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CONTRACTOR'S PAY REQUEST NO, 1 CONTRACTOR OWNER <br />ERMINE BOULEVARD CULVERT REPLACEMENT ENGINEER <br />CITY OF RAMSEY <br />BMI PROJECT NO. 813.39195 <br />TOTAL CONTRACT AMOUNT WITH APPROVED CHANGE ORDERS <br />$110,787.34 <br />$ 88,730.38 <br />TOTAL, COMPLETED WORK TO DATE <br />TOTAL, STARED MATERIALS TO DATE <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $ <br />$ 88,730.38 <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />$ 4,436.52 <br />RETAINED PERCENTAGE ( 8% ) <br />$ <br />TOTAL AMOUNT OF OTHER DEDUCTIONS <br />$ 84,293.86 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$ $4,293.86 <br />PAY CONTRACTOR AS ESTIMATE NO. 1 <br />Certificate for Partial Payment <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices <br />of work and material shown on this Estimate are correct and that all work has been <br />performed In full accordance with the terms and conditions of the Contract for this project <br />between the Owner and the undersigned Contractor, and as amended by any <br />authorized <br />changes, and that the <br />the foregoing Is <br />this Estimate, <br />correct statement of the <br />Estimate <br />Contractor, g Excavating <br />.:tclaViking Blvd, <br />Ariake, MN 55303: n f <br />j Name! 1, <br />Date <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />BOLTON & MENK, INC„ ENGINEERS, 2638 HAD !W LN, SUITE 200, CHASKA MN 55318 <br />, • '' , Project Manager <br />By; ,— <br />DAVID MARTINI, P. <br />Date: DECEMBER 1, 2008 <br />APPROVED FOR PAY,M 07 -' <br />Owner: CITY OF 'AMSEY <br />• <br />B .rd�'•" <br />Y <br />Name 6� <br />Title <br />—1 20 F, \RAMS1R1339195 \Excel \pay request 1.xls <br />Title <br />I l ti /41 <br />I ate <br />