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j 8 - I iJ <br />CONTRACTOR'S PAY REQUEST DISTRIBUTION: 1 <br />RIVERDALE DRIVE EXTENSION IMPROVEMENTS 'CONTRACTOR (1) <br />S.A.P. 119-115-003 /(o ,� (OWNER (1) 1 <br />CITY OF RAMSEY, MN (ENGINEER (1) 1 <br />BMI PROJECT NO. R16.111092 (BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $701,270.541 <br />TOTAL, COMPLETED WORK TO DATE $717,781.591 <br />TOTAL, STORED MATERIALS TO DATE $0.00] <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.001 <br />TOTAL, COMPLETED WORK & STORED MATERIALS $717,781.591 <br />RETAINED PERCENTAGE ( 5%) $35,889.08 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $681,892.51 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $535,179.39 <br />PAY CONTRACTOR AS ESTIMATE NO. 4 $146,713.12 <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 />Douglas -Kerr Underground, LLC <br />2142 330th Ave <br />Mora, MN 55051 <br />By <br />Ime <br />Date 7"'1h <br />Title <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br />By /Sv,�� �,/��� , PROJECT MANAGER <br />KEVIN P. KIELB, P.E. <br />Date 7/11/2018 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />By E,(d,t,c� <br />Name <br />And <br />6 ( ? <br />itle Date <br />Name Title Date <br />