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CONTRACTOR'S PAY REQUEST (DISTRIBUTION: <br />2017 PUMA STREET UTILITY IMPROVEMENTS (CONTRACTOR (1) <br />1'1- ID 'OWNER (1) <br />CITY OF RAMSEY, MN (ENGINEER (1) <br />BMI PROJECT NO. R16.114473 (BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $727,667.07 <br />TOTAL, COMPLETED WORK TO DATE 1 $727,076.40 <br />TOTAL, STORED MATERIALS TO DATE 1 $0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED 1 $0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS 1 $727,076.40 <br />RETAINED PERCENTAGE ( 5% ) 1 $36,353.82 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) 1 $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE 1 $690,722.58 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES I $619,046.29 <br />PAY CONTRACTOR AS ESTIMATE NO. 3 I $71,676.291 <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 />Douglas -Kerr Underground, LLC <br />2142 330th Ave <br />Mora, MN 55051 <br />ame <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 Xo ��S,i /,� , PROJECT MANAGER <br />KEVIN P. KIELB, P.E. <br />Date 7/11/2018 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />By .... � C eVt3 ts,". — 1-I(3(( <br />Name Title Date <br />And <br />Name Title Date <br />