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Pay Estimate Summary Sheet <br />Estimate Number: 1 Partial <br />Project Number: 21-04 <br />Project Name: 2021 Neighborhood Pavement Overlay Improvements <br />Period Ending June 30, 2021 <br />Contractor: North Valley, Inc. <br />Address: 20015 Iguana Street NW, Suite 100, Nowthen, MN 55330 <br />I Original Contract Amount $ 421,410.74 <br />2 Change Order(s) No. Thru No. <br />Eli <br />3 Total Funds Encumbered $ 421,410.74 <br />4 Value of Work Completed $ 50,073,86 <br />Value of Work Remaining $ 371,336.88 <br />Percent Complete 12% <br />5 Retainage 5 % $ 2,503.69 <br />' e <br />6 Previous Payment(s) $ <br />7 Deductions or Charges, <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) $ 2,503.09 <br />Payment Due (Lines 4-8) <br />$ 47, 570.17 <br />Certification of Partial Payment <br />1 hereby certify that, to the best of my knowledge and belief, all items, quantities and prices of work and material shown on <br />this Estimate are correct and that all work has been performed in full accordance with the terms and conditions of the <br />Contract for this project between owner and the undersigned Contractor, and as amended by any authorized changes and <br />the foregoing is a true and correct statement of the contract amount for the period covered by this estimate. <br />rbrth vau.� Irr. <br />Contractor Name Print aae------ <br />i± <br />Title <br />Signature <br />July 9, 2021 <br />Date <br />City of Ramsey Approval <br />Signature (Project Engineer) <br />0/Lice-A- <br />Signature (City Engineer) <br />Date <br />Date <br />Pay Estimate Page 1 of 2 <br />