SWORN STATEMENT FOR CONTRACTOR AND …

1 Escrow No.:Draw No.:1 Page:1 SWORN STATEMENT FOR CONTRACTOR AND SUBCONTRACTORTO OWNER AND TO CHICAGO TITLE INSURANCE COMPANYC ommitment No.:Escrow No.:Draw No.:1 State of Illinois County of CookTHE AFFIANT, Jay M. Bradarich Sr. being first duly SWORN , on oath deposes and says that he/she is President of LandmarkConstruction Systems, Inc., 18606 S. 81st Avenue, Tinley Park, IL 60487 that has contract with Applewood Property, LLC, ownerfor the following described premises in said County, to wit: 21020 Kostner Avenue, Matteson, IL 60443 That,forthepurposesofsaidcontract,thefol lowingpersonshavebeencontractedwith,andh avefurnished,orarefurnishingandpreparing materialsfor, ,respectively, ,trueandcompletestatementofallsuchperson s,theamounts paid and the amounts due or to become due to and AddressKind of WorkAmt of ContractRetention(inc.)

2 Current)Net of PreviousPaymentsNet AmountThis PaymentBalance toBecome Due+Extras-CreditsAdj Contract TotalLandmark Construction Systems18606 S. 81st AvenueTinley Park, IL 60487 Gen Conditions$682, $ $ $682, $ $ $ $682, +Extras-CreditsAdj Contract TotalLandmark Construction Systems18606 S. 81st AvenueTinley Park, IL 60487 Demolition$150, $ $ $150, $ $ $ $150, +Extras-CreditsAdj Contract TotalLandmark Construction Systems18606 S 81st AvenueTinley Park, IL 60487 Gen Liability Ins$88, $ $ $88, $ $ $ $88, +Extras-CreditsAdj Contract TotalLandmark Construction Systems18606 S 81st AvenueTinley Park, IL 60487 Gen Contr Fee$6,220, $ $ $6,220, $ $ $ $6,220, +Extras-CreditsAdj Contract TotalZenere Trucking & Excavating317 E.

3 Margaret , IL 60476 Earthwork$245, $ $ $245, $ $ $ $245, +Extras-CreditsAdj Contract TotalAlsterda Cartage11832 South Harding , IL 60803 Site Utilities$988, $ $ $988, $ $ $ $988, +Extras-CreditsAdj Contract TotalOak Lawn Blacktop11125 W. 189th , IL 60448 Bituminous Paving$130, $ $ $130, $ $ $ $130, +Extras-CreditsAdj Contract TotalFirst Fence N. Elm StreetHillside, IL 60162 Fencing$3, $ $ $3, $ $ $ $3, +Extras-CreditsAdj Contract TotalSebert Landscaping Company1550 W. Bartlett RoadBartlett, IL 60103 Landscaping$115, $ $ $115, $ $ $ $115, +Extras-CreditsAdj Contract TotalXtreme Edge Excavating, N.

4 Bolingbrook DriveBolingbrook, IL 60440 Concrete$450, $ $ $450, $ $ $ $450, No.:Draw No.:1 Page:2 Name and AddressKind of WorkAmt of ContractRetention(inc. Current)Net of PreviousPaymentsNet AmountThis PaymentBalance toBecome Due+Extras-CreditsAdj Contract TotalBouchard Masonry8 S 035 Madison Ridge, IL 60527 Masonry$387, $ $ $387, $ $ $ $387, +Extras-CreditsAdj Contract TotalFloyd Steel Erectors, Richert RoadWood Dale, IL 60191 Structural Steel$80, $ $ $80, $ $ $ $80, +Extras-CreditsAdj Contract TotalOrland Cabinet15505 S.

5 70th Park, IL 60462 Millwork$325, $ $ $325, $ $ $ $325, +Extras-CreditsAdj Contract TotalJ&L Metal Doors, West 183rd PlaceTinley Park, IL 60487 Doors/Frames/Hdwr$165, $ $ $165, $ $ $ $165, +Extras-CreditsAdj Contract TotalFrontrunner Systems, W. North Frontage Road Ste ABolingbrook, IL 60440 Entrances$107, $ $ $107, $ $ $ $107, +Extras-CreditsAdj Contract TotalPella Windows & Doors2505 Enterprise CircleWest Chicago, IL 60185 Windows$120, $ $ $120, $ $ $ $120, +Extras-CreditsAdj Contract TotalWhited Brothers, West 155th StreetSouth Holland, IL 60473 Skylights$35, $ $ $35, $ $ $ $35, +Extras-CreditsAdj Contract TotalNational Roofing Corporation1237 Circle Park, IL 60130 Roofing & ShtMtl$280, $ $ $280, $ $ $ $280.

