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CONTRACTOR'S PAY REQUEST (DISTRIBUTION: <br />RIVERDALE DRIVE EXTENSION IMPROVEMENTS 16- 0 (CONTRACTOR (1) <br />S.A.P. 119-115-003 (OWNER (1) <br />CITY OF RAMSEY, MN (ENGINEER (1) <br />BMI PROJECT NO. R16.111092 'BONDING CO. (1) 1 <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $701,270.54j <br />TOTAL, COMPLETED WORK TO DATE $102,083.25 <br />TOTAL, STORED MATERIALS TO DATE $0.001 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00I <br />TOTAL, COMPLETED WORK & STORED MATERIALS $102,083.25 <br />RETAINED PERCENTAGE ( 5%) $5,104.16 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.001 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $96,979.091 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $0.00I <br />PAY CONTRACTOR AS ESTIMATE NO. 1 $96,979.091 <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 thls 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 />Douglas -Kerr Underground, LLC <br />2142 330th Ave <br />Mora, MN 55051 <br />Title <br />Date /D - 1/- /7 <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MEN, IN ., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br />By <br />KEVIN P. KIELB, P.E. <br />Date 10/11/2017 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />, PROJECT MANAGER <br />By C�tA/lo `.An e1M'� I„► c e - t,t� �(� l ( <br />Name Titl " Date <br />And <br />Name Title Date <br />