.31 8.38 0.60 57.84 289.25 CHRISTOPHER L.ZITO 101 COLIN DRIVE O SHIRLEY,NY 11967 DOZER 6.5 2 8.5 36.19 307.62 CK.#7243 108-64-2931 0 EXCAVATOR S 8 8 36.19 289.52 45.68 59.43 23.42 0.60 129.13 468.01 1VRTAL ORA N 6STREET PAYLOADER O 6 8 14 33.67 471.38 SHOREHAM,NY 11786 LABORER 5.75 5.75 25.23 145.07 CK.#7248 052-74-1323 4 EXCAVATOR S 3 3 36.19 108.57 55.46 43.42 26.91 0.60 126.39 598.63 JUAN C.COLLAZOS DRIVER 3 3 6 29.41 176.46 P.O.BOX 2786 ASV O 2 2 32.4 64.80 SOUTHAMPTON,NY 11969 PAYLOADER 1.5 2.5 4 33.67 134.68 CK.#7211 084-64-3878 4 DOZER S 5 5 33.67 168.35 41.64 18.56 15.11 0.60 75.91 468.38 CRAIG T.OUDEANS 7 WEST SIDE AVENUE O EAST QUOGUE,NY 11942 CK.#7232 131-68-1974 1 LABORER S 4 4 25.23 100.92 7.72 0.00 0.00 0.501 8.22 92.70 0 S THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Dace U ' (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed in the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than ilia sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That 1 pay or superviae the payment of the persons employed by as listed in the contract,except as noted In Section 4(c)below. (a)EXCEPTION$ (Contractor or Su tractor) that during the payroll period commencing on the day of ,2(P3 and anding the /13 dey of94ia 20 d all persotU employed on said project have been paid the full weekly ages earned,Ihat no rebates have boon or III be made elgier directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION / C / r from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than His applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform wlllt Ilia work he/she performed. 3 That an a REMARKS: ( ) y apprentices employed In the above period are duly registered In a bone fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE —din addlUon to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION Of ANY DI THE ACEAM116MENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR( ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 IPAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 95 April 20,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/14 4/15 4/16 4/17 4/18 4/19 4/20 NRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK Sl OUDEANS P.O. 305 O EAST QUOGUE,NY 11942 CK.#7286 075-74-5407 1 LABORER S 8 8 8 8 32 25.23 807.36 61.77 119.37 37.16 0.60 218.90 588.46 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 CK.#7272 013-68-9451 4 LABORER S 2 7 9 25.23 227.07 17.37 0.001 0.64 0.60 18.61 208.46 JAY A.POREMBA 49 PELLETREAU STREET EXCAVATOR O 6.5 6.5 36.19 235.24 SOUTHAMPTON,NY 11968 DOZER1.5 8 9.5 33.67 319.87 CK.#7293 070-64-2225 5 HOLIDAY S 8 8 33.67 269.36 63.07 93.53 38.99 0.60 196.19 628.28 CHRISTOPHER L.ZITO 101 COLIN DRIVE O SHIRLEY,NY 11967 CK.#7297 1 08,dftll 0 DOZER S 41 4 36.19 144.76 11.08 2.07 0.04 0.60 13.79 130.97 JAMWORAN 6 ALBERT STREET PAYLOADER 0 8 8 4 20 33.67 673.40 SHOREHAM,NY 11786 EXCAVATOR 4 4 36.19 144.76 CK.#7277 052-74-1323 4 HOLIDAY S 8 8 33.67 269.36 83.21 97.79 51.741 0.60 233.33 854.19 JUAN C.COLLAZOS EXCAVATOR 2.5 2.5 36.19 90.48 P.O.BOX 2786 PAYLOADER O 1 1 33.67 33.67 SOUTHAMPTON,NY 11969 ASV8 8 32.4 259.20 CK.#7261 084-64-3878 4 HOLIDAY S 8 8 32.4 259.20 49.16 31.05 21.26 0.60 102.071540.48 CRAIG T.OUDEANS 7 WEST SIDE AVENUE O EAST QUOGUE,NY 11942 CK.#7284 131-68-1974 1 LABORER S 8 81 8 8 32 25.23 807.36 61.77 82.16 36.51 0.60 181.04 626.32 0 is THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date, (b)WHERE FRINGE BENEFITS ARE PAID IN CASH v (Name of signatory party) K (Title) ❑ -Each laborer,worker,or mechenlo listed In the above-referenced payroll has been do hereby state: apald,as Indicated on the payroll,an amount not less than the sum of the pplicable basic hourly wage rate plus the amount of the required fringe benefits (t)That t pay or supervise the payment of the persons employed by [��, /t as listed In the contract,except as noted In Section 4(c)below. CSC�/j�.G i �` �v�,.-�. fa LC. _ !1 .� � .{�� (o)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the day of� 2lY',and ending the day of . 20 d3 all peso employed on said project have been paid the full weekly ages earned,that no rebates have been or will be made either dlrec(ly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;drat the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bone fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That- (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE 'din addinon to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be meds to appropriapriatee programs for the THE WILLFUL FALSIFICATION OF ANY IN THEA EMENTSMAYSUBJECTTHECONTRACTORORSUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 8, CONTRACTOR'S PAYROLL STATEMENT i NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ j ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 95 April 20,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/14 4/I1 4/16 4/17 4/18 4/19 4/20 HRS. OFPAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK ELV ANEGAS 106 IN STREET O RIVERHEAD,NY 11901 CK.#7295 129-66-5523 5 LABORER S 7 7 25.23 176.61 13.51 0.00 0.00 0.60 14.11 162.50 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7274 011-69-8573 4 LABORER S 8 8 8 8 32 25.23 807.3661.77 72.59 33.21 0.60 168.17 639.19 O S O S S O S O S O S O THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR -03 Dace. s ' (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state paid,as indicated on the payroll,an amount not less than Ilia sum of the applicable basic hourly wage rale plus the amount of the required fringe benefits (1)That II pay or superylae the payment of the persons employed by `�,, as listed In the contract,except as noted In Section 4(c)below. bL /1g(� �e'1-�J ( p (c)EXCEPTIONS (Contractor or Sub tractor) that during the payroll period commencing on the day of ,2P,and ending the OW day of LI'La 2063 all pereo employed on said project have been paid the full weekly Mages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;Hint the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contrect:that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United Stales Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE '�in addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY 01 THECal RMI EMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 0 AND 9. CONTRACTOR'S PAYROLL STATEMENT S NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 96 April 27,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MONH4/22 THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/214/23 4/24 4/25 4/26 4/27 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK SH UDEANS P.O.B 305 O EAST QUOGUE,NY 11942 CK.#7348 075-74-5407 1 DRIVER S 8 8 29.41 235.28 18.00 13.18 3.28 0.60 35.06 200.22 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 CK.#7331 013-68-9451 4 LABORER S 8 8 8 24 25.23 605.52 46.321 42.32 19.391 0.60 108.63 496.89 JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY 11968 CK.#7350 070-64-2225 5 DOZER S 8 8 8 24 33.67 808.08 61.82 91.07 37.87 0.601 191.36 616.72 CHRISTOPHER L.ZITO - 101 COLIN DRIVE O SHIRLEY,NY 11967 CK.#7358 10 1 0 PAYLOADER S 1 5.5 5.5 36.19 199.05 15.23 7.5 2.21 0.60 25.54 173.51 JA HORAN 6 ALBERT STREET 0 SHOREHAM,NY It 786 CK.#7336 052-74-1323 4 PAYLOADER S 8 8 8 8 8 40 33.67 1346.80 103.03 149.34 69.51 0.60 322.48 1024.32 JUAN C.COLLAZOS P.O.BOX 2786 ASV O 4 8 7 19 32.4 615.60 SOUTHAMPTON,NY 11969 HYDROSEED 4 4 28.61 114.44 CK.#7319 084-64-3878 4 PAYLOADER S 1 1 33.67 33.67 58.421 49.22 29.56 0.601 137.80 625.91 CRAIG T.OUDEANS 7 WEST SIDE AVENUE O EAST QUOGUE,NY 11942 CK.#7346 131-68-1974 1 DRIVER FsF 8 81 1 16 29.41 470.56 35.99 31.64 14.17 0.60 82.40 388.16 0 S THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Dace (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanlo listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus lite amount of the required fringe benefits (1)That 1 pay or suparyl�s-a the payment of the persons employed by �? /1 as listed In the contract,except as noted In Section 4(c)below. EXCEPTIONS 0 (Contractor or Sub tractor) that during the payroll period commencing on the / day of .20 2 ,and andIng the�day of 20 all person mployed on said project have been paid the full weekly 46as earned,that no rebates have been or will be made sillier directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete,flint the wage rates for laborers,workers,or mechanics contained therein are not less than file applicable wage rates contained In any wage determination Incorporated Into the contract,Ilia[ the classifications set forth therein for each laborer,worker or mechanic conform with tate work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenliceshlp agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE //J//JA/In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEA EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 0. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] ORSUBCONTRACTOR[ 1 ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 96 April 27,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/21 4/22 4/23 4/24 4/25 4/26 4/27 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK ELV NEGAS 1069 IN STREET O RIVERHEAD,NY 11901 CK.#7317 129-66-5523 5 LABORER S 8 8 8 24 25.23 605.52 46.32 18.82 17.59 0.60 83.33 522.19 JAVIER GARCIA 1069 W.MAIN STREET 0 RIVERHEAD,NY 11901 CK.#7333 011-69-8573 4 LABORERS 8 8 8 24 25.23 605.52 46.321 42.32 19.391 0.60 108.63 496.89 JAMES T.KREUTZ 45 ATW ATER STREET O RIVERHEAD,NY 11901 PAYLOADER 8 8 33.67 269.36 CK.#7341 118-30-4104 0 DRIVER S 6.5 6.5 29.41 191.17 35.23 55.76 15.28 0.6 106.87 353.66 ANIBAL A.DIAZ 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7325 126$ 1 DRIVER is 8 8 29.41 235.28 18 13.18 3.28 0.6 35.06 200.22 ROBMWRRY 57 FOSTER AVENUE S HAMPTON BAYS,NY 11946 CK.#7353 071-28-9247 4 EXCAVATOR O 1 8 8 36.19 289.52 22.15 01 2.75 0.6 25.50 264.02 MICHAEL N.JONES P.O.BOX 191 S EAST QUOGUE,NY 11942 CK.#7339 090-68-2853 0 DOZER O 8 8 36.19 289.52 22.15 30.11 6.22 0.60 59.08 230.44 ANDREW M.FLEMING 11 BEATRICE STREET S SHIRLEY,NY 11967 CK.#7329 069-68-1419 3 PAYLOADER O 6.51 1 5 41 15.5 33.67 521.89 39.93 22.19 14.93 0.601 77.65 444.24 MANUEL GARCIA 40 PHILLIPS AVENUE $ RIVERHEAD,NY 11901 DRIVER 5 5 29.41 147.05 CK.#7335 129-78-9523 5 LABORER O 3 3 25.23 75.69 17.04 0.001 0.001 0.60 17.64 205.10 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR 4-_c - 0 Date , ' /�� 4 �• it n��1f,aV (b)WHERE FRINGE BENEFITS ARE PAID IN CASH V (Name of signatory party) uC' (Title) p -Each laborer,worker,or mechanlo listed In the above-referenced payroll has been do hereby state, aid,as Indicated on the payroll,an amount not less than(lie sum of Ilia applicable basic hourly wage rate plus the amount of the required fringe benefits (t)That I pay or superylse the payment of the persons employedd.by as listed In the contract,except as noted In Section 4(c)below. i��Lt 1� « .d i /1v(_I�itS�• sq� � p �.�� (c)EXCEPTIONS (Contractor or Sub tractor) l ,that during the payroll period commencing on the�Q� day of ,20 9,and ending the day of 20 all person employed on said project have been paid the full weekly Wages earned,that no rebates have been or will be made sillier directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;Hint the wage rates for laborers,workers,or mechanics contained therein are not less than[lie applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS., apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE — In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above have bean or will be meds to appropriate programs for the referenced payroll,payments of fringe benefits as listed In the THE WILLFUL FALSIFICATION OF ANY 01 THEA EMENT9 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR h benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 97 May 4,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THIl FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/28 4/29 4/30 5/1 5/2 5/3 5/4 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK ELV WEGAS 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7371 12956-5523 5 LABORER S 8 8 8 24 25.23 605.52 46.32 18.82 17.59 0.60 83.331 522.19 ANDREW M.FLEMING 11 BEATRICE STREET O SHIRLEY,NY 11967 CK.#7386 069-68-1419 3 PAYLOADER S 8 8 33.67 269.36 20.61 0.00 2.721 0.60 23.93 245.43 MANUEL GARCIA 40 PHILLIPS AVENUE O RIVERHEAD,NY 11901 CK.#7394 129-78-9523 5 DRIVER S 8 81 1 8 8 32 29.41 941.12 72.00 67.03 40.40 0.6 180.03 761.09 ANIBAL A.DIAZ 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7382 126 1 LABORER S 8 8 25.23 201.84 15.44 9.22 1.94 0.6 27.20 174.64 ROBE ERRY 57 FOSTER AVENUE S HAMPTON BAYS,NY 11946 CK.#7410 071-28-9247 4 EXCAVATOR O 81 81 8 24 36.19 868.56 66.441 64.95 36.751 0.6 168.74 699.82 JAVIER GARCIA 1069 W.MAIN STREET S RIVERHEAD,NY 11901 CK.#7392 011-69-8573 4 LABORER O 8 8 8 24 25.23 605.52 46.32 42.32 19.39 0.60 108.63 496.89 S O S Fol= THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date � 3 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ .Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employe l by as listed In the contract,except as noted In Section 4(c)below. l-�LL l�+«. �l�~ i �✓�—�iCl�• 11— < 'G�C.� /1�.1 (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the C7) O day of ,2(0- and ending the Z/ day of!i _ 20 (13 all perso aid employed on sold project have been pthe full weekly wages asked,that no rebates have been or will� b/e�made sillier directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION` / � from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductlons have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;thal the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bone fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEA EMENT9 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES a AND 9. I CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] ORSUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 97 MAY 4,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/28 4/29 4/30 511 5/2 5/3 5/4 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JUAN6AZOS P.O.B O SOUTHAMPTON,NY 11969 ASV 4 4 3 11 32.40 356.40 CK.#7374 084-64-3878 4 HYDROSEED S 4 4 2 10 28.61 286.10 49.16 31.04 21.26 0.60 102.06 540.44 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 CK.#7390 013-68-9451 4 LABORER S 8 8 8 24 25.23 605.52 46.321 42.32 19.391 0.60 108.63 496.89 JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY 11968 CK.#7405 070-64-2225 5 DOZER S 8 8 8 5.5 29.5 33.67 993.27 75.98 118.85 50.56 0.60 245.99 747.28 CHRISTOPHER L.ZITO 101 COLIN DRIVE O SHIRLEY,NY 11967 CK.#7414 108-64-2101h, 0 DOZER S 8 8 16 36.19 579.04 44.30 56.71 22.18 0.60 123.79 455.25 LAME 6 ALBERT STREET O SHOREHAM,NY 11786 CK.#7396 052-74-1323 4 PAYLOADER S 8 8 8 8 8 40 33.67 1346.80 103.031 149.34 69.51 0.60 322.48 1024.32 O S O S 0 S THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date (b)WHERE FRINGE BENEFITS ARE PAID IN CASH 1 U uG (Name of signatory party) (Title) p .Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (1)That I pay or supervise the payment of the persons employed by /1 l lu l�C /1�-6 / �` ��✓�—&f iy7 c'1 --�.• ��.!�� (c)EXCEPTIONS (Contractor or Sub tractor) pp that during the payroll period commencing on the 0 day o ,21T 3 and ending they day of,� 200 - all perso employed on said project have been paid the full weekly wages a ed,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;Hint the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY 01 THE ACYLSMEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES a AND e. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 98 May 11,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/5 5/6 5/7 5/8 5/9 5/10 5/11 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JUALLAZOS ASV O/T 8 8 64.80 518.40 086 ASV OIT O 6 6 8 20 32.40 648.00 SOUTHAMPTON,NY 11969 BACKHOE2 2 36.19 72.38 CK.#7426 084-64-3878 4 HYDROSEED S 2 21 28.61 57.22 99.14 135.62 66.03 0.60 301.39 994.61 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 LABORER Off 6 8 37.85 302.80 CK.#7438 013-68-9451 4 LABORER Is 8 8 8 24 25.23 605.52 69.491 99.12 40.131 0.60 209.34 698.98 JAY A.POREM3A DOZER 8 8 5 21 33.67 707.07 49 PELLETREAU STREET PAYLOADER O 4 6 12 33.67 404.04 SOUTHAMPTON,NY 11968 DRIVER 4 4 29.41 117.64 CK.#7454 F 070-64-2225 5 EXCAVATOR S 3 3 36.19 108.57 102.3 210.12 74.12 0.60 387.14 950.18 CHRISTOPHER L.ZITO 101 COLIN DRIVE O SHIRLEY,NY 11967 CK.#7463 108-6 0 DOZER S 8 2 8 18 36.19 651.42 49.84 67.57 27.14 0.60 145.15 506.27 JA RAN 6 ALBERT STREET O SHOREHAM,NY 11786 PAYLOADER 8 4 8 8 8 36 33.67 1212.12 CK.#7443 052-74-1323 4 LABORER S 4 4 25.23 100.92 100.451 140.22 67.19 0.60 308.461 1004.58 O S O S 0 S THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date 0 3 ZI� V (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) t. (Title) ❑ -Each laborer,worker,or mechanic listed in the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (t)That I pay or supervlae the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. (c)EXCEPTIONS (Contractor or Su tractor) that during the payroll period commencing on the day of� 20,0-3 nd ending the day of 20 ZO (13 all persons employed on said project have been paid the full weekly wages ea ed,that no rebates have been or will be made el8ier directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION 7L from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:Hiat the wage rates for laborers,workers,or mechanics contained therein are not less than Hie applicable wage rates contained In any wage determination Incorporated Into the contract;that the clesslflcotlons set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE --ld,n addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE AkWERTA11EMENT8 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION SEE ARTICLES 8AND 9. • CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 98 May 11,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/5 5/6 5/7 5/8 5/9 5/10 5/11 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK ELV ANEGAS 1069 IN STREET O RIVERHEAD,NY 11901 LABORER O/T 8 8 37.85 302.80 CK.#7423 129-66-5523 5 LABORER S 8 8 8 24 25.23 605.52 69.49 62.11 38.15 0.60 170.35 737.97 JAVIERGARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 LABORER O/T 8 8 37.85 302.80 CK.#7440 011-69-8573 4 LABORER S 8 8 8 24 25.23 605.52 69.491 99.12 40.131 0.60 209.341 698.98 MANUEL GARCIA 40 PHILLIPS AVENUE O RIVERHEAD,NY 11901 DRIVER 8 1 9 29.41 264.69 CK.#7442 129-78-9523 5 LABORER S 8 7 5 20 25.23 504.60 58.85 41.26 28.63 0.6 129.34 639.95 ANIBAL A.DIAZ 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7431 126-811&6 1 LABORER is 8 1 8 8 8 8 40 25.23 1009.20 77.2 173.87 50.99 0.6 302.66 706.54 SEAIWY 57 FOSTER AVENUE S HAMPTON BAYS,NY 11946 CK.#7458 050-76-6251 1 DRIVER O 8 8 29.41 235.28 18.00 13.18 3.28 0.6 35.06 200.22 S O S O S 0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date ` 03 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) p -Each laborer,worker,or mechanlo listed in the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of ilia applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or superylse the payment of the persons employ..eedd.by as listed In the contract,except as noted In Section 4(c)below. ' 1` /1✓�—dtrCSt�l.0 df �1 .- .!�� (c)EXCEPTIONS (Contractor or Sub tractor) n> ,that during the payroll period commencing on Ilia J day of AM ,20 0 and ending the//day of, 20 �J all parsons employed on said project have been paid the full weekly wages a med,that no rebates have been or will be made elgier directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 6 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:Ihat the 1� wage rates for laborers,workers,or mechanics contained therein are not less than Ilia applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bone fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE "`t<In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for Ilia THE WILLFUL FALSIFICATION OF ANY IX THE ACWEAWnfMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMINAL PROSECUTION.BEE ARTICLES 8 AND s. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 99 May 18,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDWG CLASSIFICATION OR 5/12 5/13 5/14 5/15 5/16 5/17 5/18 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JUAIWLLAZOS P.O. 786 O SOUTHAMPTON,NY 11969 ASV 8 8 5 6 6.5 33.5 32.40 1085.40 CK.#7476 084-64-3878 4 HYDROSEED S 3 2 5 28.61 143.05 93.97 118.93 61.40 0.60 274.90 953.55 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 LABORER O/T 0.5 0.5 37.85 18.93 CK.#7484 013-68-9451 4 LABORER S 8 8 8 8 8 40 25.23 1009.20 78.651 131.47 48.33 0.60 259.05 769.08 CHRISTOPHER L.ZITO 101 COLIN DRIVE O SHIRLEY,NY 11967 EXCAVATOR 4 4 36.19 144.76 CK.#7512 108-64-2931 0 DOZER S 8 6.5 14.5 36.19 524.76 51.22 70.28 28.38 0.60 150.48 519.04 JAY A.POREMBA DOZER 4 8 7 19 33.67 639.73 49 PELLETREAU STREET PAYLOADER O 4 41 33.67 134.68 SOUTHAMPTON,NY 11968 BACKHOE 1 1 36.19 36.19 070-610 5 EXCAVATOR 6.5 6.5 36.19 235.24 ASV 1.5 1.5 32.40 48.60 CK.#7497 0 ASV O!T S 0.5 0.5 64.80 32.40 86.20 153.29 59.71 0.60 299.80 827.04 JAMES J.HORAN 6 ALBERT STREET DRIVER O 2.5 2.5 29.41 73.53 SHOREHAM,NY 11786 PAYLOADER 5.5 8 8 8 29.5 33.67 993.27 CK.#7489 052-74-1323 4 PAYLOADER O/T S 2.5 2.5 67.34 168.35 94.49 119.94 61.86 0.60 276.89 958.26 O S O S 0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR s- al- a � Dace tG A5t' b �[ //i �J�, ,aV (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanlo listed in the above-referenced payroll has been do hereby state: apald,as Indicated on the payroll,an amount not less than the sum of the pplicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. _lt)That I pay or supervise the payment of the persons employe-d�lby u/ ' j �- i - /�✓�.�"tS7 e1i (c)EXCEPTIONS (Contractor or Sub tractor) 111 that during the payroll period commencing on the / day of ,206 3 end ending the /91, vriday of. 20 , all persons emplo ed on said project have been paid the Lull weekly wages earned,that no rebates have been or will be made ellher directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION / C from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the • wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work hefshe performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by The Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That - WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE fd-In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY 01 THE EMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ I OR SUBCONTRACTOR[ I ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 99 May 18,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/12 5/13 5/14 5/IS 5/16 5/17 5/18 HRS. OFPAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK ELV ANEGAS 1069 IN STREET 0 RIVERHEAD,NY 11901 LABORER 8 8 8 8 8 40 25.23 1009.20 CK.#7473 F 129-66-5523 5 LABORER O/T S 0.5 0.5 37.85 18.93 78.65 80.08 46.36 0.60 205.69 822.44 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 LABORER 8 8 8 8 8 40 25.23 1009.20 CK.#7485 011-69-8573 4 LABORER Off S 0.5 0.5 37.85 18.93 78.651 131.47 48.331 0.60 259.05 769.08 MANUEL GARCIA 40 PHILLIPS AVENUE LABORER O 8 81 3.5 8 27.5 25.23 693.83 RIVERHEAD,NY 11901 DRIVER 4.5 4.5 29.41 132.35 CK.#7513 129-78-9523 5 LABORER O/T S 0.5 0.5 37.85 18.93 64.65 52.63 33.82 0.6 151.70 693.41 ANIBAL A.DIAZ 1069 W.MAIN STREET LABORER O 8 8 8 5 3 321 25.23 807.36 RIVERHEAD,NY 11901 DRIVER 3 5 8 29.41 235.28 CK.#7479 126 1 LABORER O? S 0.5 0.5 37.85 18.93 81.21 188.01 54.58 0.6 324.40 737.17 OSC CHEZ 32 3RD.STREET S RIVERHEAD,NY 11901 CK.#7505 122-88-6906 1 LABORER 0 8 8 2.5 18.5 25.23 466.76 35.71 47.9 14.51 0.6 98.72 368.04 S O S O S O THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR XX 5 U Date , (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) 7 �C (Title) p -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby stela: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus Hie amount of the required fringe benefits _ty(1)That I pay or superylae the payment of the persona employed .by as listed In the contract,except as noted In Section 4(c)below. ,�(Jz t. 1 -/n d / - �✓(-Q`SS! 11 v.1 -�. � .!�� (c)EXCEPTIONS . (Contractor or Sub tractor) //��,that during the payroll period com encing on Ilia day of ,2W�)and ending the A? day of 20 all persons emplo ed on said project have been paid the full weekly wages 6med,that no rebates have been or w(illI be made elther directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION �Cfrom the full �l Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any parson,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:gist the • wage rates for laborers,workers,or mechanics contained therein are not less than Hie applicable wage rates contained In any wage determination Incorporated Into the contract:that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or machanlc listed r In the above referenced payroll,payments of fringe benefits as listed In the THE WILLFUL FALSIFICATION OF ANY 01 THE EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR contract have been or will be made to appropriate programs for the benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9, CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] ORSUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 100 May 25,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE HTHU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/19 5/20 5/22 5/23 5/24 5/25 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JUAN C.COLLAZOS �X 2786 O SOUTHAMPTON,NY 11969 ASV 5 5 4 7 8 29 32.40 939.60 CK.#7526 084-64-3878 4 HYDROSEED S 3 3 4 1 11 28.61 314.71 95.96 124.37 63.17 0.60 284.10 970.21 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 CK.#7532 013-68-9451 4 LABORER S 8 8 8 8 8 40 25.23 1009.20 77.201 126.36 47.04 0.60 251.20 758.00 MANUEL GARCIA 40 PHILLIPS AVENUE O RIVERHEAD,NY 11901 CK.