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TOTAL SCHEDOI~Iq "AC": <br /> Less Pay Estimate No. 1: <br /> Less Pay Estimate No. 2: <br /> Less Pay Estimate No. 3: <br /> Less Pay Estimate No. 4: <br /> Less Pay Estimate No. 5: <br /> <br />WE ~ ~ PAYMENT OF: <br /> <br />Please verify the above amounts and the receipt of the following items <br />the contractor prior to making final payment. <br /> <br />1. Certificate of Claims Payment (Lien Waiver), <br />2. Affidavit for Payment of State .Taxes (Minn. <br />3. Letter of Consent fr~m surety firm. <br /> <br />State Tax' Form 134), <br /> <br />$17,030.00 <br />$76,894.96 <br />$46,953.03 <br /> <br />$140,877.99 <br /> $21,927.43 <br /> $17,955.00 <br /> $83,522.07 <br /> $4,275.00 <br /> $1,485.34 <br /> <br />$11,713.15 <br /> <br />Certification by Contractor: I certify that all items ~nd <br />amounts shown are correct for the work completed to date. <br /> <br />~UFFAID BITUMINOUS, INC. <br /> <br />Signed: <br /> <br />Title: <br /> <br />HAKANSON ANDERSON ASS(XIIATES, <br /> <br />signed: <br />Title: <br /> <br />File: <br /> <br /> CITY OF RAMSEY <br /> signed: <br /> Title:. <br /> Date: <br /> <br />RA3: 15-106 <br /> <br /> <br />