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CONTRACTOR'S PAY REQUEST DISTRIBUTION: <br />MISSISSIPPI RIVER TRAIL CONTRACTOR (1) <br />CITY OF RAMSEY, MN OWNER (1) <br />SP 199-090-001 ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $183,272.52 <br />TOTAL, COMPLETED WORK TO DATE $2,169.90 <br />TOTAL, STORED MATERIALS TO DATE $0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS $2,169.90 <br />RETAINED PERCENTAGE ( 5%) $108.50 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $2,061.41 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $0.00 <br />PAY CONTRACTOR AS ESTIMATE NO. 1 $2,061.41 <br />Certificate for Partial Payment <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices <br />of work and material shown on this Estimate are correct and that all work has been <br />performed in full accordance with the terms and conditions of the Contract for this project <br />between the Owner and the undersigned Contractor, and as amended by any <br />authorized changes, and that the foregoing is a true and correct statement of the <br />contract amount for the period covered by this Estimate. <br />Contractor: <br />By <br />Date <br />North Valley, Inc. <br />20015 Iguana St NW #100 <br />Ik iver,lll �130 <br />Name <br />Title <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br />By e - a6 21., <br />Kevin Kielb, P.E. <br />Date <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMS <br />By <br />ame <br />eith <br />Title <br />And 3.tQ C _ e,0 ,i-4--Li i Name Title Date <br />, SENIOR PROJECT MANAGER <br />5////c <br />Date <br />