#7535 129-78-9523 5 LABORER S 8 8 8 7.5 31.5 25.23 794.75 60.79 45.08 30.37 0.60 136.84 657.91 ANIBAL A.DIAZ 1069 W.MAIN STREET O RIVERHEAD,NY 11901 LABORER 8 7.5 8 1 24.5 25.23 618.14 CK.#7529 126-88-2636 1 DRIVER S 17 7 29.41 205.87 63.04 123.87 38.3 0.60 225.81 598.20 J.HORAN PAYLOADER 6 2 8 16 33.67 538.72 6 ERT STREET DRIVER 0 2 5.5 7.5 29.41 220.58 SHOREHAM,NY 11786 DOZER 2 2 33.67 67.34 052-74-1323 4 ASV S 2 2 32.4 64.80 LABORER 2 2 25.23 50.46 CK.#7536 EXCAVATOR O 2.5 2.5 36.19 90.48 78.981 89.52 47.97 0.60 217.07 815.31 S O S 0 S i THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date _a , (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) �C (Title) ❑ .Each laborer,worker,or mechanic listed in the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than Ilia sum of Ilia applicable basic hourly wage rate plus the amount of the required fringe benefits (t)That I pay or supervise the payment of the persons employedd.by as listed in the contract,except as noted In Section 4(c)below. (c)EXCEPTIONS (Contractor or Sub tractor) that during the payroll period commencing on the 9 day of ',';'20and ending the 0 day of 20 all persons employed on said project have been paid the full weekly wages admed,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles a and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into Ills contract;[list the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanlc listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY IN THE EMENT9 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND B. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ j ORSUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 F�l FOR WEEK ENDING PROJECT AND LOCATION 0 May 25,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. E5119 N TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/20 5/21 5/22 5/23 5/24 5/25 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK ELV NEGAS 1069 . IN STREET O RIVERHEAD,NY 11901 CK.#7525 129-66-5523 5 LABORER S 8 8 8 8 8 40 25.23 1009.20 77.20 77.25 45.06 0.60 200.11 809.09 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7533 011-69-8573 4 LABORER S 8 8 8 8 8 40 25.23 1009.20 77.20 126.36 47.041 0.60 251.20 758.00 CHRISTOPHER L.ZITO 101 COLIN DRIVE DOZER O 6.5 5 4 8 8 31.5 36.19 1139.99 SHIRLEY,NY 11967 EXCAVATOR 1.5 4 5.5 36.19 199.05 CK.#7554 108-64-2931 0 PAYLOADER S 3 3 36.19 108.57 110.74 239.9 81.68 0.60 432.92 1014.69 O Aft S qw S O S O S O S 0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits _lt)That I pay or eupelylae the payment of the persons employed Py as listed In the contract,except as noted In Section 4(c)below. / (c)EXCEPTIONS 7 (Contractor or Sub tractor) / l ,that during the payroll period commencing on ilia, day o ,24 3 and ending the 1,5—day of! 2003 all persons empkyed on said project have been paid the full weekly wages ea6ed,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION 1—I / from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 9 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with His worts he/she performed. (3)That any apprentices employed in the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (fl)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE —�<In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe beneflts as listed in the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES B ANo 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 101 June 1,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRISATE16/1 TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/26 5/27 528 5/29 ]5/30 5HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK IU*OLLAZOS P. 2786 HOLIDAY O 8 8 32.40 259.20 SOUTHAMPTON,NY 11969 ASV 5 7.5 6.5 7 26 32.40 842.40 CK.#7572 084-64-3878 4 HYDROSEED S r 3 0.5 1.5 1 6 28.61 171.66 97.40 129.48 64.47 0.60 291.95 981.31 AMILCAR GARCIA 1069 W/MAIN STREET O RIVERHEAD,NY 11901 CK.#7585 013-68-9451 4 LABORER S 8 8 8 8 32 25.23 807.36 61.771 72.59 33.21 0.60 168.17 639.19 MANUEL GARCIA 40 PHILLIPS AVENUE O RIVERHEAD,NY 11901 CK.#7589 129-78-9523 5 LABORER S F 8 8 8 8 32 25.23 807.36 61.77 46.97 31.24 0.60 140.58 666.78 ANIBAL A.DIAZ 1069 W.MAIN STREET O RIVERHEAD,NY 11901 DRIVER 7 7 29.41 205.87 CK.#7577 126ANoa636 1 LABORER S 1 8 9 25.23 227.07 33.12 42.83 12.51 0.60 89.06 343.88 JA ORAN 6 ALBERT STREET O SHOREHAM,NY 11786 HOLIDAY 8 8 33.67 269.36 CK.#7591 052-74-1323 4 PAYLOADER S 8 8 33.67 269.36 41.21 18.01 14.78 0.60 74.60 464.12 O S O S 0 S THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR - Date ' -�1 .iL1 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH v (Name of signatory party) uC (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than Ilia sum of the do hereby state: applicable basic hourly wage rate plus Ilia amount of the required fringe benefits (1)That I pay or suprlrvlfla the payment of the persane employed by �l as listed In the contract,except as noted In Section 4(c)below. axk_l 1� 1 �'7�. �` ��v �i7• e'1 ��.• ��.!�' (c)EXCEPTIONS (Contractor or Sub tractor) ,77that during the payroll period commencing on tha_� day of�,20��and ending the�dayof� 20 all persons empkiyed on said project have been paid the full weekly ages earned,that no rebates have been or will be made sillier directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)Thai- (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE 4in addition to the bacic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEA EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR the benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND e, CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 101 June 1,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/26 5/27 5/28 5/29 5/30 5/31 6/1 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK EL ANEGAS 106 IN STREET O RIVERHEAD,NY 11901 CK.#7568 129-66-5523 5 LABORER S 8 8 8 8 32 25.23 807.36 61.77 46.97 31.24 0.60 140.58 666.78 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7587 011-69-8573 4 LABORER S 8 8 8 8 32 25.23 807.36 61.771 72.59 33.21 0.60 168.17 639.19 CHRISTOPHER L.ZITO 101 COLIN DRIVE HOLIDAY O 8 8 36.19 289.52 SHIRLEY,NY 11967 DOZER 3 7.5 10.5 36.19 380.00 CK.#76.17 108-64-2931 0 EXCAVATOR S 5 5 36.19 180.95 65.06 97.43 40.78 0.60 203.87 646.60 O S S O S O S O S 0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date ' 4e -T' J�iI U,Le�t "�1tU- (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) E3 -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits (t)That I pay or superylee the payment of the persons employed by (T`7 as listed In the contract,except as noted In Section 4(c)below. i� (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the day of�,204 and ending the day of 20 6 all persons empl yed on said project have been pal the full week) ages earned,that no rebates have been or will be made sillier directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION 7L from the full Contractor or subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 9 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;dial the wage rates for laborers,workers,or mechanics contained therein are not less than His applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE �e"") _A/In addition to the basic hourly wage rates paid to each taborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE AkYE UAlTEMENT-8 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND e. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ) ORSUBCONTRACTOR[ ) ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 102 June 8,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MONTUE H6/5 FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/2 6/3 6/6 6/7 6/8 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JCOLLAZOS P-9P. 2786 PAYLOADER O 8 8 33.67 269.36 SOUTHAMPTON,NY 11969 BACKHOE 8 2 6 1.5 17.5 36.19 633.33 CK.#7633 084-64-3878 4 LABORER S r 6 6 25.23 151.38 80.63 92.77 49.45 0.60 223.45 830.62 AMILCAR GARCIA 1069 W/MAIN STREET 0 RIVERHEAD,NY 11901 CK.#7641 013-68-9451 4 LABORER S 8 1 8 8 24 25.23 605.52 46.321 42.32 19.39 0.60 108.63 496.89 MANUEL GARCIA 40 PHILLIPS AVENUE 0 RIVERHEAD,NY 11901 LABORER 8 8 8 8 32 25.23 807.36 CK.#7647 129-78-9523 5 LABORER S 1I 37.85 37.85 64.66 52.65 33.83 0.60 151.74 693.47 JAY A.POREMBA PAYLOADER 1 1 33.67 33.67 49 PELLETREAU STREET EXCAVATOR O 6 7.5 81 7 28.5 36.19 1031.42 SOUTHAMPTON,NY11968 DOZER 2 0.5 2.5 33.67 84.18 CK.#7660 03991W225 - 0 DOZER O/F S 1.5 1.5 67.34 101.01 95.65 186.62 68.16 0.60 351.03 899.25 Smwi.OUDEANS LABORER 3 6 7.5 6 22.5 25.23 567.68 CK.#7681 LABOREER O/F 1 1 37.85 37.85 0.96 0 0 0.06 1.02 11.60 P.O.BOX 305 PAYLOADER O 2 2 33.67 67.34 EAST QUOGUE,NY 11942 DRIVER 0.5 0.5 29.41 14.71 CK.#7658 075-74-5407 1 BACKHOE S 2 2 36.19 72.38 57.18 103.17 33.05 0.60 194.00 553.34 O S O S 0 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date - 16 - 6-3 [ 6rO- , le �Q ,L�' ,�tT ��A4 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanlo listed in the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of Ilia applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by /� /I as listed In the contract,except as noted In Section 4(c)below. .{�'l k_ 7 t C c c l -��— / �` �v�&�l�S�/I a'Z C/1 .• (�.l�� (c)EXCEPTIONS 0 (Contractor or Sub tractor) ,that during the payroll period commencing on Ilia day of .20 013 andendingthe F_day of 20 all pers s employed on said project have been pald the full week) wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any parson,other then permissible deductions as defined In Articles 8 and 9 and described below. (2)That any payrolls submitted for the above period are correct and complete:flint the S wage rates for laborers,workers,or mechanics contained therein are not less than file applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with Ilia work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a Slate apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a,)�WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE 'Mp-In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listedEME In the above referenced payroll,payments of fringe benefits as It contract have been or will be made to appropriate programs for the ed In the THE WILLFUL FALSIFICATION OF ANY Of THE NTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES BAND 8. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ I OR SUBCONTRACTOR I 1 ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 102 June 8,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 6/2 6/3 6/4 6/5 6/6 6/7 6/8 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK E Y.BANEGAS I AIN STREET O RIVERHEAD,NY 11901 CK.#7629 129-66-5523 5 LABORER S 8 8 8 24 25.23 605.52 46.32 18.82 17.59 0.60 83.33 522.19 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7644 011-69-8573 4 LABORER S 8 8 81 24 25.23 605.52 46.321 42.32 19.391 0.60 108.63 496.89 CHRISTOPHER L.ZITO DOZER 8 3.5 11.5 36.19 416.19 101 COLINDRIVE EXCAVATOR O 4 4 36.19 144.76 LABORER 6 6 36.19 217.14 SHIRLEY,NY 11967 DRIVER 1 I 36.19 36.19 CK.#7674 108-64-2931 0 PAYLOADER S 1 I 36.19 36.19 65.06 97.43 40.78 0.601 203.87 646.60 SEAN TERRY 57 FOSTER AVENUE O HA ON BAYS,NY 11946 CK.#7671 0 A51 1 DRIVER S 8 8 29.41 235.28 18.00 13.18 3.28 0.60 35.06 200.22 CARLOS ARTEAGA 1069 WEST MAIN STREET S RIVERHEAD,NY 11901 CK.#7676 098-674532 4 LABORER O 8 8 8 1 24 25.23 605.521 46.32 25.491 18.73 0.61 91.14 514.38 S O S O is THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date b ' �'�en t �.lt �r�{�� V� (b)WHERE FRINGE BENEFITS ARE PAID IN CASH �/ (Name of signatory party) (Title) p -Each laborer,worker,or mechanlo listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus Ilia amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. L,1• l(�« /n.a i �vS7 11�C11 �--�'.• ��.J (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll erlod commencing on the day of , 200-3ending the day of 20 all per ns employed on said project have been paid the full week) ages earned,that no rebates have beenorw II be .made elther directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION r from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not lose than the applicable wage rates contained In any wage determination Incorporated Into tite contract;that the classifications set forth therein for each laborer,worker or mechanic conform with tite work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bone fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE --din addlgon to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of frimga benefits as listed In the THE WILLFUL FALSIFICATION OF ANY Of THEA EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR contract have been or will be made to appropriate programs for(lie benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND e. CONTRACTOR'S PAYROLL STATEMENT NPME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 F LL# FOR WEEK ENDING PROJECT AND LOCATION 80 DEC.22,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET �1 NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT R12/22 TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 12/16 12/17 12/18 12/19 12/20 12/21HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JAMES T.KREUTZ 45 ATWATER STREET 0 RIVERHEAD,NY 11901 EXCAVATOR 6 6 36.19 217.14 CK.