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CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />CONTRACTOR (1) <br />NW SANITARY SEWER AND WATERMAIN EXTENSION <br />OWNER (1) <br />CITY OF RAMSEY <br />ENGINEER 1 <br />BMI PROJECT NO.: 012.35976 <br />BONDING CO, (1 <br />TOTAL AMOUNT BID PLUS APPROVED CHANCE ORRERS <br />$6,693,820.17 <br />TOTAL, COMPLETED WORK TO DATE <br />$6,449,589.27 <br />TOTAL, STORED MATERIALS TO DATE <br />$31,302.74 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$31,302.74 <br />TOTAL COMPLETED WORK & STORED MATERIALS <br />$6,449,589.27 <br />TOTAL RETAINED PERCENTAGE 0% <br />$0.00 <br />TOTAL AMOUNT. RETAINED ON PREVIOUS ESTIMATES <br />$127,524.89 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR DEDUCTIONS <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$6,449,589.27 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$6,248,719,38 <br />RELEASE FROM RETAINAGE ACCOUNT AS ESTIMATE NO. FINAL <br />$127,524.89 <br />PAY CONTRACTOR AS ESTIMATE NO. FINAL <br />$73,345.00 <br />Certificate for Final 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 changes, and that the foregoing is a true and correct statement of the amount <br />for the Final Estimate, that the provisions of M. S. 290.92 have been complied with and that <br />all claims against me by reason of the Contract have been paid or satisfactorily secured. <br />Contractor: LaTour Construction <br />1234 Country Road 8 Northwest <br />Maple lake, MN 5 <br />By <br />/ Name Title <br />Date <br />Approved <br />Contractor's Surety <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BO N MENK, INC., VEERS, 7533 SUNWOOD DRIVE, RAMSEY, MN. <br />By _ PROJECT ENGINEER <br />Justin emrlte, P,E. <br />Date <br />APPROVED FOR PAYMENT: - <br />OWNER: City of Ramsey <br />By , �I�G✓ PGA �o 0 <br />Name Title Date <br />And <br />Name Title Date <br />