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CONTRACTOR'S PAY REQUEST !DISTRIBUTION: <br />BUNKER LAKE BOULEVARD AND PUMA STREET IMPROVEMENTS CONTRACTOR (1) <br />OWNER (1) <br />CITY OF RAMSEY, MN ENGINEER (1) <br />BMI R16.115858 BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $923,458.23 <br />TOTAL, COMPLETED WORK TO DATE $376,828.15 <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 $376,828.15 <br />RETAINED PERCENTAGE ( 5%) $18,841.41 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $357,986.74 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $0.00 <br />PAY CONTRACTOR AS ESTIMATE NO. 1 $357,986.74 <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 5051 <br />By ,P14:---". I <br />Title <br />Date 9 <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE, SUITE 206, RAMSEY, MN 55303 <br />By pt /, PROJECT MANAGER <br />KEVIN P. KIELB, P.E. <br />Date 9/14/2018 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />By ,.C� \PA <br />Name <br />And <br />19(i4-OR <br />Date <br />Name Title Date <br />