#6596 11830-4104 0 PAYLOADER S 2 5 7 33.67 235.69 34.65 54.611 14.82 0.60 104.68 348.15 DUAN C.COLLAZOS LABORER 1 2 5 8 25.23 201.84 .0.BOX 2786 BACKHOE 0 1 1 1 36.19 36.19 SOUTHAMPTON,NY 11969 PAYLOADER 6 5 6 17 33.67 572.39 EXCAVATOR 0.5 2 2.5 36.19 90.48 CK-#6580 084643878 4 ASV S 2.5 6 3 11.5 32.40 372.60 97.43 132.43 64.48 0.60 294.94 978.56 CHRISTOPHER ZITO 93 REVILO AVENUE DOZER 0 3 23 8 36.19 289.52 SHIRLEY,NY 11967 EXCAVATOR 5 3 5 13 36.19 470.47 CK.#6610 108-642931 0 PAYLOADER 8 8 36.19 289.52 80.29 134.26 54.41 0.6 269.56 779.95 JAVIER GARCIA 1069 W.MAIN STREET 0 RIVERHEAD,NY 11901 LABORER 8 8 8 85 37 25.23 933.51 CK.#6593 01169.8573 4 LABORER O/T S 1 1 37.85 37.85 74.30 118.22 44.45 0.60 237.57 733.79 CARLOS J.LEON P.O.BOX 2231 0 SOUTHAMPTON,NY 11969 CK.#6597 92073-7560 4 LABORER S 8 8 25.23 201.84 15.44 0.00 0.00 0.60 16.04 185.80 ANIBAL A.DIAZ 1069 WEST MAIN STREET 0 RIVERHEAD,NY 11901 LABORER 8 83 19 25.23 479.37 CK.#6584 126.882636 5 DRIVER S B 5 13 29.41 382.33 65.92 135.34 40.89 0.60 242.75 618.95 CRAIG T.OUDEANS 7 WEST SIDE AVENUE LABORER 0 2 3 8 6 5 24 25.23 605.52 EAST QUOGUE.NY 11942 ASV 6 5 2 13 32.4 421.20 CK.#6601 13168.1974 1 LABORER O/T S 1 1 37.851 37.85 81.44 122.75 54.12 0.60 258.91 805.66 JAY A.POREMBA 49 PELL£TREAU STREET 0 SOUTHAMPTON,NY 11969 CK.#6605 070.642225 5 DOZER S 8 8 33.67 269.36 20.61 0.00 1.56 0.60 22.77 246.59 WILLIAM T.BRATEK 77 WILDFLOWER CT.AOT.10 O I MORICHES.NY 11955 CK.#6578 12734.6992 1 DRIVER S 81 5 13 29.41 382.33 29.24 44.03 10.671 0.60 84.54 297.79 0 5 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date I -11/0-L �. 1 r (b)WHERE FRINGE BENEFITS ARE PAID IN CASH v (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. ( 9 - /I ?.�l q ,(p, (/T/ —f�' (c)EXCEPTIONS (Contractor or Sub tractor) that during the payroll period commencing on the�� day of "'�"'� ,206 and ending the got day of L)e-e-- 20 d 2 all persons employed on sold project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below. (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (o)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r // in the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEEMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 ffo LL# FOR WEEK ENDING PROJECT AND LOCATION 81 DEC.29,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSSTFICAWHAO WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 12/23 12/24 12/25 12/26 12/27 12/28 12/29 HRS. OF PAY AMOUNT STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNEDTAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO 93 REVILO AVENUE 0 SHIRLEY,NY 11967 DOZER 8 8 8 8 32 36.19 1158.08 CK......3 6660 108-642931 0 HOLIDAY S 8 8 36.19 289.52 110.74 241.75 81.68 0.60 434.77 1012.83 GARCIA *1V1ER 069 W.MAIN STREET 0 RIVERHEAD,NY 11901 CK.#6642 011 698573 4 ILABORER S 81 6.51 1 14.51 25.23 365.84 27.981 8.41 6.201 0.60 43.19 322.65 CARLOSJ.LEON P.O.BOX 2231 0 SOUTHAMPTON,NY 11969 CK.#6646 92073 7560 4 LABORER 8 6.5 14.5 25.23 365.84 27.98 1.10 5.81 0.60 35.49 330.35 ANIBAL A.DIAZ 1069 WEST MAIN STREET O RIVERHEAD,NY 11901 CK.#6637 12688.2636 1 ILABORER S 8 6.5 14.5 25.23 365.84 27.98 32.90 8.80 0.60 70.28 295.56 DAVID DOS SANTOS 115 DODGINGTOWN ROAD O BETHEL,CT.06801 CK.#6665 04066.7979 1 LABORER S 71 7 25.23 176.61 13.51 6.80 0.00 20.31 156.30 0 S O S 0 S 0 S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Data 5_0 -7 ' 4/1—t b, vt/4 v ,,LK._Lb,4C1( (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) p -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rale plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by / n as listed In the contract,except as noted In Section 4(c)below. (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the_ Ake day of ,200 land ending the [ day of" 20(� all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION f ' from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles B and 9 and described below: 2 That an payrolls submitted for the above period are correct and complete:Uta[the O YPY P P wage rates for laborers,workers,or mechanics contained therein ere not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with His work he/she performed. (3)That any apprentices employed In the above period era duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS rSIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the UL FALSIFICATION OF ANY Of Tti AQE&M1fMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8AND s. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ) OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 82 JAN.5,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME.ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI IS SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 12/30 12/31 1/1 1/2 1/3 1/4 1/5 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO 93 REVILO AVENUE EXCAVATOR 0 8 8 8 24 36.19 868.56 SHIRLEY,NY 11967 HOLIDAY 8 8 36.19 289.52 CK.#6713 10864-2931 0 PAYLOADER S 8 8 36.19 289.52 110.74 239.90 81.68 0.60 432.92 1014.68 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#6696 011 698573 4 LABORER S 8 5 13 25.23 327.99 25.10 4.24 4.68 0.60 34.62 293.37 JUAN C.COLLAZOS P.O.BOX 2786 ASV 0 6 6 32.40 194.40 SOUTHAMPTON,NY 11969 LABORER 2 2 4 25.23 100.92 CK.#6683 084-643878 4 EXCAVATOR 6 6 36.19 217.14 39.2 15.38 13.23 0.60 68.41 444.05 ANIBAL A.DIAZ 1069 WEST MAIN STREET DRIVER O 7 1 3 10 29.41 294.10 RIVERHEAD,NY 11901 HOLIDAY 8 8 29.41 235.28 CK.#6686 12688-2636 1 LABORER S 51 5 25.23 126.15 50.151 78.38 26.76 0.60 155.89 499.64 AMILCAR GARCIA 1069 WEST MAIN STREET 0 RIVERHEAD,NY 11901 CK.#6694 013.689451 4 LABORER S 8 51 13 25.23 327.99 25.10 4.24 4.68 0.601 34.62 293.37 JAMES J.HORAN 6 ALBERT STREET 0 SHOREHAM,NY 11786 PAYLOADER 8 3 11 33.67 370.37 CK.#6698 05274-1323 4 1EXCAVATOR S 51 5 36.19 180.95 42.17 19.27 15.53 0.60P 77.57 473.75 1 0 S 0 S 0 S 0 5 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date n 1 1 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) �K (Title) ❑ .Each laborer,worker,or mechanlo listed in the above-referenced payroll hes been paid,as indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (1)That I pay or supervise the payment of the persons employe�dlby `�,, /I 4-- 9t �- /��(--�CSL•��-C/J (c)EXCEPTIONS (Contractor or Sub tractor) that during the payroll period commencing on th day of ,20 and ending the day of 20 6 3 all persons employed on said project have been paid the full weekibbages earned,that no rebates have been or will be made either directly or Indlrec(ly to or an behalf of said EXCEPTION(CRAFT) EXPLANATION /f— H from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r l In the above referenced payroll,payments of fringe benefits as listed In the th contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE EMENT8 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT M OR ADDRESS NAME OF CONTRACTOR[ ] 0 [ ] TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 83 JAN.12.2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK 0 MON TUE WED THU FRI SAT F.NTOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 1/6 1/7 1/8 1/9 1/10 1/1HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO EXCAVATOR 4 4 36.19 144.76 93 REVILO AVENUE PAYLOADER 0 4 7.5 4 8 3 26.5 36.19 959.04 SHIRLEY,NY 11967 LABORER 0.5 0.5 36.19 18.10 CK.#6749 • 108-64-2931 0 DOZER S 4 5 9 36.19 325.71 110.74 239.90 81.68 0.60 432.92 1014.69 JAVIER GARCIA 1069 W.MAIN STREET 0 RIVERHEAD,NY 11901 CK.#6735 011 698573 4 LABORER IS 6 8 8 22 25.23 555.06 42.461 34.751 16.32 0.60 94.13 460.93 JUAN C.COLLAZOS ASV 2.5 2.5 32.40 81.00 P.O.BOX 2786 BACKHOE 2 1.5 3.5 36.19 126.67 SOUTHAMPTON,NY 11969 PAYLOADER 0.5 4 4.5 33.67 151.52 08464.3878 4 DOZER 0.50.5 33.67 16.84 LABORER 3.5 6 2 11.5 25.23 290.15 CK.#6726 DRIVER 1.5 1.5 29.41 44.12 54.34 41.21 25.90 0.60 122.05 588.25 ANIBAL A.DIAZ 1069 WEST MAIN STREET 0 RIVERHEAD,NY 11901 CK.#6729 126-882636 1 LABORER S 8 8 25.23 201.84 15.44 9.22 1.94 0.60 27.20 174.64 0 S 0.00 0 S 0.00 0 S 0 S O 5 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date J l y-6 /6 7 I (b)WHERE FRINGE BENEFITS ARE PAID IN CASH V (Name of signatory party) �C (Title) ❑ .Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. +i1(.� 1, 1�. E C �1 ��✓�.� – e� .- ��.1 (c)EXCEPTIONS (Contractor or Sub tractor) //�� ,that during the payroll period commencing on the. day of ,2A and ending the /A day of. � 20 6 3 all pe s employed on said proJect have been paid the full week/ ges earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION / I from the full /Contractor or subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period ere correct and complete:that the wage rates for laborers,workers,or mechanics contained therein ere not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanko listed r In the above referenced payroll,payments of fringe benefits as listed In the th contract haus been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE A662WK EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEEARTICL98 8AND 8. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 84 JAN.19,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 1/13 1/14 1/15 1/16 1/17 1/18 1/19 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY JEARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO 93 REVILO AVENUE DOZER O 3.5 8 11.5 36.19 416.19 SHIRLEY,NY 11967 PAYLOADER 1 8 9 36.19 325.71 CK.#6783 10864-2931 0 EXCAVATOR S 3.5 8 8 1995 36.19 705.71 110.74 239.90 81.68 0.60 432.92 1014.69 HAWN A.CAVANAUGH 16 SHINNECOCK AVENUE O MASTIC,NY 11950 ERROR COR. 6.5 6.5 17.00 -110.50 CK.#6788 086600808 1 DRIVER 5 6.5 6.5 29.41 191.17 6.17 8.47 14.64 66.03 0.00 O S 0.00 0 S 0.00 0 S 0.00 0 S 0 S O S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR f - a � - a3 DateV1 Q , ,Z— r h/4 i n (b)WHERE FRINGE BENEFITS ARE PAID IN CASH V (Name of signatory party) uC (Title) ❑ -Each laborer,worker,or mechenlo listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed in the contract,except as noted In Section 4(c)below. qtr(, Z�.�tLt l ,/n l �✓�.��57 a`�C1 � -� /�� (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the / day o ,20 Sand ending the19 day of S)D� 20 d 3 all per s employed on said project have been paid the full weekly Wages earned,that no rebates have beenorw II be made el0ier directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period ere correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that Ilia classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE a I _A/In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed ✓'J r In the above referenced payroll,payments of fringe benefits as listed In the th contract have been or will be made to appropriate programs fore THE WILLFUL FALSIFICATION OF ANY Of THE EMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMINAL PROSECUT70M SEE ARTICLES 8 AND s. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 85 JAN.26,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (B) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 1/20 1/21 1/22 1/23 1/24 1/25 1/26 HRS OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JUAN C.COLLAZOS P.O.BOX 2786 0 SOUTHAMPTON,NY 11969 CK.#6803 084-643878 4 PAYLOADER S 8 5 13 33.67 437.71 33.49 7.91 9.04 0.60 51.04 386.67 • 0 S 0.00 0 S 0.00 0 S 0.00 • 0 S 0.00 O S O S 0 S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date _ �I , V 'te,,(ZL((Z4' (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechonlo listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less then the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (1)That I pay or supervise the payment of the persons employedpby Al) �' �.t• } 1��, //�.d �` �v�-j�iC tiC a'1 C/J f' /I (c)EXCEPTIONS (Contractor or Sub n tractor) • that during the payroll period commencing on the day ofi Iii 20,and ending the Z day of 20 6-3 all pare s employed on sold project have been paid the full weekly ages earned,that no rebates have been or will be made sillier directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any parson and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period ere correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract,that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period era duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listedr / In the above referenced payroll,payments of fringe benefits as listed contract haus been or will be made to appropriate programs for the ed in the THE WILLFUL FALSIFICATION OF ANY Of THE AMS01EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9, CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.V.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 86 FEB.2,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SATSUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 1/27 1/28 1/29 1/30 1/31 2/1 2/2 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S_T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JAMESJ.HORAN 6 ALBERT STREET 0 SHOREHAM,NY 11786 CK.#6850 052.74.1323 4 PAYLOADER S 5 5 33.67 168.35 12.88 0.00 0.00 0.60 13.48 154.87 0 S 0 S 0 S • 0 S O S 0 S O S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date r � , (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ .Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby stator paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or superylse the payment of the persons employed by as listed in the contract,except as noted In Section 4(c)below. L�C.t- 1�� ✓�—� �'�e9 ., �� (c)EXCEPTIONS (Contractor or Sub tractor) A,�that during the payroll period comme IIng o/n the a�t-7 day of ,2lV',and ending the 6Z day of ' '—" 20 v all pers s employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION 2 from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles S and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training.United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE _AIn addition to the basic hourly wage rates paid to each laborer,worker or mechanic Ilsted r /In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 87 FEB.9,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND N0.OF WORK 0 MON TUE WED THU FRI SATSUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 2/3 2/4 2/5 2/6 2/7 2/6 2/9 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO 93 REVILO AVENUE O SHIRLEY,NY 11967 CK.#6897 108642931 0 DOZER S 8 8 36.19 289.52 22.15 16.55 5.83 0.60 45.13 244.39 WL A.DIA2 EST MAIN STREET O RIVERHEAD,NY 11901 CK.#6877 126.88.2636 1 LABORER S 4 4 25.23 100.921 7.72 0.00 0.00 0.50 8.22 92.70 JAY A.POREMBA LABORER O/T 1 1 37.85 37.85 49 PELLETREAU STREET PAYLOADER 0 8 8 16 33.67 538.72 SOUTHAMPTON,NY 11968 DOZER 8 6.5 14.5 33.67 488.22 CK.#6892 070642225 5 EXCAVATOR S 1.5 1.5 36.19 54.29 85.61 140.19 53.25 0.61 279.65 839.43 JAMESJ.HORAN 6 ALBERT STREET O SHOREHAM,NY 11786 CK.#6885 052.74.1323 4 PAYLOADER S 8 8 33.67 269.36 20.61 0 1.95 0.6 23.16 246.2 S 0 S • 0 S O S 0 S 0 S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date l J — ,�` (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less then the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits (t)That I pay or supervise the payment of the persons employedby as listed In the contract,except as noted In Section 4(c)below. )(c)EXCEPTIONS (Contractor or Sub tractor) //,tt that during the payroll period commencing on tha -3 day of_�P,20 u3and ending the?dayof 20 6-3 all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION I from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That- (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed l In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEAfQVE9TA EMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.see ARTICLES a AND 9. CONTRACTORS PAYROLL STATEMENT NAME OF CONTRACTOR[ ] ORSUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING N MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL FOR WEEK ENDING PROJECT AND LOCATION AN FEB.16,3003 SOUTHOLD LANDFILL CLOSURE (1) 122) 13) (4)DAY AND DATE (5) (6) (7) (9) (9) DEDUCTIONS NET NAME,ADDRESSAND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER WHOLDING CLASSIFICATION OR 310 2111 2_12 313 314 215 396 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY 11969 CK.#69.23 070-64--3335 5 DOZER S 8 8 5 21 33.67 707.07 54.09 48.75 25.02 0.80 128.46 578.61 O S O S O i S S 0 S O S O S 0 S 0 S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date i1v , ? — Ott i1 'd - (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state., applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed in the contract,except as noted In Section 4(c)below. l� " /n G / ee9�C/J/�� f�1 (c)EXCEPTIONS 7' " (Contractor or Sub tractor) /S that during the payroll period commencing on the �d day of c ,20e)3,nd ending the(ol/ day of: all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 9 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a Slate apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE -In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the th contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE A EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND e. CONTRACTOR'S PAYROLL STATEMENT NAME OFCONTRACTOR[ ] ORSUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.111111 PAYROLL n FOR WEEK ENDING PROJECT AND LOCATION R) MAR.9,W3 SOUTHOLD LANDFILL CLOSURE (1) (2) 13) (4)DAY AND DATE (5) IN (7) (R) ('J) DEDUCTIONS NET NAME,ADDRESSAND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSST1.CAH WAGES SOCIAL SECURITY NUMBER W:HOLDING CLASSIFICATION OR 33 3.4 33 36 39 3:8 39 HRS. OF PAY AMOUNT NG STATE OTHERTOTAL PAID OF EMPLOYEE EXEMPTIONS ST. HOURS WORKED EACH DAY EARNED TAX DEDUCTIONS FOR WEEK JAY A.POREMBA 49 PELLEFREAU STREET O SOUTHAMPTON,NY 11969 PAYLOADER 8 2.510.5 33.67 .353.54 CK.A 7020 070.64--2225 5 DOZER S B 8 8 24 33.67 9118.08 88.86 151.68 56.16 0.60 297.30 864.32 ANIBAL A.DIAZ * WEST MAIN STREET O RIVERHEAD,NY 11901 CK.N 7011 126-88-2636 1 LABORER S 2.5 8 10.5 25.23 264.92 20.27 17.62 4.46 0.60 4295 221.97 O S O S S O S O S O S O S O S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date � , (b)WHERE FRINGE BENEFITS ARE PAID IN CASH U (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed in the above-referenced payroll has been paid,as indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits (t)That I pay or supervise the payment of the persons employed by / as listed In the contract,except as noted In Section 4(c)below. lL C�`-- "/ L :�- 1�v{-Ai�S�•�l.Ca'1 �f� � / fL� (c)EXCEPTIONS (Contractor or Sub tractor) l that during the payroll period commencing on the2 day of_�,20d and ending the, I day of )JZO V 3 all persons employed on sold project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION Hfrom the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles a and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listedr In the above referenced payroll,payments of fringe benefits as listed contract haus been or will be made to appropriate programs for the ed In the THE WILLFUL FALSIFICATION OF ANY 01 THE EMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Sectlon 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9, CONTRACTOR'SPAYROLLSTATEMENT NAME OFCONTRACTOR[ j ORSUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS INC. 940 W.MAIN STREET RIVERHEAD.N.Y.11911 PA'�1tOLL n FOR WEEK ENDING PROJECT AND LOCATION 90 MAR.16,'(X)3 SOUTHOLD LANDFILL CLOSURE 11) (2) (3) (4)DAY AND DATE (5) (6) (7) IA) 191 DEDUCTIONS NET NAME,ADDRFSSAND NO.OF WORK O.T. MON TUE WED THU FIU SAT SUN TOTAL RATE GROSSTFICAH.OLDING WAGES SOCIAL SECURITY NUMBER W HOLDING CLASSIFICATION OR 3 Ill 3:11 313 313 314 3:15 396 HRS. 3 AMOUNT STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS ST. HOURS WORKED EACH DAY EARNED TAX DEDUCTIONS FOR WEEK ANDREW M.FLEMING I I BEATRICE STREET O SHIPLEY,NY 11967 CK#7064 069.68-1419 3 DRIVER S 8 8 16 29.41 470.56 35.99 17.06 11.90 0.60 6.5.55 405.01 10ICHAEL N.JONES O.BOX 191 0 EAST QUOGUE,NY 11943 CKN 7069 090-68-3853 0 EXCAVATOR S 8 R 36.19 389.53 22.151 30.11 6.22 0.60 59.09 330.44 JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY 11968 PAYLOADER 8 8 5 21 33.67 7117.07 CK.#7077 070-64-2225 5 EXCAVATOR S 3 B 8 19 36.19 687.61 106.69 214.60 72.13 0.60 3`14.112 1000.66 ANIBAL A.DIAZ 1069 WEST MAIN STREET O RIVERHEAD.NY 11901 LABORER 2.5 8 R R 1 37.5 25.23 693.83 CK.47062 136-1R--2636 1 DRIVER S Q5 0.5 3241 4.71 54.20 92.69 30.39 0.60 177.111 530.66 JAMES J.HORAN 6 ALBERT STREET SHOREHAM,NY 11786 CK.#7087 052-74-1323 4 PAYLOADER 5 8 R 33.67 269.36 20.61 0 1.95 0.6 23.16 246.2 JUAN C.COLLAZOS BACKHOE 0.5 5 5.5 36.19 199.05 P.O.BOX 2796 LABORER O 2 3 6 1 12 25.23 3112.76 SOUTHAMPTON,NY 11969 ASV 2 8 Ill 32.4 324.00 CK.#7056 R4-64-3X78 4 PAYLOADER S 7 7 33.67 335.69 81.20 93.89 49.96 0.60 225.651 835.85 AWN A.CAVANAUGH 116 SHINNECOCK AVENUE 0 MASTIC.NY 11950 CK.#7058 086-60-0908 1 DRIVER S 2 8 10 29.41 294.10 22.49 17.59 5.63 30.01 75.72 218.38 CRAIG T.OUDEANS 7 WEST SIDE AVENUE 0 EAST QUOGUE,NY 11943 CK.#7073 131-68-1974 1 DRIVER S 8 8 16 29.41 470.56 35.99 31.64 14.17 0.60 82.40 388.16 CHRISTOPHER ZITO 93 REVILO AVENUE 0 SHIRLEY,NY 11967 CK.#7080 10&642931 0 DOZER S 8 8 8 8 8 40 36.19 1447.60 110.74 239.901 81.68 0.601 432.92 1014.68 O S s r THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date Q J (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanio listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rete plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (1)That I pay or supervise the payment of the parsons employed by -ALL- ' 1�� /J�^ bt �✓�-��17-�B—v� ., ( �{�' (c)EXCEPTIONS (Contractor or Sub tractor) h l that during the payroll period commencing on the �V day of ,203 and ending thee,day of 20 d 3 all persons employed an said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION / from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined in Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE '/In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE AfQVEATA1eEMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8AN09. CONTRACTOR'S PAIROLL STATEMENT NAMEOFCONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING B MATERIALS,INC. ")W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL rc FOR WEEK ENDING PROJECT AND LOCATION 1 )0 MAR.M.2003 SOUTHOLD LANDFILL CLOSURE (11 12) (3) 14)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER WHOLDING CLASSIFICATION OR '_111 211 2'12 213 214213 '_I6 HRS. OFPAI' AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK SHAWN J.OUDEANS P.O.BOX 305 O EAST QUOGUE,NY 11942 CKA 7075 075-74-3407 1 DRIVER S 8 1116 29.41 470.56 35.99 48.47 14.73 0.60 99.79 370.77 MILCAR GARCIA W.MAIN STREET O RIVERHEAD,NY 11901 CKA 7065 013-68-9451 4 LABORER S 8 1 9 25.23 2-17.07 17.37 0.00 0.64 0.60 18.61 208.46 ROBERT TERRY SR. 57 FOSTER AVENUE 0 HAMPTON BAYS NY 11946 CKA 7078 07128-9247 4 EXCAVATOR S 8 8 36.19 289.52 22.15 0 2.75 0.61 25.50 264.02 rrO 5 S O S O S O 5 O S O S 0 s F THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR 3 �46 Date (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) +x (Title) ❑ -Each laborer,worker,or mechenlo listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That i pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. -ALL 7 l�✓� �1�- �✓�.�r C/J ��' (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the " day of / ,20 o and ending the—ZL day ofQ_4�0 Q 3 all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;firat the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE _A/In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as tilted in the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). To Crvu.OR CRIMINAL PROSECUTION.SEE ARTICLES a AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] ORSUBCONTRACTOR( ] ADDRESS TEP-R4 CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 91 MAR.23,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 3/17 3/IS 3/19 3/20 321 3/22 3/23 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK SHAWN J.OUDEANS O.BOX 305 DRIVER O 8 8 8 8 32 29.41 941.12 EAST QUOGUE,NY 11942 LABORER 6.5 6.5 25.23 164.00 CK.#7107 075-74-5407 1 ROLLER S 1.5 1.5 32.40 48.60 88.26 212.89 60.89 0.60 362.64 791.08 MICHAEL N.JONES P.O.BOX 191 O EAST QUOGUE,NY 11942 EXCAVATOR 3 8 8 19 36.19 687.61 CK.#7102 090-68-2853 0 LABORER S 1.5 1.5 36.19 54.29 56.761 117.53 34.001 0.60 208.89 533.01 JAY A.POREMBA 49 PELLETREAU STREET O SOUTHAMPTON,NY 11968 EXCAVATOR 8 8 36.19 289.52 CK.#7108 070-664-2225 5 PAYLOADER S 8 8 33.67 269.36 42.75 53.691 20.8 0.601 117.84 441.04 ANIBAL A.DIAZ 1069 WEST MAIN STREET O RIVERHEAD,NY 11901 CK.#7094 126-88-2636 1 LABORER S 8 8 8 8 8 40 25.23 1009.20 77.20 173.87 50.99 0.60 302.66 706.54 IWMES J.HORAN ALBERT STREET PAYLOADER O 1.5 8 8 17.5 33.67 589.23 SHOREHAM,NY 11786 LABORER 1.5 1.5 25.23 37.85 CK.#7100 052-74-1323 4 EXCAVATOR S 1.5 1.5 36.19 54.29 52.12 36.871 23.92 0.601 113.51 567.86 JUAN C.COLLAZOS P.O.BOX 2786 O SOUTHAMPTON,NY 11969 ASV 7.5 8 3 8 8 34.5 32.4 1117.80 CK.#7091 084-64-3878 4 PAYLOADER S 5 5 33.67 168.35 98.391 132.96 65.351 0.60 297.30 988.85 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7098 011-69-8573 4 LABORER S 8 8 16 25.23 403.68 30.88 12.04 7.90 0.60 51.42 352.26 SEAN TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NY 11946 CK.#7111 050-76-6251 1 DRIVER S 8 8 29.41 235.28 18.00 13.18 3.28 0.60 35.06 200.22 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR 4 Date 3 � as�o � (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits _H)That I pay or supervise the payment of the persons employed.by as listed In the contract,except as noted In Section 4(c)below. l�4--t�--- - -"d IV- /I✓�.��"CSS-�-�.�—C1.