STATE OF CALIFORNIA PAYMENT VOUCHER DEPARTMENT OF TRANSPORTATION PROGRESS SERIAL NO. 09-294-13-21 CONTRACT NO. 05-0P8104 LOCATION: % COMPLETE 91% 05-SCR-17-7.0/7.3 FEDERAL PROJECT % TIME ACHS-P017(102) STP-P017(102) H S R INC 530 ALDO AVENUE PROGRESS PAYMENT NO. 04 SANTA CLARA CA 95054 PAYMENT PERIOD ENDING 10-20-09 ESCROW # = 00000 TOTAL ESTIMATE TOTAL FROM TO DATE LAST ESTIMATE THIS ESTIMATE _______________ _______________ _______________ 1. Contract Items without Mobilization 1,279,293.08 934,720.44 344,572.64 2a. Extra Work b. Adjustment Compensation 3. Materials on Hand 4. Amount Earned Subject to Retention 1,279,293.08 934,720.44 344,572.64 5. Mobilization 150,000.00 150,000.00 0.00 _______________ _______________ _______________ 6. Total Work Completed 1,429,293.08 7. Deductions 8a. Contract Retentions b. Unsatisfactory Progress c. Reduction After 95% Completion _______________ _______________ _______________ 9. Total Pay to Contractor 1,429,293.08 1,084,720.44 344,572.64 10. Reduction for Amount Paid to Escrow 11. Payment to Escrow 0.00 12. Net Payment this Estimate 344,572.64 I hereby certify that all work, including extra work as covered by daily extra work reports, for which payment is to be made on this estimate has been done in accordance with the contract and authorized contract change orders. _________________________________ __________ Authorized Signature Date