Chicago Title NCS Chicago: SYFCREC 2021

} ss. Page 1 of 1 Pages of that has , owner for on the following described premises in said County, to wit 3 4 5 $6,000,000.00 $23,400.00 $0.00 n/a day of 20 $5,766,000.00 It is understood that the total amount paid to date plus the amount requested in this application shall not exceed I agree to furnish Waivers of Lien for all materials under my contract when demanded. Signed Marvel-ous General Contractors, Inc. % of the cost of work completed to date. $65,000.00 $258,000.00 $140,000.00 $5,766,000.00 $0.00 $0.00 $0.00 $0.00 Balance to Become Due (inc. Rententions) 7 $425,000.00 $19,000.00 Subscribed and sworn to before me this $536,000.00 $490,000.00 $516,000.00 $300,000.00 $450,000.00 $650,000.00 $492,000.00 $950,000.00 $257,400.00 To Be Let $475,000.00 $0.00 $0.00 $0.00 $0.00 873 Hibbard Rd., Palos Heights IL 60421 $0.00 Flooring General Conditions Demolition Rough & Trim Carpentry $0.00 $0.00 $0.00 $0.00 $0.00 $34,000.00 $0.00 $0.00 To Be Let $234,000.00 $0.00 $234,000.00 $6,000,000.00 Contingency $257,400.00 $0.00 $0.00 $0.00 A-1 Contractors 78756 N Rand Road, Mount Prospect, IL 60543 Creative Drywall, Inc. 3246 Central Ave., Evanston, IL 60201 Electric Name and Address 1 Retention (inc.current) Net of Previous Payments 6 Net Amount This Payment 2 Kind of Work Amount of Contract Illinois Cook President Marvel-ous General Contractors, Inc. Carol Danvers Marvel-ous General Contractors, Inc. State of being first duly sworn, on oath deposes and says that she is The affiant, $0.00 $0.00 Illinois Fire Systems Simply Air Systems 3456 W. 67th Ave., Naperville IL 60365 Fabulous Flooring 6543 Centerline Rd., Harwood Heights IL 60677 $0.00 $0.00 $0.00 Marvel-ous General Contractors, Inc. 7806 Ridge Ave, Chicago IL 60645 Move It Demo, Inc. 654 Mill Creek Terr., Addison IL 60743 Viking Decking, Inc. $234,000.00 Decking 38526 Centennial Rd., Batavia IL 60534 Chicago Plumbing Co. 1285 Old Orchard Road, Skokie IL 60078 Masterful Carpenters, Inc. 5633 Main Stree, OakBrook IL 60521 ________________________________________________________ Notary Public LESS % RETAINED WORK COMPLETED TO DATE $140,000.00 $0.00 $0.00 $0.00 The above sworn statement should be obtained by the owner before each and every payment. Provided by Chicago Title Insurance Company NET AMOUNT OF THIS PAYMENT NET PREVIOUSLY PAID NET AMOUNT EARNED BALANCE TO BECOME DUE (Inc. Retention) Carol Danvers, President CREDITS TO CONTRACT ADJUSTED TOTAL CONTRACT SWORN STATEMENT OF CONTRACTOR AND SUBCONTRACTOR TO OWNER AND TO CHICAGO TITLE INSURANCE COMPANY General Construction - Renovation Framing, Drywall & Insulation $490,000.00 Fire Sprinklers $300,000.00 $550,000.00 Roofing & Windows $155,000.00 $0.00 $13,600.00 $450,000.00 $0.00 $0.00 $3,400.00 $0.00 $0.00 $0.00 Plumbing HVAC Landscaping $3,900.00 $25,000.00 $136,000.00 $39,000.00 $0.00 $2,500.00 $650,000.00 $450,000.00 $950,000.00 $492,000.00 $575,000.00 $475,000.00 TOTAL CONTRACT AND EXTRAS $6,000,000.00 $258,000.00 Contingency $65,000.00 Parking Lot TOTALS County of $6,000,000.00 $0.00 AMOUNT OF ORIGINAL CONTRACT EXTRAS TO CONTRACT 7643 Central Ave., Chicago IL 60675 Bright Lite Electric $0.00 That, for the purposes of said contract, the following persons have been contracted with, and have furnished, or are furnishing and preparing materials for, and have done or are doing labor on said improvement. That there is due and to become due them, respectively, the amounts set opposite their names for materials or labor as stated. That this statement is a full, true and complete statement of all such persons, the amounts paid and the amounts due or to become due to each. contract with Daring Developer, LLC 123 ABC Road, Chicago IL 60622 106