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PAY ESTIMATE #10 (FINAL) Owner <br />Ramsey Town Center Phase 2, Segment 1 Improvements <br />Zeolite Street NW, Civic Center Drive NW and Sapphire Street NW <br />Improvement Project No. 05 -22 <br />Please verify the amount of previous payments, and the receipt of the following items prior to making payment. <br />1. Certificate of claims payment (lien waiver), <br />2. Affidavit of payment of States taxes (MN State TAX Form IC 134); <br />3. Letter of consent from surety firm. <br />APPROVALS: <br />CONTRACTOR: W.B. MILLER, INC. <br />Certification by Contractor. I�ify that all items and amounts are correct for the work completed to date. <br />Signed: <br />Title: Date <br />ENGINEER: HAKA SON ANDERSON ASSOCIATES, INC. <br />Certification by Engineer. We recommend payment for work and quantifies as shown. <br />Signed �- c _ - <br />Titl __ ,, _ ,ate <br />OWNER: CITY OF RAMSE <br />Signed: ( "�- <br />Title //' yG Date / S <br />PF_4 nf3 <br />-73- <br />