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					Instructions for Contractor Payment Request

The Ohio State University                                                                                      http://fod.osu.edu
Facilities Operations and Development
400 Central Classroom Bldg ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                Phone: 614-292-4458 Fax: 614-292-2539

The Contractor Payment Request workbook was created in Microsoft Excel XP, Version 2003 SP2. There are 10
worksheet tabs that comprise the entire document The last tab is for office use only and is not completed by the
contractor. In most of the tabs there are multiple pages. Please review the entire document prior to commencing.
The Contractor Payment Request is to provide an accurate and detailed breakdown for the Work, in accordance with
the requirements of Article 9 of the General Conditions and following the preferred titles and sequences in the
Construction Specifications Institute (CSI) used in the Specifications. The Architect/Engineer and the Construction
Manager (if applicable) will review the Contractor Payment Request for accuracy and completeness; no payment will be
made without an approved Contractor Payment Request

The detail required on the schedule of values of the Contractor Payment Request is to allow for easy confirmation of the
status of each item of Work. For example, a multi-story building should include a “per floor” item for finish Work by the
general Contractor such as metal studs, drywall and paint; or a large single story building may be broken down “by wing”
and the same metal studs, drywall and paint. Mechanical and electrical Contractors will include separate line items for all
major pieces of equipment and group small equipment items by type. These trades are requested to follow the “per
floor” or “per wing” approach for rough in, wiring, and device hookup, or for piping and hookup. The line items for labor
and material shall accurately reflect the cost for each item; separate items are not to be shown for overhead or profit, but
should be included in the totals for labor and materials.

Legend
Cell Colors as Used on Forms
Yellow             Normal entry information
Turquoise          Information entered under special circumstances
Red                Enter maximum retainage only after first 50%+ pay request
Lavender           Information to copy from
Light Turquoise    Information to copy to
Pale Blue          Check appropriate box
Tan                Optional Area For Calculation


General Instructions for Contractor Payment Request
In accordance with Instructions to Bidders 6.4.1.5 of the Standard Conditions of Contract for Construction, all
Contractors must provide evidence that an authorization agreement for automatic deposit of state warrants has
been submitted to the Auditor of the State of Ohio. Use of electronic funds transfer (EFT) will normally result in
payment 7 to 10 days earlier than by State warrant.

Payment to the Contractor will be processed according to Article 9 of the General Conditions. The procedure for
reviewing and approving payment requests shall be established at the pre-construction meeting. On larger Projects, it is
advisable to distribute a pencil copy of the payment request for preliminary review by the Architect/Engineer and the
Construction Manager (if applicable) one week before formal submittal.

The Contractor will submit the required number of copies of the executed payment request. Original signatures are
required on all copies and are requested in blue ink. The payment request is processed by the Office of the State
Architect (SAO) and returned to the Owner for vouchering, however, some Owners prefer to review, approve and
voucher the payment request before submitting to SAO.




SAO-F140-01v1210                                                                               Instructions, Page 1 of 3
Instructions for Contractor Payment Request

The Ohio State University                                                                                     http://fod.osu.edu
Facilities Operations and Development
400 Central Classroom Bldg ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                  Phone: 614-292-4458 Fax: 614-292-2539
The Contractor shall submit a certified payroll report with each payment request which includes labor, see Section
9.2.1.3 of the General Conditions. One (1) certified payroll report is required for each week of Work reflected on the
payment request. Any payment request, which does not include labor, requires a certified payroll report indicating the
period covered by the payment request specifically noting that “no labor was performed during this period.” SAO
requests one copy of the certified payroll reports (for the Contractor and all Subcontractors who performed labor for
requested period) be attached to the back of the second copy of the payment request to reduce the possibility that
someone requiring a copy of the payment request will also take the certified payroll.

The Contractor shall request payment for Change Orders which have been approved and for which Work was
performed during the time covered by the payment request.

If a Contractor is requesting payment for materials delivered on the Project site or other approved storage site, the
Contractor shall complete the Materials Stored section of this application. The Contractor shall pay any travel expenses
incurred by the Architect/Engineer or the Construction Manager (if applicable) to visit a storage site other than the
Project location.

