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Ple~_~e verify the amount of pre~,ious pas.~-n~nts, if any, prior to making payment and <br />the receipt by the City of the following items from the contractor prior to maYdang <br />payment. <br /> <br />1. Certificate of Claims Payment (Lien Waiver), <br />2. Affidavit for Payment of State Taxes (Fdann. State Tax Form 134), <br />3. Letter of Consent from surety firm. <br /> <br />Certification by Contractor: I .certify that all items and <br />amounts shown are correc~ for the work completed to date. <br /> <br />W.B. MIT.~YR, INC. <br /> <br />Signed: <br /> <br />Title: <br /> <br />HAKANSON ANDERSON ASSOCIATES, INC. <br />Signed: <br /> <br />Title: <br /> <br />CITY OF RAMSEY <br /> <br />Signed: <br /> <br />Title: <br /> <br />D~ta: <br /> <br />File: RAB:15-6 <br /> <br /> <br />