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11 <br />REQUEST FOR PAYMENT <br />Deep Well No. .Y=i <br />City Project No. 96=1- C1%a2- <br />File No. 43802 <br />'SUMMARY <br />1 Original Contract Amount <br />2 Change Order - Addition <br />3 Change Order - Deduction <br />4 Revised Contract Amount <br />'5 Value Completed to Date <br />6 Material on Hand (Well No. 4 Casing) <br />7 Amount Earned <br />8 Less Retainage 5% Well No. 4 Only (.05 x $23,439.67) <br />9 Subtotal <br />10 Less Amount Paid Previously <br />' 11 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br />9 <br />' Recommended for Approval : <br />PP b Y <br />' BONESTROO, ROSENE, ANDERLIK & ASSOCIATES, INC. <br />1 <br />Approved by Contractor: <br />Alberg Water Services, LLC <br />Specked Contract Completion Date: <br />Approved by Owner: <br />City of V <br />Date: <br />$ 192,420.00 <br />$ 192,420.00 <br />$ 131,921.50 <br />$ 13,433.67 <br />$ 145,355.17 <br />$ 1,171.98 <br />$ 144,183.19 <br />$ 136,691.24 <br />$ 7,491.95 <br />t ti 5h S 1 U f r <br />1.\43B\43B02\REQUEST9.WB2 X I <br />