Retainage is to be held on payment requests in the amount of eight percent (8%) of labor until a construction Contract
has reached fifty-percent (50%) completion. The calculation for determining whether the Contract has reached fifty-
percent (50%) completion is as follows: total labor and material “billed” to date to include approved stored materials
divided by total Contract amount plus total Change Orders approved to date. The Contractor will be asked by SAO to
sign an escrow agreement soon after Contract award. When a payment request is received that exceeds 50 percent as
calculated above, SAO will transfer the retainage into escrow where it will earn interest. If a Contractor fails to return the
escrow agreement, no escrow can be established.

In order to request final payment, the payment request must include the following: required payroll reports, a
Certification of Contract Completion evidencing that all Project record document submittals are satisfactory and an
Affidavit of Contractor to certify compliance with prevailing wage and payment to Subcontractors and Material Suppliers.


Escrow funds remain on account with the escrow agent until the final, 100 percent payment is requested, a Contract
Completion Certificate is issued and a signed Affidavit of Contractor has been received. At that time, escrow and earned
interest are released and forwarded to the Contractor. An early release of escrow may be allowed if Change Orders are
issued late in the Contract and the Contractor has completed 100 percent of the base Contract Work.

Step By Step Instructions
Initial Schedule of Values

  At the beginning of the Contract each Contractor is required to complete the basic information at the top of the Section
  A – Summary page (area in yellow except for request number and period) as well as columns a through d of Section B
  – Schedule of Values Summary (items 1 through 8 plus area in yellow) for as many line items as are required. Prior to
  entering the line items on Schedule B, the contractor should fill out Tab H - EDGE to include all EDGE subcontractors
  and suppliers expected to be used. The EDGE subcontractors must also be entered on Tab G - Subcontractors. Use
  of EDGE vendors must be identified on the Schedule of Values by entering the corresponding alpha character from
  column a of tab H - EDGE into column b of the Schedule of Values along with the other required data. The Schedule
  of Values must then be signed by the Contractor and submitted to the Architect/Engineer and the Construction
  Manager (if applicable) for approval. The Schedule of Values will then be forwarded to the Project Manager for final
  approval. The Contractor will receive a signed copy of the approved Schedule of Values. No payment requests will be
  processed before the Schedule of Values has been approved.



Note: If you are trying to enter data into a cell and get a pop-up warning that you cannot enter into a protected
cell you are trying to enter data where you should not be. Data is NEVER entered into a cell that is white or
lavender.
Instructions for Contractor Payment Request

The Ohio State University                                                                       http://fod.osu.edu
Facilities Operations and Development
400 Central Classroom Bldg ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210   Phone: 614-292-4458 Fax: 614-292-2539

SAO-F140-01v1210                                                                Instructions, Page 2 of 3
Instructions for Contractor Payment Request

The Ohio State University                                                                                       http://fod.osu.edu
Facilities Operations and Development
400 Central Classroom Bldg ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                  Phone: 614-292-4458 Fax: 614-292-2539

Payment Request
  1. Contractor Payment Requests are normally submitted on a monthly basis
  2. Enter Request No. and dates from and to on Section A – Summary

  3. Go to Section C – Schedule of Values Details. Enter amounts from previous applications in columns e and f (light
  turquoise). Enter amounts for current period in columns h and i. If you prefer you can move the cursor to the right, off
  the form and enter the percentage complete for any or all of the line items. Note: You should be able to copy the
  information you need to enter in columns c and d from Section B – Schedule of Values Summary columns k and l
  (lavender color) of the previous Contractor Payment Request. When you paste the information you will need to use
  "paste special and click on "values and number formats"

  4. Go to Section D - Change Order Summary. Enter all Change Orders that have been approved since the last
  payment request that was submitted in columns a through f (yellow area). You must separately identify EDGE vendors
  used.

  5. Go to Section E - Change Order Details. Enter amounts from previous applications in columns c and d (light
  turquoise). Enter amounts for current period in columns f and g. If you prefer you can move the cursor to the right, off
  the form and enter the percentage complete for any or all of the line items. Note: You should be able to copy the
  information you need to enter in columns c and d from Section D – Change Order Summary columns I and j (lavender
  color) of the previous Contractor Payment Request. When you paste the information you will need to use "paste
  special and click on "values and number formats"

  6. Go to Section F - Stored Materials. Enter information as required. Be sure to check each item as to whether stored
  on or off site.

