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CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />MISSISSIPPI RIVER TRAIL <br />CITY OF RAMSEY, MN <br />SP 199-090-001 <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$177,040.64 <br />TOTAL, COMPLETED WORK TO DATE <br />$173,835.85 <br />TOTAL, STORED MATERIALS TO DATE <br />$0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />$173,835.85 <br />RETAINED PERCENTAGE ( 5%) <br />$8,691.79 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$165,144.05 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$106,032.57 <br />PAY CONTRACTOR AS ESTIMATE NO. 4 <br />$59,111.48 <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: North Valley, Inc. <br />20015 Iguana St NW #100 <br />Nowthen, MN 55330 <br />By ,� i;,r <br />'Brad Sdtheper Name Title <br />Date Sspbarber 14, 2015 <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br />By�``"� ��`� , SENIOR PROJECT MANAGER <br />Kevin Kielb, P.E. <br />Date September 16, 2015 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY, MN <br />By % G( v,L /z:-411— c v 2 -/C <br />Name Title Date <br />And g tAA,e . L--...-\-Q-4.-----Th Ci �.e r- 2 ( S / ( C <br />Name Title Date <br />