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I <br />i <br />I <br />I <br />I <br />I <br />i <br />I <br /> <br /> I <br /> ! <br /> ! <br />"~ <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> <br />Contractor <br /> <br />By <br /> <br />By <br /> <br />Owner <br /> <br />By <br /> <br />I hereby certify that all items and amounts shown <br />are correct for the work completed to date. <br /> <br />H & M Asphalt <br /> <br />r'--. _~..~~ ~ ~-~4- ~' ~ Date <br /> !(Name and Title) <br /> <br /> The work on this project and the application for payment have been <br />/~~vlewed an~~unt showrl~/~~,, !Pr'oje~t Engine~r)' ' . iS rec°mmended f°r paymelti"~/~Date <br /> <br />APPROVED FOR PAYMENT <br /> <br />City of Ramsey <br /> <br />~ame and Title) <br /> <br />Date <br /> <br />Parle 2 of 5 <br /> <br />7/ <br /> <br /> <br />