6 +Extras-CreditsAdj Contract TotalAmerican National Insulation2319 Diehl RoadAurora, IL 60502 Spray Insulation$26, $ $ $26, $ $ $ $26, +Extras-CreditsAdj Contract TotalNorthwest Insulation1625 Dundee Ave, Unit EElgin, IL 60120 Insulation$50, $ $ $50, $ $ $ $50, +Extras-CreditsAdj Contract TotalWilkin Insulation Carboy RoadMt. Prospect, IL 60056 Fireproofing$5, $ $ $5, $ $ $ $5, +Extras-CreditsAdj Contract TotalWeathershield LLC1415 Centre CircleDowners Grove, IL 60515 Air Barrier$37, $ $ $37, $ $ $ $37, +Extras-CreditsAdj Contract TotalTriumph Restoration Inc18822 S.

7 82nd AveMokena, IL 60448 Caulking$12, $ $ $12, $ $ $ $12, +Extras-CreditsAdj Contract TotalVision Interior DW Corp5709 W. 120th StreetAlsip, IL 60803 Framing & Drywall$914, $ $ $914, $ $ $ $914, +Extras-CreditsAdj Contract TotalSuperior Truss & Panel, W 159th StMarkham, IL 60428 Panels & Trusses$400, $ $ $400, $ $ $ $400, +Extras-CreditsAdj Contract TotalWolcott Construction Corp13438 West Little Creek DriveHomer Glen, IL 60491 Carpentry$939, $ $ $939, $ $ $ $939, No.:Draw No.:1 Page:3 Name and AddressKind of WorkAmt of ContractRetention(inc.)

8 Current)Net of PreviousPaymentsNet AmountThis PaymentBalance toBecome Due+Extras-CreditsAdj Contract TotalPinnacle Flooring Company487 Carlsbad TrailRoselle, IL 60172 Tile & Flooring$477, $ $ $477, $ $ $ $477, +Extras-CreditsAdj Contract TotalSchneider Acoustics, Millennium DriveElgin, IL 60124 Acoustic Ceilings$78, $ $ $78, $ $ $ $78, +Extras-CreditsAdj Contract TotalPrism Painting Box 1944 Highland, IN 46322 Painting/WallCov$74, $ $ $74, $ $ $ $74, +Extras-CreditsAdj Contract TotalCarney & Company, Schneider DriveSouth Elgin, IL 60177 Specialties$34, $ $ $34, $ $ $ $34, +Extras-CreditsAdj Contract TotalAbsolute Fire Protection5279 28th AvenueRockford, IL 61109 Fire Protection$105, $ $ $105, $ $ $ $105, +Extras-CreditsAdj Contract TotalBirk Plumbing, West 120th StreetAlsip, IL 60803 Plumbing$535, $ $ $535, $ $ $ $535, +Extras-CreditsAdj Contract TotalBudd Mechanical Systems586 Fayette StreetHammond, IN 46320 HVAC$500, $ $ $500, $ $ $ $500.

9 +Extras-CreditsAdj Contract TotalABS Electrical Division2560 Federal Signal DriveUniversity Park, IL 60484 Electrical$1,150, $ $ $1,150, $ $ $ $1,150, +Extras-CreditsAdj Contract TotalAllowance, Testing$20, $ $ $20, $ $ $ $20, +Extras-CreditsAdj Contract TotalAllowance, Food Srvc Equip$393, $ $ $393, $ $ $ $393, +Extras-CreditsAdj Contract TotalNOT LET, Fire Alarm$53, $ $ $53, $ $ $ $53, +Extras-CreditsAdj Contract TotalNOT LET, Nurse Call$126, $ $ $126, $ $ $ $126, +Extras-CreditsAdj Contract TotalNOT LET, Access Control$54, $ $ $54, $ $ $ $54, +Extras-CreditsAdj Contract TotalNOT LET, Sound/Paging Syst$39, $ $ $39, $ $ $ $39, +Extras-CreditsAdj Contract TotalNOT LET, Voice Data$54, $ $ $54, $ $ $ $54, +Extras-CreditsAdj Contract TotalNOT LET, Intercom$5, $ $ $5, $ $ $ $5, No.

10 :Draw No.:1 Page:4 Name and AddressKind of WorkAmt of ContractRetention(inc. Current)Net of PreviousPaymentsNet AmountThis PaymentBalance toBecome Due+Extras-CreditsAdj Contract TotalContingency, Allowance$100, $ $ $100, $ $ $ $100, No.:Draw No.:1 Page:5 Amt of ContractRetention(inc. Current)Net of PreviousPaymentsNet AmountThis PaymentBalance toBecome DueTOTAL$16,758, $ $ $ $16,758, OF ORIGINAL CONTRACT$16,758, TO CONTRACT$ CONTRACT AND EXTRAS$16,758, TO CONTRACT$ TOTAL CONTRACT$16,758, COMPLETED TO DATE$ RETAINED$ AMOUNT EARNED$ PREVIOUSLY PAID$ AMOUNT OF THIS PAYMENT$ TO BECOME DUE (Inc.)