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CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />2017 PUMA STREET UTILITY IMPROVEMENTS <br />CITY OF RAMSEY, MN <br />BMI PROJECT NO. R16.114473 <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$727,667.07 <br />TOTAL, COMPLETED WORK TO DATE <br />$230,884.28 <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 />$230,884.28 <br />RETAINED PERCENTAGE ( ' 5%) <br />$11,544.21 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$219,340.06 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$0.00 <br />PAY CONTRACTOR AS ESTIMATE NO. 1 <br />$219,340.06 <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: Douglas -Kerr Underground, LLC <br />2142 330th Ave <br />` Mora, 55051 <br />� <br />By r ill ."n4_i v, <br />ame Title <br />Date / -)- - / / - l 7 <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br />By,5.,--k aZ) A.461- , PROJECT MANAGER <br />KEVIN P. KIELB, P.E. <br />Date 12/11/2017 <br />APPROVED FOR PAYMENT: . <br />OWNER: CITY OF RAMSEY <br />By e.1 ak,,r1,.¢.u— I Z l t 4- ( 1 7- <br />Name Title Date <br />And <br />Name Title Date <br />