� �,( p '��t,� (c)EXCEPTIONS (Contractor or Sub tractor) that during the payroll period commencing on the day of ,2003,and ending the day of. 20 4.3 all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will b/e�.made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION r ► from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete,Dial the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract,that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period era duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE ' ;In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed In the above referenced payroll, an of fringe benefits as listed zL� contract have been or will be madede to apppropriate programs for the In the THE WILLFUL FALSIFICATION OF ANY Of THE EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR to the benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMNAi.PROsmuriou 8156 ARTICLES 8 AND e. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,NY.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 91 March 23,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 2/17 Z/I8 2/19 2/20 2/21 2/22 2/23 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO •3 REVILO AVENUE DOZER O 7 1.5 8 1 7 24.5 36.19 886.66 SHIRLEY,NY 11967 PAYLOADER 1 7 8 36.19 289.52 CK.#7113 108-64-2931 0 EXCAVATOR S 6.5 1 7.5 36.19 271.43 110.74 239.90 81.68 0.60 432.92 1014.69 AMILCAR GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7097 01368-9451 4 LABORER S 8 8 8 8 8 40 25.231 1009.20 77.201 126.36 47.04 0.60 251.20 758.00 O S O S • S O S O S O S O THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR a 3 'as=0 3 Date 1 ✓(`J�` }1 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH UV !(Name of/signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (t)That I pay or supervise the payment of the persons employed by �u ' 1�� - /�✓<�l's2�l-C %�.�L7 (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on the ,7 day of ,20esand ending the A3 day of ��- 206-3 all persons employed on sold proJect have been pald the full weekly wages eamed,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION I C// I from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;flint the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;flint the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period era duly registered in a bona flde REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE _A/In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract haus been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE EMENTB MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 6 AND 9. t CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR( I OR SUBCONTRACTOR[ I ADDRESS y TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 92 MAR.30,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W!HOLDING CLASSIFICATION OR 3/24 3/25 3/26 3/27 3/28 3/29 3/30 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX -DEDUCTIONS FOR WEEK SHAWN J.OUDEANS &0.BOX 305 LABORER O/T O 2.5 2.5 37.85 94.63 EAST QUOGUE,NY 11942 LABORER 4.5 8 8 8 28.5 25.23 719.06 CK.#7144 075-74-5407 1 DRIVER S 8 8 29.41 235.28 80.25 184.61 53.71 0.60 319.17 729.80 MICHAEL N.JONES P.O.BOX 191 EXCAVATOR O 8 1 8 17 36.19 615.23 EAST QUOGUE,NY 11942 DOZER 7 4 4 15 36.19 542.85 CK.#7138 090-68-2853 0 PAYLOADER S 4 4 8 36.191 289.52 110.74 313.471 82.341 0.60 507.15 940.45 JAY A.POREM13A 49 PELLETREAU STREET O SOUTHAMPTON,NY 11968 CK.#7145 070-64-2225 5 PAYLOADER S 8 8 33.67 269.36 20.61 14.53 5.02 0.601 40.76 228.6 ANIBAL A.DIAZ 1069 WEST MAIN STREET O RIVERHEAD,NY 11901 CK.#7132 126-88-2636 1 LABORER S 8 8 8 8 8 40 25.23 1009.20 77.20 173.87 50.99 0.60 302.66 706.54 & MES J.HOP 6 ALBERT STREET O SHOREHAM,NY 11786 CK.#7137 052-74-1323 4 PAYLOADER S 8 8 8 8 8 40 33.67 1346.80 103.03 149.34 69.51 0.60 322.48 1024.32 JUAN C.COLLAZOS P.O.BOX 2786 O SOUTHAMPTON,NY 11969 ASV 8 7.5 8 8 8 39.5 32.4 1279.80 CK.#7129 084-64-3878 4 DRIVER S 0.5 0.5 29.41 14.71 99.03 135.22 65.92 0.60 300.77 993.74 JAVIER GARCIA CK.#7153 1069 W.MAIN STREET O RIVERHEAD,NY 11901 011-69-8573 4 LABORER S 5.5 8 13.5 25.23 340.61 26.06 5.50 5.18 0.60 37.34 303.27 CRAIG T.OUDEANS 7 WEST SIDE AVENUE 0 EAST QUOGUE,NY 11942 DRIVER 8 8 29.41 235.28 CK.#7143 131-68-1974 1 LABORER S 8 8 B 1 32 25.23 807.36 79.76 117.451 52.62 0.60 250.43 792.21 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR r Date � I � ✓ (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ .Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: apald,as Indicated on the payroll,an amount not less than the sum of the pplicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. �- /I�'��•�c.�� ,( p., ' (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period commencing on th f day of�;20 d Sand ending the 3 d day of_�_ 20 Q 3 all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION from the full Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 6 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;gist the wage rates for laborers,workers,or mechanics contained therein are not leas than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the baslc hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY 01 THE AfQYE.0TAEMENT8 MAY SUBJECT THE CONTRACTOR DR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. It CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ) ORSUBCONTRACTOR[ I ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 92 MAR.30,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU LIFRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 3/24 3/25 3/26 3/2728 3i29 3/30 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO �3 REVILO AVENUE O SHIRLEY,NY 11967 DOZER 8 4 12 36.19 434.28 CK.#7150 108-64-2931 0 EXCAVATOR IS 8 8 8 4 28 36.19 1013.321 110.74 239.90 81.68 0.60 432.92 1014.68 AMILCAR GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 LABORER O/T 2.5 2.5 37.85 94.63 CK.#7136 013-68-9451 4 LABORER S 8 8 8 8 8 40 25.23 1009.20 84.45 151.91 53.521 0.60 290.48 813.35 O S O S S O S O S O S O THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR ' Data � ' 'i (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ .Each laborer,worker,or mechanic listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by !J,, as listed In the contract,except as noted In Section 4(c)below. �.L ' 1�. " ��C � D' /I✓�. �'�S��L e��C/1 �( p .f L� (c)EXCEPTIONS (Contractor or Sub tractor) (� ,that during the payroll period commencing on the day of)ik�,20 3 Sand ending the 36 day of 206 3 all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION / r from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submltted for Iiia above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered in a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency axlsts In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a,))WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE — In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed 60!!�fr In the above referenced payroll,payments of fringe benefits as listed In the contract haus been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE AQESTA11EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 0ANO9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR I I OR SUBCONTRACTOR( I ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 93 April 6,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 3/31 4/1 4/2 4/3 4/4 4/5 4/6 HRS. 3 AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK SHAWN J.OUDEANS 100.BOX 305 O EAST QUOGUE,NY 11942 LABORER Orr 0.5 1.5 2 37.85 75.70 CK.#7192 075-74-5407 1 LABORER S 8 8 8 8 8 40 25.23 1009.20 82.99 194.31 56.18 0.60 334.08 750.82 ELVIN Y.BANEGAS 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK#7165 129-66-5523 5 LABORER S 7 7.5 14.5 25.23 365.84 27.981 0.00 5.041 0.60 33.62 332.22 JAY A.POREMBA PAYLOADER 8 6 8 8 30 33.67 1010.10 49 PELLETREAU STREET DRIVER O 2 2 29.41 58.82 SOUTHAMPTON,NY 11968 EXCAVATOR 1 I 36.19 36.19 CK.#7193 070-64-2225 5 LABORER S 2 2 25.23 50.46 88.41 161.05 61.68 0.60 311.74 843.83 ANIBAL A.DIAZ 1069 WEST MAIN STREET O RIVERHEAD,NY 11901 CK.#7173 126-88-2636 1 LABORER S 7.5 7.5 15 25.23 378.45 28.95 34.65 9.46 0.60 73.66 304.79 MES J.HORAN 06 ALBERT STREET O SHOREHAM,NY 11786 CK.#7184 052-74-1323 4 PAYLOADER S 8 8 8 8 8 40 33.67 1346.80 103.03 149.34 69.51 0.60 322.48 1024.32 JUAN C.COLLAZOS P.O.BOX 2786 O SOUTHAMPTON,NY 11969 ASV 6.5 6.5 32.4 210.60 CK.#7169 084-64-3878 4 IDOZER S I 1 1 1 33.67 33.67 18.68 0.00 0.94 0.60 20.22 224.05 JAVIER GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7183 011-69-8573 4 LABORER IS 8 7.5 15.5 25.23 391.07 29.92 10.55 7.33 0.60 48.40 342.67 CRAIG T.OUDEANS 7 WEST SIDE AVENUE LABORERO/T 0 2.5 1.5 4 37.85 151.40 EAST QUOGUE,NY 11942 LABORER 8 2.5 8 8 8 34.5 25.23 870.44 CK.#7191 131-68-1974 1 DRIVER S 5.5 5.5 29.41 161.76 90.541 152.781 62.281 0.601 306.20 877.40 C THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date 73 i t (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rata plus the amount of the required fringe benefits (1)That I pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. l(�� - ~L i �- /i �1�C/1 ,( p• ( �t (c)EXCEPTIONS (Contractor or Sub tractor) ,that during the payroll period comma cIng day ofAM ,2W/�3and ending the 6 day of 20 4 3 all persons employed on said project have been paid the full weekly es earned,that no rebates have been or will� be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION CH! from the full leontractor or subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract,that The classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE " In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits asth contract have been or will be made to appropriate programs for the ed In the THE WILLFUL FALSIFICATION OF ANY Or THE AfQYESWEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). To CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ I ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 92 April 6,2003 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 3/31 4/I 4/2 4/3 4/4 4/5 4/6 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK CHRISTOPHER ZITO *3 REVILO AVENUE O SHIRLEY,NY 11967 DOZER 8 8 8 1.5 25.5 36.19 922.85 CK.#7200 108-04-2931 0 PAYLOADER S 8 8 36.19 289.52 92.75 176.39 65.57 0.60 335.31 877.06 AMILCAR GARCIA 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#7181 013-08-9451 4 LABORER S 7.5 7.5 15 25.23 378.45 28.95 9.29 6.76 0.60 45.60 332.85 ANDREW M.FLEMING 11 BEATRICE STREET 0 SHIRLEY,NY 11967 DRIVER 4 7.5 11.5 29.41 338.22 CK.#7178 069-68-1419 3 LABORER S 0.5 0.5 25.23 12.62 26.84 5.08 5.98 0.60 38.50 312.34 JAMES L.NICHOL 430 AMITY STREET O WOODBRIDGE CT.06525 CK.#7190 042-78-0638 2 PAYLOADER S 8 8 33.67 269.36 20.61 2.8 0.29 23.70 245.66 �OBERT TERRY 7 FOSTER AVENUE S HAMPTON BAYS,NY 11946 CK.#7197 071-28-9247 4 EXCAVATOR O 8 8 8 24 36.19 868.56 66.44 64.95 36.75 0.60 168.74 699.82 SEAN TERRY 57 FOSTER AVENUE S HAMPTON BAYS.NY 11946 CK.#7198 050-76-6251 1 DRIVER 0 4 8 8 20 29.41 588.20 45.00 66.11 22.15 0.60 133.86 454.34 S O S O THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR r Date — ' (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) p -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: aid,as Indicated on the payroll,an amount not less then the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (t)That 1 pay or supervise the payment of the persons employed by / as listed In the contract,except as noted In Section 4(c)below. p (c)EXCEPTIONS (Contractor or Sub tractor) that during the payroll Perlod commencing on the day of l� ,206?and ending the T day of 20 �j all parsons employed on said project have been paid the full weekly ges earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION CH from the full (contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work helshe performed. (3)That any apprentices employed In the above period era duly registered In a bona flda REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE --d In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the th contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE EMENT8 MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 0 AND 9. 1 • ' CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR( ] OR SUBCONTRACTOR( ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 51 June 2,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/27 5/28 5/29 5/30 5/37 6/1 6/2 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 ST QUOGUE,NY 11942 HOLIDAY 8 8 34.54 276.32 CK.#5033 2853 0 DOZER S 8 8 8 8 32 34.54 1105.28 105.69 295.34 77.82 0.60 479.45 902.15 J.OUDEANS P.O.BOX 305 0 EAST QUOGUE,NY 11942 CK.#5035 07574.5407 1 LABORER S 4 S. 12 24.53 294.36 22.52 22.18 5.64 0.60 50.94 243.42 JAY A.POREMBA 49 PELLETREAU STREET HOLIDAY 0 8 8 32.12 256.96 SOUTHAMPTON,NY11968 EXCAVATOR 8 8 34.54 276.32 ICK.#5051 070.642225 5 DOZER is 8 8 16 32.12 513.92 80.11 123.12 48.32 0.60 252.15 795.05 CHRISTOPHER ZITO 93 REVILO AVENUE HOLIDAY 0 8 8 34.54 276.32 SHIRLEY,NY 11967 DOZER 5 5 32.12 160.60 CK.