  7. Go to Section G - Subcontractors. List ALL Subcontractors. Check whether or not each Subcontractor was used
  during the period covered by this request. Check whether or not payrolls are attached. Check whether or not
  apprenticeship agreement has been submitted. Check whether or not payrolls have been submitted for each
  Subcontractor. Note: You are responsible for obtaining and providing payrolls for all of the Subcontractors you use.
  Failure to provide payrolls for all Subcontractors used during the period of this request is a violation of your Contract.


  8. Go to Section A - Summary. Amounts completed to date have been calculated and carried forward to the summary
  page based upon the data you have entered. Retainage to date has also been calculated and entered. Also entered is
  the percentage that this Contract is now complete based upon the information entered. If the percent complete shows
  50% or more complete and this is the first pay request for which this has been the case the amount of retainage
  shown will be the final total for retainage for this contract and you should override the calculation for retainage on all
  future pay requests for this contract and enter this amount on all future pay requests. Enter the amounts which should
  be withheld for liens, Liquidated Damages or other withholdings about which you have been informed. Enter the
  amount of previous payments from previous pay request. At this point the form has calculated the amount due on this
  payment request.

  9. Print the Section A - Summary page. Then go to each tab (Worksheet) and print the number of pages on which you
  have entered data on this contract. Each Worksheet will display the number of pages on that Worksheet in the bottom
  right hand corner of every page. If it reads Page 1 of 5 in the bottom right you would want to print 5 pages of that
  Worksheet. The entire Workbook contains over 110 pages so you would not want to print all of the pages in the
  Workbook as many of them are unnecessary for most contracts.

  10. You should now have one copy of the entire Contractor Payment Request. Make as many copies of the payment
  request as the Architect/Engineer has told you that you will need to submit for this contract. Sign each copy. Attach
  the required payrolls to the second copy as instructed above. Submit all copies to the Architect/Engineer for approval
  and further processing.

  Please refer any questions or concerns about the forms to your project coordinator.

SAO-F140-01v1210                                                                                Instructions, Page 3 of 3
Contractor Payment Request
The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name and Address                        Project Information                               A/E Name and Address                       A - Summary
                                                   Contract No.
                                                   Local No.                                                                                    Request No.
                                                   Project Name & Location                                                                      Sheet     1   of        1
Contr. Phone                                                                                         CM Name and Address
Contr. Fax                                                                                                                                      For the period
Contr. Tax ID                                                                                                                                   from
Contr. E-mail                                      Type of Contract                                                                             to


Contractor Certification                                          Partial Payment Details                      Labor $               Materials $              Total $
Contractor certifies the Original Application values in this      Completed to date
Payment Request have not changed from the values first                    Original Contract Amount
approved, all information in this Payment Request is true
                                                                          Change Order Amount
and accurate, all payments received to date have been
used by the Contractor to discharge, in full, the obligations
incurred and provided during the periods for which                        Stored Materials                               N/A
payment was made, and the Contractor has, to the best of
its knowledge, completed the Work to date in accordance                   Subtotal - Earned (A)
within the terms and conditions of the contract, including                Percent Complete
payment of the applicable Prevailing Wage rates.

                                                                  Withheld Amounts
Authorized signature                             Date                    Lien(s)
                                                                         Retainage Amount
                                                                         Liquidated Damages
Work Progress Certification                                              Other
Each firm signing below certifies that, based upon its on-
site observations, the payment requested to date is a fair
and reasonable request for the Work provided to date.                     Subtotal - Withheld (B)

                                                                  Previous Payments (C)
Architect/Engineer (A/E)                         Date

                                                                  Total Requested this
Construction Manager                             Date             Application (A - B - C)

State Architect's Office Approval                                 Owner Approvals


Authorized signature                             Date             Authorized signature                  Date             Authorized signature                      Date
SAO-F140-01v1210   Section A - Summary, Page 1 of 1
Contractor Payment Request

The Ohio State University                                                                                                                                              http://fod.osu.edu
Facilities Operations and Development                                                                                                                                Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                            Fax: 614-292-2539

