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TENEX ENTERPRISES, INC. 850'SW 14th Court Pompano Beach, FL 33060 CERTIFICATION OF PAYMENT CHANGE ORDER # 5 FOR: SOUTH OF SIB: INSTALLATION OF BRICK PAVER, SIDEWALK, & CURB AND GUTTER CONTRACTOR: TEN EX ENTERPRISES, INC. 850 SW 14th Court Pompano Beach, FL 33060 CHANGE ORDER # DATE: 5 December 24, 2010 OWNER: CITY OF SUNNY ISLES BEACH 18070 COLLINS AVE SUNNY ISLES BEACH,FL 33160 PROJECT NO. 5681 APPLIED AS CHANGE ORDER #5 TO CITY BID # 09.09.01 CONTRACT AMOUNT: $ $ 30,994.20 CURRENT CONTRACT AMOUNT: 30,994.20 CONTRACT STARTING DATE: CONTRACT TIME: CONTRACT TIME ADJUSTMENTS: CURRENT CONTRACT TIME: TOTAL ELAPSED TIME: AMOUNT COMPLETED: $ 30,994.20 % OF ELAPSE TIME: SCHEDULE COMPLETION: SUBTOTAL: $ 30,994.20 ACTUAL CONTRACT PROGRESS: PREVIOUS BILLINGS: $ SCHEDULED CONTRACT PROGRESS: TOTAL AMOUNT DUE: $ 30,994.20 CONTRACTOR'S CERTIFICATION As the agent for the contractor, I, the undersigned hereby certify that this is a ture and correct statement of work performed and materials delivered, I further certify that the contractor has good title of all materials delivered under this Partial Payment Estimate and there are no vendors' claims, mechanics' claims, or other c1aims2[Jjgbts.to-claims again~tt~Ls job, and that all previous partial payments recieved under this contract have been applie tcfOIscharge in full all of the Contracto~ obligations reflected in prior Partial Payment requests. ) .~.-/"/ GNA'fURE. TENEX ENTERPRISES, INC. COMPANY NAME HAMID FOULADII PRESIDENT PRINT NAMEfTITLE 1'~/~f/) () DATE In accordance with the contract, the undersigned approves the pay estimate submitted by the Contractor, subject to corrections, as noted on the Pay Estimate Form in the amount due as shown above APPROVED: CITY OF SUNNY ISLES BEACH APPROVED: By: By: