APPLICATION AND CERTIFICATE FOR PAYMENTRidgeline Mechanical, Inc.
4410 Foundry Road
Dayton, OH 45404
To Summit Builders · Attn: Accounts Payable · Job 2406 · Maple Street Medical Office
Application no.4
Period to10/31/2026
SubcontractSC-2406-015 · HVAC
Original contract sum$386,000.00
Net change by change orders$9,900.00
Contract sum to date$395,900.00
ItemDescription of workScheduled valuePreviousThis periodTo date%
1Mobilization and submittals12,000.0012,000.000.0012,000.00100%
2Ductwork rough-in148,000.0074,000.0028,000.00102,000.0069%
3Hydronic piping86,000.0043,000.000.0043,000.0050%
4Equipment set: RTUs and AHUs92,000.0023,000.0014,000.0037,000.0040%
5Controls and balancing36,000.000.000.000.000%
6Startup and closeout12,000.000.000.000.000%
CO-01Added VAV box, Suite 2106,400.006,400.000.006,400.00100%
CO-02Added fire dampers, corridor B3,500.000.003,500.003,500.00100%
Total completed and stored to date$203,900.00
Retainage, 10% of completed work$20,390.00
Total earned less retainage$183,510.00
Less previous certificates for payment$142,560.00
Current payment due$40,950.00
Stored materials this period: none · Notarized 11/02/2026 · Conditional waiver attached