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'1 <br /> I <br /> I <br /> <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 />I hereby certify that all items and amounts shown <br />are correct for the work completed to date. <br /> <br />Contractor <br /> <br />H & M Asphalt <br /> <br />'(Name and Title) <br /> <br />Date <br /> <br />By <br /> <br />,,T~e work on this project and the application for payment have been <br />/ r~ewed and the a~ount shown is recommended for payment. <br />/ ' '(PT~jectEngine~)'-v, // - <br /> t> <br /> <br />APPROVED FOR PAYMENT <br /> <br />Owner <br /> <br />City of Ramsey <br /> <br />By <br /> <br />(Name and Title) <br /> <br />Date <br /> <br />Page 2 o[ 5 <br /> <br />5~ <br /> <br /> <br />