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CONTRACTOR'S PAY REQUEST DISTRIBUTION: <br /> MISSISSIPPI RIVER TRAIL- PHASE 3 CONTRACTOR(1) <br /> S.P. 199-090-002 OWNER(1) <br /> CITY OF RAMSEY, MINNESOTA ENGINEER (1) <br /> BMI PROJECT NO. R16.110941 190NDING CO. (1) <br /> [DEDUCTION <br /> OTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $627,986.40 <br /> OTAL, COMPLETED WORK TO DATE $97,402.63 <br /> OTAL, STORED MATERIALS TO DATE $0.00 <br /> FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 <br /> OTAL, COMPLETED WORK&STORED MATERIALS $97,402.63 <br /> RETAINED PERCENTAGE ( 5% ) $4,870.13 <br /> TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br /> NET AMOUNT DUE TO CONTRACTOR TO DATE $92,532.50 <br /> TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $0.00 <br /> PAY CONTRACTOR AS ESTIMATE NO. 1 $92,532.50 <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: Park Construction Company <br /> 1481 81 st Avenue NE <br /> Minneapolis, MN 55432 <br /> B <br /> Name Title <br /> Date ///L/)ZZ �90/ <br /> CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br /> ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br /> By 1 { L GG1=" , PROJECT MANAGER <br /> KEVIN P. KIELB, P.E. <br /> Date 11/08/2016 <br /> APPROVED FOR PAYMENT: <br /> OWNER: CITY OF RAMSEY <br /> By e C° E.tNe- <br /> Name Title Date <br /> And <br /> Name Title Date <br />