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_ -O <br />CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />RIVERDALE DRIVE EXTENSION IMPROVEMENTS <br />S.A.P. 119-115-003 <br />CITY OF RAMSEY, MN, SP 0202-101 <br />BMI PROJECT NO. R16.111092 <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$701,270.54 <br />TOTAL, COMPLETED WORK TO DATE <br />$726,535.09 <br />TOTAL, STORED MATERIALS TO DATE <br />$0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />$726,535.09 <br />RETAINED PERCENTAGE ( 0%) <br />$0.00 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$726,535.09 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$681,892.51 <br />PAY CONTRACTOR AS ESTIMATE NO. 5 - FINAL <br />$44,642.58 <br />Certificate for Final Payment <br />I hereby certify that, to the best of my knowledge and belief, all <br />of work and material shown on this Estimate are correct and that <br />performed in full accordance with the terms and conditions of the <br />between the Owner and the undersigned Contractor, and as amended <br />authorized changes, and that the foregoing is a true and correct <br />for the Final Estimate, that the provisions of M. S. 290.92 <br />all claims against me by reason of the Contract have been <br />Contractor: Douglas -Kerr Underground, <br />2142 330th Ave <br />` Mora, MN 5051 <br />By�-/ <br />items quantities and prices <br />all work has been <br />Contract for this project <br />by any <br />statement of the amount <br />have been complied with and that <br />paid or satisfactorily secured. <br />LLC <br />Gme <br />Date /.3--.)6•-fE <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 eA.A..,---\. .c,P�%� , PROJECT MANAGER <br />KEVIN P. KIELB, P.E. <br />Date 12/26/2018 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />By •-a— c--.--12-- Ci G (,-‘Q 0 r ) (l il--/ (9 <br />Name Title Date <br />And <br />Name Title Date <br />