#5045 10864-2931 0 EXCAVATOR S 3 8 8 8 27 34.54 932.581 104.77 220.661 76.33 0.60 402.36 967.14 MARCO BANEGAS 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#50201 0178.9063 5 ILABORER S 6.5 6.5 24.53 159.45 12.20 0.00 0.00 0.60 12.80 146.65 HOLIDAY 8 8 32-12 256.96 D.LUNDGREN PAYLOADER 1 1 2 32.12 64.24 ,KORY LANE EXCAVATOR 0 5 81 13 34.54 449.02 HIGGANUM,CT.06441 LABORER 3.5 3.5 24.53 85.86 CK.#5034 042.605004 0 DRIVER S 3.51 8 11.5 29.41 338.22 91.37 240.72 64.99 0.60 397.68 796.62 JASON E.HAND P.O.BOX 393 HOLIDAY 0 8 8 29.411 235.28 HAMPTON BAYS,NY 11946 DRIVER 3 6 6 15 29.41 441.15 CK*5032 118.645404 5 LABORER S 4 2 1 7 24.53 171.71 64.88 70.63 34.691 0.601 170.80 677.34 ANDREW M.FLEMING 11 BEATRICE STREET HOLIDAY 0 8 8 29.41 235.28 SHIRLEY,NY 11967 DRIVER 1.5 1 7 6 14.5 29.41 426.45 CK.#5030 06968.1419 3 LABORER S 1 1 24.53 24.53 52.50 46.83 25.58 0.60 125.51 560.75 CARLOS ARTEAGA 1069 WEST MAIN STREET O RIVERHEAD,NY 11901 CK.#5017 098.674532 4 LABORER S 6.5 4 8 18.5 24.53 453.81 34.72 9.90 9.88 0.60 55.10 398.71 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NY 11946 CK.#5043 1 34.54 552.64 42.27 19.78 15.61 0.6 78.26 474.38 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Data (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) p -Each laborer,worker,or mechanic listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits � 1)That I pay or su�eryise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. �C (c)EXCEPTIONS (Contractor or Subco tor) ,that during the payroll period commencing on the —7 e( day of ,20W,and ending the day of„ Q_ 20(1L all persons empl-yWon said project have been pa a full weekly wages earned,that no rebates have been or will bemade either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION /Z21 from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles S and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE �qlIn addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed ln the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE MENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT r ' r NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 50 May 26,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI ISATA]SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/20 5/21 5/22 5/23 5/24 5/25 5/26 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOGUE,NY 11942 EXCAVATOR 8 8 3 19 34.54 656.26 CK.#4989 090-682853 0 DOZER S 8 8 5 21 34.54 725.34 105.69 295.34 77.82 0.60 479.45 902.15 WN J.OUDEANS BOX 305 0 EAST QUOGUE,NY 11942 LABORER 3 3 24.53 73.59 CK.#4993 075745407 1 DRIVER S 3 3 29.41 88.23 12.381 5.32 0.34 0.60 18.64 143.18 JAY A.POREMBA 49 PELLETREAU STREET EXCAVATOR 0 1 1 34.54 34.54 SOUTHAMPTON,NY11968 DRIVER 4 4 29.41 117.64 CK.#5000 070642225 5 DOZER is 3 3 32.12 96.36 19.01 0 0.73 0.60 20.34 228.20 CHRISTOPHER ZITO 93 REVILO AVENUE 0 SHIRLEY,NY 11967 CK.#5004 108.642931 0 DOZER S 8 8 8 8 8 40 32.12 1284.80 98.29 197.79 70.53 0.60 367.21 917.59 MARCO BANEGAS 1069 W.MAIN STREET 0 RIVERHEAD,NY 11901 jCK.#4976 011.789063 5 LABORER S 6 8 14 24.53 343.42 26.27 0.00 4.14 0.60 31.01 312.41 KEITH D.LUNDGREN 40 HICKORY LANE DRIVER 0 6 6 29.41 176.46 ANUM,CT.06441 EXCAVATOR 8 8 5 21 34.54 725.34 CK.#4990 0605004 0 LABORER S 3 3 24.53 73.59 74.611 181.61 49.99 0.60 306.81 668.58 JASON E.HAND P.O.BOX 393 0 HAMPTON BAYS,NY 11946 CK.#4988 118645404 5 DRIVERS 8 8 8 24 29.41 705.84 53.99 49.291 24.94 0.60 128.82 577.02 ANDREW M.FLEMING - 11 BEATRICE STREET 0 SHIRLEY,NY 11967 CK.#4986 069.68.1419 3 DRIVER S 81 7 81 81 8 39 29.41 1146.99 87.74 115.94 57.14 0.60 261.42 885.57 0 S 0 5 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date /,-> (0r)-? (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (TIGa) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits a (1)That I pay or supervise the payment of the persons employed by s listed In the contract,except as noted In Section 4(c)below. (Contractor or S ontractor) (c)EXCEPTIONS � that during the payroll period commencing on the_Q u day of 20CLand ending the day of� re 20()Z all persons em ed on,said project have been paid the full weekly wages d,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION C from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined in Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE '=In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed In the above referenced payroll,payments of fringe benefits as listed In the contractct have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY 01 THE ACQZATAlIMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8AND 9. CONTRACTOR'S PAYROLL STATEMENT i MAVE OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 49 MAY 19,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/13 5/14 5/15 5/16 5/17 5/18 5/19 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES EXCAVATOR 8 4 8 3.5 5 28.5 34.54 984.39 P.O.BOX 191 DOZER 0/T 0 0.5 0.5 69.08 34.54 EAST QUOGUE,NY 11942 DOZER 4.5 3 7.5 34.54 259.05 CK.#4937 00-682853 0 PAYLOADER S 4 4 34.54 138.16 108.33 305.71 80.18 0.60 494.82 921.32 N J.OUDEANS OX 305 0 EAST QUOGUE,NY 11942 LABORER 5.5 6 8 5 2.5 27 24.53 662.31 CK.#4958 075.74.5407 1 DRIVER S 31 1 3 29.41 88.23 57.41 105331 33.271 0.60 196.61 553.93 JAY A.POREMBA 49 PELLETREAU STREET 0 SOUTHAMPTON,NY11968 PAYLOADER 1 8 9 32.12 289.08 CK.#4941 070642225 5 LABORER S 7 7 24.53 171.71 35.25 12.53 9.75 0.601 58.13 402.66 CHRISTOPHER ZITO 93 REVILO AVENUE DOZER O/T O 21 1 1 2 64.24 128.48 SHIRLEY,NY 11967 DOZER 8 8 3 19 32.12 610.28 CK.#4942 108642931 0 EXCAVATOR S 8 5 8 21 34.54 725.34 112.00 246.20 82.81 0.60 441.61 1022.49 MARCO BANEGAS 1069 W.MAIN STREET O RIVERHEAD,NY 11901 CK.#4956 011 789063 5 LABORER S 61 8 1 2.51.. 16.5 24.53 404.75 30.96 0.00 6.65 0.60 38.21 366.54 SEAN TERRY 'SSDFOSTER AVENUE 0 TON BAYS,NY 11946 CK.#4944 766251 1 DRIVER S 2.5 2.5 29.41 73.53 5.63 0.00 0.001 0.37 6.00 67.53 CARLOS ARTEAGA 1069 W.MAIN STREET 0 RIVERHEAD,NY 11901 CK.#4961 098.67.4532 4 LABORER S 5.5 8 13.5 24.53 331.16 25.33 0.00 4.42 0.60 30.35 300.81 0 S 0 S 0 s M C THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Data O (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (TRIO) ❑ -Each laborer,worker,or mechanic listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits a t)That 1 pay or supervise the payment of the persons employed by s listed In the contract,except as noted in Section 4(c)below. �,c.r.� rm (c)EXCEPTIONS (Contractor or bcontractor) f' - `� vl- Cr that during the payroll period commencing on the 13 day of 20L)?_and ending the—IL day of 20C)?- all persons emplo on said project have been paid the full weekly wa�that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION 7- ` from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: • (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE MENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL.OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NA OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL# FOR WEEK ENDING PROJECT AND LOCATION 48 May 12,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS FHD WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 5/6 5/7 5/8 5/9 5/10 5/11 5/12 HRS. OF PAY AMOUNT FICAING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOGUE,NY 11942 DOZER 8 8 8 24 34.54 828.96 CK.#4915 090.68.2853 0 EXCAVATOR S 8 8 16 34.54 552.64 105.69 295.34 77.82 0.60 479.45 902.15 0BN J.OUDEANS CK.#4965 . OX 305 CORRECTION LABORER 0 5 5 24.53 122.65 9.38 1.40 0.00 0.60 11.381 111.27 EAST QUOGUE,NY 11942 CK.#4919 075 745407 1 LABORER S 3 3 24.53 73.59 5.63 0.00 0.001 0.37 6.00 67.59 JAY A.POREMBA 49 PELLETREAU STREET EXCAVATOR 0 8 8 16 34.54 552.64 SOUTHAMPTON,NY11968 LABORER 8 7 15 24.53 367.95 CK 34914 070-642225 5 PAYLOADER S 1 1 32.12 32.12 72.88 97.61 41.85 0.60 212.94 739.77 CHRISTOPHER ZITO - 93 REVILO AVENUE 0 SHIRLEY,NY 11967 CK.#4917 108642931 0 EXCAVATOR is B 8 8 8 6 40 34.54 1381.60 10569 223.93 77.16 0.60 407.38 974.22 MARCO BANEGAS CK.#4963 1069 W.MAIN STREET CORRECTION LABORER 0 5 5 24.53 122.65 9.381 0 0 0.61 9.98 112.67 RIVERHEAD,NY 11901 CK.#4921 01178-9063 5 LABORER S 3.. 3 24.53 73.59 5.63 0.00 0.00 0.37 6.00 67.59 JASON E.HAND P.O.BOX 393 0 TON BAYS,NEW YORK 11946 DRIVER 8 8 16 29.41 470.56 CK.#4916 45404 5 LABORER S 81 81 1 16 24.53 392.48 66.021 73.40 35.71 0.60 175.73 687.31 0 0 S 0 0 S 0 is 0 Is THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR DateIr 1 7 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ .Each laborer,worker,or mechanic listed to the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (1)That 1 pay or su ervise the payment of the parsons employed by nAA:�4 Z-4 IT, (c)EXCEPTIONS (Contractor or Su tractor) ,that during the payroll period commencing on the day of ,200L and ending theday of 2017L all persons empoyAd on said project have been paid fhe full weekly wages fWrned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION :C-2�1 from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other then permissible deductions as defined In Articles B and 9 and described below: • (2)That any payrolls submitted for the above period are correct and complete:that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated Into the contract,that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the th contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEACm QT "ENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. t � CONTRACTORS PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CSNTRACTING&MATERIALS.INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 47 May 5,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/29 4/30 5/1 5/2 5/3 5/4 5/5 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOGUE,NY 11942 DOZER 8 8 8 8 32 34.54 1105.28 CK.*4868 2853 0 EXCAVATOR S 8 8 34.54 276.32 105.69 295.34 77.82 0.60 479.45 902.15 T TERRY 57 FOSTER AVENUE HAMPTON BAYS,NY 11946 CK.•4874 071.28.9247 4 EXCAVATOR S 8 8 16 34.54 552.64 42.27 19.78 15.61 0.60 78.26 474.38 JAY A.POREMBA EXCAVATOR 7 7 7 8 29 34.54 1001.66 49 PELLETREAU STREET PAYLOADER 0 1 1 1 3 32.12 96.36 SOUTHAMPTON,NY11968 DOZER 1 1 32.12 32.12 CK.•4869 070.64.2225 5 LABORER IS 7 7 24.53 171.71 99.59 191.87 65.77 0.601 357.83 944.02 CHRISTOPHER ZIT0 93 REVILO AVENUE 0 SHIRLEY,NY 11967 CK.*4876 108.64.2931 2 DOZER S 8 8 16 32.12 513.92 39.311 46.94 17.861 0.60 104.71 409.21 JUAN C.COLLAZOS P.O.BOX 2786 O SOUTHAMPTON,NY 11969 PAYLOADER 6 6 32.12 192.72 CK.*4872 084643878 4 DRIVER S 2 2 29.41 58.82 19.25 0.00 1.23 0.60 21.08 230.46 JASON E.HAND P.O.BOX 393 LABORER 0 3 3 24.53 73.59 ON BAYS.NEW YORK 11946 DRIVER 8 8 16 29.41 470.56 CK.•4871 5404 2 ROLLER S 3.5 3.5 30.9 108.15 49.90 41.26 21.27 0.60 113.03 539.27 THOMAS E.SYPHER,JR. 49845 NORTH ROAD 0 SOUTHOLD,NY 11971 DOZER 8 8 16 32.12 513.92 CK.•4870 104.66.5306 5 EXCAVATOR S 8 8 a 24 34.54 828.96 102.731 182.32 71.87 0.60 357.52 985.36 0 S O S 0 15 THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) p -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby stets: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits r (1)That I pay or supervise the payment of the persons employed by \ as listed in the contract,except as noted in Section 4(c)below. C� J (c)EXCEPTIONS • (Contractor or Su ontractor) ,that during the payroll period commencing on th day of� 20 ,and ending the day of 20 all person employed on said project have been paid the full weekly wages sehied,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the bask hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of TH SMAENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. . s CONTRACTORS PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 46 April 28,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/22 4/23 4/24 4/25 4/26 4/27 4/28 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOG U E,NY 11942 CK.•4848 82853 0 DOZER S 8 8 8 8 8 40 34.54 1381.60 105.69 295.34 77.82 0.60 479.45 902.15 TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NY 11946 CK.s 4853 050.76.6251 1 DRIVER S 8 8 29.41 235.28 18.00 13.32 3.281 0.601 35.20 200.08 JAYA.POREM BA 49 PELLETREAU STREET PAYLOADER 0 8 5 13 32.12 417.56 SOUTHAMPTON,NY11968 DRIVER 3 8 11 29.41 323.51 CK.•4849 070.64.2225 5 EXCAVATOR S 8 8 16 34.54 552.64 98.97 189.68 65.21 0.60 354.461 939.25 CHRISTOPHER ZITO 93 REVI LO AVENUE 0 SHIRLEY.NY 11967 EXCAVATOR 8 8 16 34.54 552.64 CK.•4845 108.64.2931 2 DOZER S 8 8 32.12 256.96 61.941 91.30 37.98 0.60 191.82 617.78 JUAN C.COLLAZOS P.O.BOX 2786 LABORER 0 2 1 2 24.53 49.06 SOUTHAMPTON,NY 11969 PAYLOADER 3 1.5 4.5 32.12 144.54 CK.R 4834 084.64.3878 4 DRIVER S 3 6.5 .. 9.5 29.41 279.40 36.19 11.82 10.91 0.60 59.52 413.48 JASON E.HAND P.O.BOX 393 0 ON BAYS,NEW YORK 11946 DRIVER 8 8 16 29.41 470.56 CK.•4852 5404 2 LABORER S 8 8 24.53 196.24 51.01 43.43 22.27 0.60 117.31 549.49 THOMAS E.SYPHER,JR. 49845 NORTH ROAD EXCAVATOR O 8 8 34.54 276.32 SOUTHOLD,NY 11971 DOZER 8 8 8 6 30 32.12 963.60 CK.