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SCHEILrLE 4. 000 - IMPRQV~ENT PRfl/ECT 90-6 - DYS~ ST. <br /> <br /> Estimated Used <br />Item ~3__mntity To Date <br /> <br />1. 2356.505 Bituntinous Material <br /> <br />Extension <br /> <br />3600 GAL 3608 GAL $0.8106 GAL $2,924.64 <br /> <br />2. 2356.507 Seal Coat Aggregate <br />TOTAL SCHE~ 4.000: <br /> <br />190 T- 187 T $16.88 T <br /> <br />$3,156.56 <br /> <br />$6,081.20 <br /> <br />$19,195.84 <br /> <br />Please verify the amount of previous payments, if any, and the receipt by the <br />City of the following items from the contrmctor prior to making payment. <br /> <br />1. Certificate of Claims Payment (Lien Waiver), <br />2. Affidavit for Payment of State Taxes (Minn. <br />3. Letter of Consent from surety firm. <br /> <br />State Tax Form 134), <br /> <br />OONTRACTOR: Certification by Contractor: I certify that all items and amounts <br /> ~ are correct for the work completed to date. <br /> <br />BISUMINOUS ~YS, INC. <br />Signed: <br /> <br />Title: Date: <br /> <br />HAKANSON ANDERSON ASSOCIkTES, INC. <br />signed: <br /> <br />Title: Date: <br /> <br />CITY OF RAMSEY <br /> <br />signed: <br />Title: <br /> <br />Date: <br /> <br />File: RA3:01-122 <br /> <br /> <br />