Contractor Name                                                                              Contract No.                                       B - Schedule of Values
Project Name                                                                                                                                        Summary
                                                                                             Local No.                                          Request No.
Project Location                                                                                                                                Sheet            2         of         1

                                                                           Original Application                                       Current Period
 a. b.            c.                         d.                    e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                                Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item           Section                  Description             Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
 1             00 61 00     Bond
 2             00 62 16     Insurance
 3             00 72 00     General Conditions
 4             01 31 13     Project Coordination
 5             01 71 13     Mobilization
                            Close-out Items
 6             01 77 00     (incl. Waste Dirversion Report)
 7            01 21 00.01   Allowance: Sched. Consultant
 8            01 21 00.02   Allowance: Project Identification
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                                                                                                                                     Section B - Schedule of Values Summary, Page 1 of 0

      SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                   Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet            3         of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
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                                                                                                                            Section B - Schedule of Values Summary, Page 2 of 0


      SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                   Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet            4         of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
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                                                                                                                            Section B - Schedule of Values Summary, Page 3 of 0


      SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                   Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet            5         of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
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                                                                                                                            Section B - Schedule of Values Summary, Page 4 of 0


      SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                   Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet            6         of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
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                                                                                                                            Section B - Schedule of Values Summary, Page 5 of 0


      SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                   Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet            7         of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
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                                                                                                                            Section B - Schedule of Values Summary, Page 6 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                   Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet            8         of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
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                                                                                                                            Section B - Schedule of Values Summary, Page 7 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                   Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet            9         of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                      l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to              Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $                Date $
162
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                                                                                                                            Section B - Schedule of Values Summary, Page 8 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                 http://fod.osu.edu
Facilities Operations and Development                                                                                                                   Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                               Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                          Request No.
Project Location                                                                                                                       Sheet         10        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.          j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this      % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period      Date           Date $             Date $
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Total this Sheet


                                                                                                                            Section B - Schedule of Values Summary, Page 9 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         11        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
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                                                                                                                          Section B - Schedule of Values Summary, Page 10 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         12        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
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                                                                                                                          Section B - Schedule of Values Summary, Page 11 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         13        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
254
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                                                                                                                          Section B - Schedule of Values Summary, Page 12 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         14        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 13 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         15        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 14 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         16        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 15 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         17        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 16 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         18        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 17 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         19        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 18 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         20        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 19 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         21        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 20 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         22        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 21 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         23        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 22 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         24        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 23 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         25        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 24 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                http://fod.osu.edu
Facilities Operations and Development                                                                                                                  Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                              Fax: 614-292-2539

Contractor Name                                                                     Contract No.                                       B - Schedule of Values
Project Name                                                                                                                               Summary
                                                                                    Local No.                                         Request No.
Project Location                                                                                                                      Sheet         26        of         1

                                                                  Original Application                                       Current Period
 a. b.          c.                d.                      e.                f.              g.           h.          i.         j.             k.                   l.
       EDGE




                                                       Original         Original         Original   Completed to   % this     % to          Labor to           Material to
Item          Section         Description              Labor $         Material $        Total $      Date $       Period     Date           Date $             Date $
553
554
555
556
557
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
Total this Sheet


                                                                                                                          Section B - Schedule of Values Summary, Page 25 of 0


   SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                             http://fod.osu.edu
Facilities Operations and Development                                                                                                                               Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                           Fax: 614-292-2539

Contractor Name                                                                                Contract No.                                     C - Schedule of Values
Project Name                                                                                                                                        Details
                                                                                               Local No.                                        Request No.
Project Location                                                                                                                                Sheet           2         of        1


                                                                        Previous Applications to Date                                 Current Period
 a. b.            c.                         d.                    e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                                Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item           Section                  Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
 1             00 61 00     Bond
 2             00 62 16     Insurance
 3             00 72 00     General Conditions
 4             01 31 13     Project Coordination
 5             01 71 13     Mobilization
                            Close-out Items
 6             01 77 00     (incl. Waste Dirversion Report)
 7            01 21 00.01   Allowance: Sched. Consultant
 8            01 21 00.02   Allowance: Project Identification
 9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Total this Sheet


         SAO-F140-01v1210                                                                                                             Section C - Schedule of Values Details, Page 1 of 0
Contractor Payment Request

