Laserfiche WebLink
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 />$176,836.19 <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 />$176,836.19 <br />RETAINED PERCENTAGE ( 2%) <br />$3,536.72 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$173,299.46 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$165,144.05 <br />PAY CONTRACTOR AS ESTIMATE NO. 5 <br />$8,155.41 <br />Certificate for Final 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 amount <br />for the Final Estimate, that the provisions of M. S. 290.92 have been complied with and that <br />all claims against me by reason of the Contract have been paid or satisfactorily secured. <br />Contractor: North Valley, Inc. <br />20015 Iguana St NW #100 <br />Nowthen, N 5 30 <br />By aik, kL \\J A �, <br />Name Title <br />Date ‘1ID\'at <br />Approved <br />Contractor's Surety <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, <br />,Y By � 04)9 —, SENIOR PROJECT <br />MN 55303 <br />MANAGER <br />Kevin Kielb, P.E. <br />Date January 12, 2018 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY, MN <br />E)A.LiAA—C e, i'b it <br />6 g <br />By e-.c, 6". 1 i - c- t <br />Name Title Date <br />And <br />Name Title Date <br />