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I hereby certify that all items and amounts shown <br /> are correct for the work completed to date. <br /> <br />Contractor _ H & M Asphalt <br /> (Ne ead 'tie) . -- <br /> <br /> x--, The work on this pr~ect and the application for payment have been <br />By ~' . Date ~~~~ <br /> <br /> APPROVED FOR PAYMENT <br /> <br />Owner~//. / Ci~ of Ramsey ~ <br />ay ~~ ~ Date <br /> <br />Page 2 of 5 <br /> <br /> <br />