The Ohio State University                                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                 Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet           3         of        1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 2 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                 Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet           4         of        1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 3 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                 Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet           5         of        1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 4 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                 Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet           6         of        1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 5 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                 Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet           7         of        1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 6 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                 Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet           8         of        1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 7 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                                 Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet           9         of        1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                    k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to              Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $                Date $
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 8 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                     C - Schedule of Values
Project Name                                                                                                                              Details
                                                                                     Local No.                                        Request No.
Project Location                                                                                                                      Sheet         10        of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                      j.                   k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this             Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $                  Date $              Date $
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
Total this Sheet


                                                                                                                            Section C - Schedule of Values Details, Page 9 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          11      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 10 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          12      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 11 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          13      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 12 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          14      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 13 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          15      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 14 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          16      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 15 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          17      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 16 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          18      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 17 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          19      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 18 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          20      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 19 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          21      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 20 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          22      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 21 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          23      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 22 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          24      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 23 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          25      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 24 of 0
         SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                      Contract No.                                  C - Schedule of Values
Project Name                                                                                                                           Details
                                                                                     Local No.                                     Request No.
Project Location                                                                                                                   Sheet          26      of          1


                                                              Previous Applications to Date                                 Current Period
 a. b.          c.                d.                     e.                f.               g.          h.             i.                    j.                 k.
       EDGE




                                                      Previous          Previous         Previous   Labor this   Material this         Labor to            Material to
Item          Section         Description             Labor $           Material $        Total $    Period $     Period $              Date $              Date $
553
554
555
556
557
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
Total this Sheet


                                                                                                                       Section C - Schedule of Values Details, Page 25 of 0
         SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




SAO-F140-01v1210   Section C - Schedule of Values Details, Page 1 of 0
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 2 of 0
SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 3 of 0
SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 4 of 0
SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 5 of 0
SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 6 of 0
SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 7 of 0
SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 8 of 0
SAO-F140-01v1210
                                               http://fod.osu.edu
                                             Phone: 614-292-4458
                                              Fax: 614-292-2539




                                                                            Optional Calculation
                                                                          Labor Material % To
                                                                         Percent Percent Date




                   Section C - Schedule of Values Details, Page 9 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 10 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 11 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 12 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 13 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 14 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 15 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 16 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 17 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 18 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 19 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 20 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 21 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 22 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 23 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 24 of 0
SAO-F140-01v1210
                                                 http://fod.osu.edu
                                               Phone: 614-292-4458
                                                Fax: 614-292-2539




                                                                             Optional Calculation
                                                                           Labor Material % To
                                                                          Percent Percent Date




                   Section C - Schedule of Values Details, Page 25 of 0
SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                     D - Change Order
Project Name                                                                                                                          Summary
                                                                                 Local No.                                        Request No.
Project Location                                                                                                                  Sheet           2         of        1

                                                           Change Order Info                                              Current Period
  a.     b.        c.            d.               e.                f.              g.            h.      i.         j.                    k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to           Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $                Date $               Date $




Total this Sheet

   SAO-F140-01v1210                                                                                                        Section D - Change Order Summary, Page 1 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                     D - Change Order
Project Name                                                                                                                          Summary
                                                                                 Local No.                                        Request No.
Project Location                                                                                                                  Sheet           3         of        1

                                                           Change Order Info                                              Current Period
  a.     b.        c.            d.               e.                f.              g.            h.      i.         j.                    k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to           Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $                Date $               Date $




Total this Sheet

   SAO-F140-01v1210                                                                                                        Section D - Change Order Summary, Page 2 of 0
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                  D - Change Order
Project Name                                                                                                                       Summary
                                                                                 Local No.                                     Request No.
Project Location                                                                                                               Sheet           4         of       1

                                                           Change Order Info                                          Current Period
  a.     b.        c.            d.              e.                f.               g.            h.      i.        j.                 k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to        Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $             Date $               Date $




Total this Sheet


   SAO-F140-01v1210                                                                                                     Section D - Change Order Summary, Page 3 of 0
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                  D - Change Order
Project Name                                                                                                                       Summary
                                                                                 Local No.                                     Request No.
Project Location                                                                                                               Sheet           5         of       1

                                                           Change Order Info                                          Current Period
  a.     b.        c.            d.              e.                f.               g.            h.      i.        j.                 k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to        Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $             Date $               Date $




