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CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />2020 PUMA STREET IMPROVEMENTS <br />SAP 199-109-007 <br />CITY OF RAMSEY <br />CITY PROJECT NO. 20-04 <br />RM I PROJECT NO, R12.121681 <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$622,062.11 <br />TOTAL, COMPLETED WORK TO DATE <br />$276,111.23 <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 & STOREDMATERIALS <br />$276,111.23 <br />RETAINED PERCENTAGE ( 5/) <br />$13,805.56 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$262,305.67 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$0.00 <br />PAY CONTRACTOR AS ESTIMATE NO. 1 <br />$262,305,67 <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: Douglas -Kerr Underground, L.L.C. <br />POBox85 <br />Mora, MN 55051 <br />By r li , �,:.,�. <br />ame Title <br />Date eN Y „ , :- % rl.v .: v <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTO& MENK, INC. 7533Sunwood Drive NW, Suite 206, Ramsey, MN 55303 <br />By <br />, PROJECT ENGINEER <br />Date 9/14/2020 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF RAMSEY <br />By <br />And <br />Name <br />76-0y //' 1/2V/;70c7c) <br />Title <br />Date <br />( I 4, 2-0 <br />Name Title Date <br />