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CONTRACTOR'S PAY REQUEST <br />2017 PUMA STREET UTILITY IMPROVEMENTS <br />CITY OF RAMSEY, MN <br />BMI PROJECT NO. R16.114473 <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />TOTAL, COMPLETED WORK TO DATE <br />TOTAL, STORED MATERIALS TO DATE <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />RETAINED PERCENTAGE ( 0% ) <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />PAY CONTRACTOR AS ESTIMATE NO. 4 - FINAL <br />Certificate for Final Payment <br />DISTRIBUTION: <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />$727,667.07 <br />$733,316.40 <br />$0.00 <br />$0.00 <br />$733,316.40 <br />$0.00 <br />$0.00 <br />$733,316.40 <br />$690,722.58 <br />$42,593.82 <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 />Douglas -Kerr Underground, LLC <br />2142 330th Ave <br />Mora, MN 55051 <br />4i <br />"Name <br />Date /b -.2.Y- /A <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 <br />KEVIN P. KIELB, P.E. <br />Date 10/24/2018 <br />,PROJECT MANAGER <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />By 1 As, _ -�b`1 t w V,--/3(1a <br />Title - Date <br />And <br />Name <br />Name Title Date <br />