Total this Sheet


   SAO-F140-01v1210                                                                                                     Section D - Change Order Summary, Page 4 of 0
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                  D - Change Order
Project Name                                                                                                                       Summary
                                                                                 Local No.                                     Request No.
Project Location                                                                                                               Sheet           6         of       1

                                                           Change Order Info                                          Current Period
  a.     b.        c.            d.              e.                f.               g.            h.      i.        j.                 k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to        Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $             Date $               Date $




Total this Sheet


   SAO-F140-01v1210                                                                                                     Section D - Change Order Summary, Page 5 of 0
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                  D - Change Order
Project Name                                                                                                                       Summary
                                                                                 Local No.                                     Request No.
Project Location                                                                                                               Sheet           7         of       1

                                                           Change Order Info                                          Current Period
  a.     b.        c.            d.              e.                f.               g.            h.      i.        j.                 k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to        Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $             Date $               Date $




Total this Sheet


   SAO-F140-01v1210                                                                                                     Section D - Change Order Summary, Page 6 of 0
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                  D - Change Order
Project Name                                                                                                                       Summary
                                                                                 Local No.                                     Request No.
Project Location                                                                                                               Sheet           8         of       1

                                                           Change Order Info                                          Current Period
  a.     b.        c.            d.              e.                f.               g.            h.      i.        j.                 k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to        Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $             Date $               Date $




Total this Sheet


   SAO-F140-01v1210                                                                                                     Section D - Change Order Summary, Page 7 of 0
Contractor Payment Request

The Ohio State University                                                                                                                            http://fod.osu.edu
Facilities Operations and Development                                                                                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                          Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                  D - Change Order
Project Name                                                                                                                       Summary
                                                                                 Local No.                                     Request No.
Project Location                                                                                                               Sheet           9         of       1

                                                           Change Order Info                                          Current Period
  a.     b.        c.            d.              e.                f.               g.            h.      i.        j.                 k.                    l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to        Labor to             Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $             Date $               Date $




Total this Sheet


   SAO-F140-01v1210                                                                                                     Section D - Change Order Summary, Page 8 of 0
Contractor Payment Request

The Ohio State University                                                                                                                          http://fod.osu.edu
Facilities Operations and Development                                                                                                            Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                        Fax: 614-292-2539

Contractor Name                                                                  Contract No.                                  D - Change Order
Project Name                                                                                                                       Summary
                                                                                 Local No.                                     Request No.
Project Location                                                                                                               Sheet        10         of       1

                                                           Change Order Info                                          Current Period
  a.     b.        c.            d.              e.                f.               g.            h.      i.        j.                 k.                  l.
         EDGE




                                            Change Order      Change Order     Change Order     % this   % to   Completed to        Labor to           Material to
CO No.          Section    Date Approved      Labor $          Material $         Total $       Period   Date     Date $             Date $             Date $




Total this Sheet


   SAO-F140-01v1210                                                                                                     Section D - Change Order Summary, Page 9 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         2         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 1 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         3         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 2 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         4         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 3 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         5         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 4 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         6         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 5 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         7         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 6 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         8         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 7 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         9         of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 8 of 0
Contractor Payment Request

The Ohio State University                                                                                                                               http://fod.osu.edu
Facilities Operations and Development                                                                                                                 Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                             Fax: 614-292-2539

Contractor Name                                                               Contract No.                                        E - Change Order
Project Name                                                                                                                          Details
                                                                              Local No.                                           Request No.
Project Location                                                                                                                  Sheet         10        of         1

                                                     Previous Applications to Date                                        Current Period
  a. b.            c.           d.              e.                f.               g.              h.                i.                    j.                  k.
      EDGE




 CO                            Date          Previous           Previous          Previous    CO Labor this   CO Material this       CO Labor to        CO Material to
 No.           Section       Approved       CO Labor $        CO Material $      CO Total $     Period $         Period $              Date $              Date $




Total this Sheet

   SAO-F140-01v1210
                                                                                                                             Section E - Change Order Details, Page 9 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                     Optional Calculation for
                                                                          current period
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 1 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 2 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 3 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 4 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 5 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 6 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 7 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 8 of 0
                                              http://fod.osu.edu
                                            Phone: 614-292-4458
                                             Fax: 614-292-2539