•4850 104.66.5306 5 PAYLOADER S 2 2 32.12 64.24 99.77 171.86 69.22 0.60 341.45 962.71 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NY 11946 CK.•4842 071.28.9247 4 EXCAVATOR S 81 8 16 34.541 552.64 42.27 19.78 15.61 0.60 78.26 474.38 0 S 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) p -Each laborer,worker,or mechanic listed in the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In Section 4(c)below. (1)That I pay or supervise the payment of the persor�errlployed by n �At- / 9, / $ uti (c)EXCEPTIONS • (Contractor or Subc tractor) that during the payroll period commencing on the day of ,2002,and ending the day of_ C- 20 Q'Z all persons employed on said project have been paid the full weekly ea eamed,that no rebates have been or will be made either directly or indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION 1` 1 from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles B and 9 and described below: • (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duty registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the bask hourly wage rates paid to each laborer,worker or mechanic listed y r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY 01 THE AkWEAWfIMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES a AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ j ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 45 April 21,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND NO.OF WORK O.T. MON TUE WED THU FRI SATSUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/15 4/16 4/17 4/18 4/19 4/20 4/21 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOGUE,NY 11942 DOZER 8 7 7 8 8 38 32.12 1220.56 CK.•4814 8-2853 0 EXCAVATOR S 1 1 2 34.54 69.08 98.66 267.76 71.52 0.60 438.54 851.10 qw TERRY 57 FOSTER AVENUE O HAMPTON BAYS,NY 11946 CK.•4790 05076-6251 1 DRIVER S 8 8 8 8 32 29.41 941.12 72.00 156.79 46.33 0.60 275.72 665.40 JAY A.POREMBA 49 PELLETREAU STREET PAYLOADER 0 8 8 5 3 2 26 32.12 835.12 SOUTHAMPTON,NY11968 ROLLER 3 3 30.90 92.70 CK.•4787 070.64.2225 5 EXCAVATOR 5 51 6 11 34.54 379.94 100.041 193.47 66.171 0.60 360.281 947.48 CHRISTOPHER ZITO 93 REVILO AVENUE 0 SHIRLEY,NY 11967 EXCAVATOR 8 8 34.54 276.32 CK.r 4791 108.642931 2 DOZER S 8 8 8 al 32 32.12 1027.84 99.77 203.02 71.85 0.60 375.24 928.92 JUAN C.COLLAZOS P.O.BOX 2786 0 SOUTHAMPTON,NY 11969 C K.e 4785 084-643878 4 PAYLOADER S 8 8 32.12 256.96 19.66 0.00 1.45 0.60 21.71 235.25 JASON E.HAND P.O.BOX 393 O PTON BAYS,NEW YORK 11946 CK.#4789 5404 2 DRIVER S 8 8 al 8 32 29.41 941.12 72.001 94.48 41.06 0.60 208.14 732.98 THOMAS E.SYPHER,JR. 49845 NORTH ROAD O SOUTHOLD,NY 11971 EXCAVATOR 8 8 8 8 32 34.54 1105.28 CK.k 4788 104.66.5306 5 DRIVER S 8 8 29.41 235.28 102.55 181.69 71.71 0.60 356.55 984.01 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NY 11946 CK.•4793 071.28.9247 4 EXCAVATOR S 8 8 34.541 276.32 21.141 0.00 2.231 0.60 23.97 252.35 0 S 0.00 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date 1 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed in the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits _ (t)That I pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. ✓) (c)EXCEPTIONS (Contractor o bcontractor) that during the payroll period commencing on the O day of rA PC% 20 M and ending theL_day of 20 all persons lamployed on said project have been paid the full weekly ges eared,that no rebates have been or will be made /either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE � -In addition to the bask hourly wage rates paid to each laborer,worker or mechanic listed In the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE Ar6EMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT r NAME OF CONTRACTOR[ I OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 44 April 14,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND N0.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/8 4/9 4/10 4/11 4/12 4/13 4/14 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOG U E,N Y 11942 CK*4752 -2853 0 DOZER s 8 8 8 8 8 40 32.12 1284.80 98.29 266.30 71.19 0.60 436.38 848.42 W M.FLEMING 11 BEATRICE STREET O SHIRLEY,NY 11967 ERROR CORR 4/1/02 1 1 29.41 29.41 CK.*4757 069.68.1419 3 DRIVER S 8 8 16 29.41 470.56 38.25 20.29 13.63 0.60 72.77 427.20 JAY A.POREMBA 49 PELLETREAU STREET 0 SOUTHAMPTON,NY11968 CK.R 4754 070-64-2225 5 PAYLOADER S 8 8 81 8 al 40 32.12 1284.80 98.29 187.27 64.60 0.60 350.761 934.04 CHRISTOPHER ZITO 93 REVI LO AVENUE 0 SHIRLEY,NY 11967 EXCAVATOR 8 8 16 34.54 552.64 CK.M 4759 108-642931 2 DOZER S 8 8 2 18 32.12 578.16 86.51 156.21 59.98 0.60 303.30 827.50 JUAN C.COLLAZOS P.O.BOX 2786 0 SOUTHAMPTON,NY 11969 CK.*4753 084643878 4 PAYLOADER S 8 8 8 8 8.. 40 32.12 1284.801 98.29 135.48 65.26 0.60 299.63 985.17 JASON E.HAND P.O.BOX 393 DRIVER 0 3.5 8 8 19.5 29.41 573.50 VTON BAYS,NEW YORK 11946 LABORER 1.5 1.5 24.53 36.80 CK.•4756 -5404 2 ROLLER S 3 8 8 19 30.9 587.10 91.60 163.67 58.61 0.60 314.48 882.92 THOMAS E.SYPHER,JR. 49845 NORTH ROAD 0 SOUTHOLD,NY 11971 CK.*4755 104.665306 5 EXCAVATOR S 8 8 8 8 8 40 34.54 1381.60 105.69 192.77 74.52 0.60 373.58 1008.02 0 S 0 S 0.00 0 s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date i^ Z (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) / (Title) p -Each laborer,worker,or mechanic listed In the above-referenced payroll has been do hereby state: paid,as Indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits (1)That 1 pay or supervise the payment of the persons employed by as listed In the contract,except as noted In Section 4(c)below. (c)EXCEPTIONS (Contractor or Su ntractor) ,that during the payroll period commencing on the day of ,20"'/�`7,and ending the_!_Lday of Z 20 O all person mployed on said project have been paid the full weekly Wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION l ! from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined in Articles B and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed ✓J r In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Or THEAC1JF STA11911ENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMMAL PROSECUTION.SEE ARTICLES 8 AND 9. . ,*0 r, CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD.N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 43 April 7,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND N0.OF WORK O.T. MON TUE WED THU FRI SA�11417 TOTAL RATE GROSS WITH- WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 4/1 4/2 4/3 4/4 4/5 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOG U E,NY 11942 CK.*4712 853 0 DOZER S 8 8 8 8 8 40 32.12 1284.80 98.29 266.30 71.19 0.60 436.38 848.42 M.FLEMING 11 BEATRICE STREET 0 SHIRLEY,NY 11967 ck.o4714 069.68.1419 3 DRIVER S 5 81 13 29.41 382.33 29.241 8.52 7.371 0.601 45.73 336.60 JAYA.POREMBA EXCAVATOR 3 3 34.54 103.62 49 PELLETREAU STREET LABORER 0 1 1 24.53 24.53 SOUTHAMPTON,NY11968 PAYLOADER 4 5.5 8 8 25.5 32.12 819.06 CK.#4716 070.64.2225 5 DOZER S 8 8 32.12 256.96 92.12 165.5 59.08 0.60 317.30 886.87 CHRISTOPHER ZITO ! 93 REVILO AVENUE 0 SHIRLEY,NY 11967 CK.•4736 108.64.2931 2 DOZER S 1 7.5 8 8 23.5 32.12 754.82 57.741 83.08 34,221 0.60 175.64 579.18 JUAN C.COLLAZOS PAYLOADER 1 8 8 8 8 33 32.12 1059.96 P.O.BOX 2786 DRIVER 0 3 1 3 29.41 88.23 SOUTHAMPTON,NY 11969 EXCAVATOR 2.5 2.5 34.54 86.35 CK.•4713 084.64.3878 4 LABORER S 1.5 1.5 24.53 36.80 97.25 131.85 64.34 0.60 294.04 977.30 SHAWN J.OUDEANS P.O.BOX 305 0 & OG U E,NY 11942 LABORER 8 8 24.53 196.24 CK.K 4717 5407 1 DRIVER S 8 8 29.41 235.28 33.01 42.76 12.43 0.60 88.80 342.72 THOMAS E.SYPHER,JR. 49845 NORTH ROAD EXCAVATOR 0 8 8 8 8 32 34.54 1105.28 SOUTHOLD,NY 11971 DOZER 5.5 5.5 32.12 176.66 CK.e 4727 104-66.5306 1 1 2 PAYLOADER S 1 2 2 32.12 64.24 102.981 183.21 72.10 0.60 358.89 987.29 JASON E.HAND P.O.BOX 393 0 HAMPTON BAYS,NEW YORK 11946 CK.•4728 118.64.5404 5 DRIVER S 8 8 8 24 29.41 705.841 53.99 49.29 24.94 0.60 128.82 577.02 0 S 0.00 0 s s THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date (b)WHERE FRINGE BENEFITS ARE PAID IN CASH 1 ' - 0:4 (Name of signatory party) (This) ❑ -Each laborer,worker,or mechanic listed in the above-referenced payroll has been do hereby state: paid,as indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted in Section 4(c)below. (1)That I pay or supervise the payment of the persons employed by alL'/(� (c)EXCEPTIONS (Contractor or S ontractor) 7 jot that during the payroll period commencing on the day of .200 and ending the I day of aA ��20 V�� all perso employed on said project have been paid the full weekly ges eamed,that no rebates have been or will be made either directly or Indirectly to or on behalf of sold EXCEPTION(CRAFT) EXPLANATION —7—c & from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Articles 8 and 9 and described below: (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed In the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed r In the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9. CONTRACTOR'S PAYROLL STATEMENT NAME OF CONTRACTOR[ ] OR SUBCONTRACTOR[ ] ADDRESS TERRY CONTRACTING&MATERIALS,INC. 840 W.MAIN STREET RIVERHEAD,N.Y.11901 PAYROLL• FOR WEEK ENDING PROJECT AND LOCATION 42 MAR.31,2002 SOUTHOLD LANDFILL CLOSURE (1) (2) (3) (4)DAY AND DATE (5) (6) (7) (8) (9) DEDUCTIONS NET NAME,ADDRESS AND N0.OF WORK O.T. MON TUE WED THU FRI SAT SUN TOTAL RATE GROSS WITH. WAGES SOCIAL SECURITY NUMBER W/HOLDING CLASSIFICATION OR 3/25 3/26 3/27 3/28 3/29 3/30 3/31 HRS. OF PAY AMOUNT FICA HOLDING STATE OTHER TOTAL PAID OF EMPLOYEE EXEMPTIONS S.T. HOURS WORKED EACH DAY EARNED TAX TAX DEDUCTIONS FOR WEEK MICHAEL N.JONES P.O.BOX 191 0 EAST QUOGUE,NY 11942 DOZER 8 5 8 8 29 32.12 931.48 CK.K 4680 QabfiR.9R.r3 0 HOLIDAY S 8 8 32.12 256.96 90.911 239.14 64.59 0.60 395.24 793.20 lw M.FLEMING 11 BEATRICE STREET 0 SHIRLEY,NY 11967 CK.r 4683 069.68.1419 3 DRIVER S 8 8 29.41 235.28 18.00 0.00 1.351 0.60 19.95 215.33 JAYA.POREM BA 49 PELLETREAU STREET 0 SOUTHAMPTON,NY11968 PAYLOADER 8 8 8 24 32.12 770.88 CK.s 4682 070.64.2225 5 HOLIDAY S 1 8 1 8 32.12 256.96 78.63 117.89 47.00 0.60 244.121 783.72 CHRISTOPHER ZITO 93 REVILO AVENUE O SHIRLEY,NY 11967 EXCAVATOR 8 8 8 24 34.54 828.96 CK.•4665 108.64.2931 2 HOLIDAY S 8 8 34.54 276.32 84.56 149.32 58.231 0.60 292.71 812.57 JUAN C.COLLAZOS P.O.BOX 2786 0 SOUTHAMPTON,NY 11969 PAYLOADER 8 8 8 8 32 32.12 1027.84 CK.M 4691 084.64.3878 4 HOLIDAY S 8 .. 8 32.12 256.96 98.29 135.48 65.26 0.60 299.63 985.17 CRAIG T.OUDEANS 7 WESTSIDE AVENUE O UOG U E,NY 11942 CK.•4677 1974 4 LABORER S 2.5 2.5 24.53 61.33 4.69 0.00 0.00 0.31 5.00 56.33 THOMAS E.SYPHER,JR. 49845 NORTH ROAD PAYLOADER 0 8 8 32.12 256.96 SOUTHOLD,NY 11971 DRIVER 8 8 16 29.41 470.56 CK.#4671 104.66.5306 2 HOLIDAY S 8 8 32.12 256.96 75.31 100.22 47.32 0.60 223.45 761.03 JASON E.HAND P.O.BOX 393 0 HAMPTON BAYS,NEW YORK 11946 LABORER 1.5 1.5 24.53 36.80 CK.a 4692 118.64.5404 5 DRIVER S 8 8 8 24 29.41 705.84 56.81 54.81 27.46 0.60 139.68 602.96 ROBERT TERRY 57 FOSTER AVENUE 0 HAMPTON BAYS,NY 11946 CK.•4681 071.28.9247 4 EXCAVATOR S 8 8 34.541 276.32 21.141 0.00 2.23 0.60 23.971 252.35 0 s .o r THIS CERTIFICATION MUST BE COMPLETED ON EACH WEEKLY PAYROLL FORM USED BY THE CONTRACTOR OR SUBCONTRACTOR Date 7 '3 6 v (b)WHERE FRINGE BENEFITS ARE PAID IN CASH (Name of signatory party) (Title) ❑ -Each laborer,worker,or mechanic listed In the above-referenced payroll has been paid,as Indicated on the payroll,an amount not less than the sum of the do hereby state: applicable basic hourly wage rete plus the amount of the required fringe benefits (t)That 1 pay or supervise the payment of the persons 7mployed by as listed In the contract,except as noted In Section 4(c)below. (c)EXCEPTIONS (ContractorW Subcontractor) ,that during the payroll period commencing an tthe �r day of j� ,20 nd ending the 3 J day of /-J�- 20d-7-- all 0d-7--all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said EXCEPTION(CRAFT) EXPLANATION -7-?l from the full (Contractor or Subcontractor) weekly wages earned by any penton and that no deductions have been made either directly or Indirectly from the full wages earned by any parson,other than permissible deductions as defined In Articles 8 and 9 and described below. • (2)That any payrolls submitted for the above period are correct and complete;that the wage rates for laborers,workers,or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer,worker or mechanic conform with the work he/she performed. (3)That any apprentices employed in the above period are duly registered In a bona fide REMARKS: apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recognized agency exists In a State,are registered with On Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS SIGNATURE ` (In addition to the basic hourly wage rates paid to each laborer,worker or mechanic listed "dr In the above referenced payroll,payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the THE WILLFUL FALSIFICATION OF ANY Of THE AkWr 0 NTS MAY SUB.IECT THE CONTRACTOR OR SUBCONTRACTOR benefit of such employees,except as noted In Section 4(c). TO CIVIL OR CRIMINAL PROSECUTION.SEE ARTICLES 8 AND 9.