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I <br /> I <br /> I' <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br />,I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> <br />FINALPAYMENTPHASEI <br /> <br />PIease verify the amount of previous payments, if any, and the receipt of the following items prior to making payment. <br />1. Certificate of claims payment (lien waiver), <br /> <br />2, Affidavit of payment of States taxes (MN State TAX Form 134), <br /> <br />3. Letter of consent from surety firm, <br /> <br />APPROVALS: <br />CONTRACTOR'. <br /> Certification by C,e~ctor: I certify tha.~items <br /> <br /> ~2t?,. ~ ,.~ ~ ~.~"' <br /> <br />and amounts are correct for the work completed to date. <br /> <br />Date: <br /> <br />ENGINEER: Certification by Engineer: We ~recommend payment for work and quantities as. shown. <br /> HAKANSON '7~IDER"'SON A~SOCIA]~. S' I~C~ -- <br /> <br />OWNER: ~¢ ~~ ~¢ <br /> c~ OF ~SEY .,.'..'"" / . ·/~ ' ' <br /> <br /> ~tle: ~; [~ ~ t'~c ~ Date: IZ /~/0 ~ <br /> <br />~haOl~shared docs~municipal~aramsey~ra417pe4.xl$ <br /> <br />Engineer <br /> <br />12J712001 <br /> <br /> -163- <br /> <br /> <br />