                                                                      Optional Calculation
                                                                    Labor Material % To
                                                                   Percent Percent Date




SAO-F140-01v1210
                   Section E - Change Order Details, Page 9 of 0
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       2          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 1 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       3          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 2 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       4          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 3 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       5          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 4 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       6          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 5 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       7          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 6 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       8          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 7 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet       9          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 8 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539

Contractor Name                                                      Contract No.                                        F - Stored Materials
Project Name
                                                                     Local No.                                           Request No.
Project Location                                                                                                         Sheet      10          of        1

               Line   Invoice         Material                                         Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description         Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet



SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                      http://fod.osu.edu
Facilities Operations and Development                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                    Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 9 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                     http://fod.osu.edu
Facilities Operations and Development                                                                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                   Fax: 614-292-2539

Contractor Name                                                      Contract No.                                          F - Stored Materials
Project Name
                                                                     Local No.                                             Request No.
Project Location                                                                                                           Sheet      11          of        1

               Line   Invoice         Material                                           Previous     New Materials   Mat. Installed this       Current Material
 On    Off     Ref.     No.           Supplier                  Description           Stored Amount   Stored (Add)    Period (Deduct)               Stored




                                                     Total This Sheet
                                                     Grand Total (Final Sheet Only)


SAO-F140-01v1210                                     Payments Allowed @ 92%
Contractor Payment Request

The Ohio State University                                                                       http://fod.osu.edu
Facilities Operations and Development                                                         Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                     Fax: 614-292-2539

                                                                             Section F - Stored Materials, Page 10 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                      http://fod.osu.edu
Facilities Operations and Development                                                                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                    Fax: 614-292-2539

Contractor Name                                                     Contract No.                                                 G -     Subcontractors
Project Name
                                                                    Local No.                                                    Request No.
Project Location                                                                                                                 Sheet   2     of         1

                    List all Subcontractors                    Utilized This Pay Period   Payrolls Attached   Apprent. Agree. Submited   Pay. Sched. Submitted
                                                                      Yes     No            Yes      No             Yes     No                Yes     No
   1
   2
   3
   4
   5
   6
   7
   8
   9
   10
   11
   12
   13
   14
   15
   16
   17
   18
   19
   20
   21
   22
   23
   24
   25
SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                     http://fod.osu.edu
Facilities Operations and Development                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                   Fax: 614-292-2539

                                                                             Section G - Subcontractors, Page 1 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                      http://fod.osu.edu
Facilities Operations and Development                                                                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                    Fax: 614-292-2539

Contractor Name                                                     Contract No.                                                 G -     Subcontractors
Project Name
                                                                    Local No.                                                    Request No.
Project Location                                                                                                                 Sheet   3     of         1

                    List all Subcontractors                    Utilized This Pay Period   Payrolls Attached   Apprent. Agree. Submited   Pay. Sched. Submitted
                                                                      Yes     No            Yes      No             Yes     No                Yes     No
   26
   27
   28
   29
   30
   31
   32
   33
   34
   35
   36
   37
   38
   39
   40
   41
   42
   43
   44
   45
   46
   47
   48
   49
   50
SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                     http://fod.osu.edu
Facilities Operations and Development                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                   Fax: 614-292-2539

                                                                             Section G - Subcontractors, Page 2 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                      http://fod.osu.edu
Facilities Operations and Development                                                                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                    Fax: 614-292-2539

Contractor Name                                                     Contract No.                                                 G -     Subcontractors
Project Name
                                                                    Local No.                                                    Request No.
Project Location                                                                                                                 Sheet   4     of         1

                    List all Subcontractors                    Utilized This Pay Period   Payrolls Attached   Apprent. Agree. Submited   Pay. Sched. Submitted
                                                                      Yes     No            Yes      No             Yes     No                Yes     No
   51
   52
   53
   54
   55
   56
   57
   58
   59
   60
   61
   62
   63
   64
   65
   66
   67
   68
   69
   70
   71
   72
   73
   74
   75
SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                     http://fod.osu.edu
Facilities Operations and Development                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                   Fax: 614-292-2539

                                                                             Section G - Subcontractors, Page 3 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                      http://fod.osu.edu
Facilities Operations and Development                                                                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                    Fax: 614-292-2539

