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CONTRACTOR'S PAY REQUEST DISTRIBUTION: <br />RAMSEY WELL HOUSE NO. 3 NATURAL GAS GENERATOF CONTRACTOR (1) <br />CITY OF RAMSEY, MN OWNER (1) <br />CITY PROJECT NO. 17-06, BMI PROJECT NO. R16.113601 'ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $90,500.00 <br />TOTAL, COMPLETED WORK TO DATE $90,500.00 <br />TOTAL, STORED MATERIALS TO DATE $0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS $90,500.00 <br />RETAINED PERCENTAGE ( 0%) 1 $0.00 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE I $90,500.00 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES I $50,853.50 <br />PAY CONTRACTOR AS ESTIMATE NO. FINAL $39,646.50 <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: <br />By <br />Date <br />KILLMER ELECTRIC CO., INC. <br />5141 Lakeland Ave N <br />C stal, MN 55429 <br />Name <br />QACCD <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 Sew — <br />Kevin Kielb, P.E. <br />Date August 15, 2018 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY, MN <br />Name <br />And <br />, SENIOR PROJECT MANAGER <br />Gl\A-ees- 5 l ( <br />TitlY Date <br />Name Title Date <br />