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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 1130NDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $627,986.40 <br />TOTAL, COMPLETED WORK TO DATE $614,494.49 <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 $614,494.49 <br />RETAINED PERCENTAGE ( 5%) $30,724.72 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $583,769.76 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $485,934.47 <br />PAY CONTRACTOR AS ESTIMATE NO. 5 $97,835.30 <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 />Park Construction Company <br />1481 81stAvenue NE <br />Minneapolis, MN 55432 <br />#2114- <br />Name Ti <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br />By , PROJECT MANAGER <br />KEVIN P. KIELB, P.E. <br />Date <br />A-0)7 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />By C: ‘-) �J 1 Y e-Q_ - I f ( <br />Name " Title Date <br />And <br />Name Title Date <br />