Contractor Name                                                     Contract No.                                                 G -     Subcontractors
Project Name
                                                                    Local No.                                                    Request No.
Project Location                                                                                                                 Sheet   5     of         1

                    List all Subcontractors                    Utilized This Pay Period   Payrolls Attached   Apprent. Agree. Submited   Pay. Sched. Submitted
                                                                      Yes     No            Yes      No             Yes     No                Yes     No
   76
   77
   78
   79
   80
   81
   82
   83
   84
   85
   86
   87
   88
   89
   90
   91
   92
   93
   94
   95
   96
   97
   98
   99
  100
SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                     http://fod.osu.edu
Facilities Operations and Development                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                   Fax: 614-292-2539

                                                                             Section G - Subcontractors, Page 4 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                      http://fod.osu.edu
Facilities Operations and Development                                                                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                    Fax: 614-292-2539

Contractor Name                                                     Contract No.                                                 G -     Subcontractors
Project Name
                                                                    Local No.                                                    Request No.
Project Location                                                                                                                 Sheet   6     of         1


                    List all Subcontractors                    Utilized This Pay Period   Payrolls Attached   Apprent. Agree. Submited   Pay. Sched. Submitted
                                                                      Yes     No            Yes      No             Yes     No                Yes     No
  101
  102
  103
  104
  105
  106
  107
  108
  109
  110
  111
  112
  113
  114
  115
  116
  117
  118
  119
  120
  121
  122
  123
  124
  125
SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                     http://fod.osu.edu
Facilities Operations and Development                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                   Fax: 614-292-2539

                                                                             Section G - Subcontractors, Page 5 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                      http://fod.osu.edu
Facilities Operations and Development                                                                                                        Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                    Fax: 614-292-2539

Contractor Name                                                     Contract No.                                                 G -     Subcontractors
Project Name
                                                                    Local No.                                                    Request No.
Project Location                                                                                                                 Sheet   7     of         1


                    List all Subcontractors                    Utilized This Pay Period   Payrolls Attached   Apprent. Agree. Submited   Pay. Sched. Submitted
                                                                      Yes     No            Yes      No             Yes     No                Yes     No
  126
  127
  128
  129
  130
  131
  132
  133
  134
  135
  136
  137
  138
  139
  140
  141
  142
  143
  144
  145
  146
  147
  148
  149
  150
SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                     http://fod.osu.edu
Facilities Operations and Development                                                       Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                   Fax: 614-292-2539

                                                                             Section G - Subcontractors, Page 6 of 0




SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                  http://fod.osu.edu
Facilities Operations and Development                                                                                                    Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                Fax: 614-292-2539

Contractor Name                                                       Contract No.                                                       H - EDGE
Project Name
                                                                      Local No.                                            Request No.
Project Location                                                                                                           Sheet    2       of        1

 a                              b                                 c                 d        e            f         g        h                   i
Reference




                                                                                          Projected   Projected   Actual   Actual
                                                                                  Award     Start       End        Start    End             Status
                               Name                             Tax ID             Date     Date        Date       Date     Date    Active Complete Void
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T



            SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                                                                                   http://fod.osu.edu
Facilities Operations and Development                                                                                                     Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210                                                                 Fax: 614-292-2539


                                                                                                                                    Section H - EDGE, Page 1 of 0
Contractor Name                                                       Contract No.                                                        H - EDGE
Project Name
                                                                      Local No.                                            Request No.
Project Location                                                                                                           Sheet     3        of         1

 a                              b                                 c                 d        e            f         g        h                     i
Reference




                                                                                          Projected   Projected   Actual   Actual
                                                                                  Award     Start       End        Start    End               Status
                               Name                             Tax ID             Date     Date        Date       Date     Date      Active Complete Void
U
V
W
X
Y
Z




            SAO-F140-01v1210
Contractor Payment Request

The Ohio State University                                                            http://fod.osu.edu
Facilities Operations and Development                                              Phone: 614-292-4458
400 Central Classroom Building ▪ 2009 Millikin Road ▪ Columbus, Ohio 43210          Fax: 614-292-2539




                                                                             Section H - EDGE, Page 2 of 0




    SAO-F140-01v1210

				
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