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! hereby certify that all items and amounts shown <br />are correct for the work completed to date, <br /> <br />Contractor <br /> <br /> , me and Title) <br /> <br />H & M Asphalt <br /> <br />Date <br /> <br /> The work on this project and the application for payment have been <br />~iewed and th~ amount shown is recommended for payment. <br /> <br /> Date <br /> ' (Proje~ct Engmeerl <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 />Pane 2 of 5 <br /> <br />'7/ <br /> <br /> <br />