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Estimate Number: 1 <br />Project Number: 21-06 <br />Pay Estimate Summary Sheet <br />Partial <br />Project Name: 2021 Crack Seal Improvements <br />Period Ending August 31, 2021 <br />Contractor: Northwest Asphalt and Maintenance <br />Address: 11560 190th Street NE, Thief River Falls, MN 56701 <br />I Original Contract Amount $ 110,428.07 <br />2 Change Order(s) No. Thru No. <br />3 Total Funds Encumbered $ 110,428.07 <br />4 Value of Work Completed $ 119,196.50 <br />Value of Work Remaining $ (8,768.43) <br />Percent Complete 100% <br />5 Retainage 5 % $ 5,959.83 <br />6 Previous Payment(s) $ <br />7 Deductions or Charges <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) $ 5,959.83 <br />Payment Due (Lines 4-8) $ 113,236.67 <br />Certification of Partial Payment <br />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 />tvr/4kF Apiativ/24z4,-teiwY0 sP)e-* de - <br />Contractor Name Print Name <br />faieef-176 --Pckvc(h4/6 <br />Titl <br />Si 'ature <br />o <br />Date <br />City of Ramsey Approval <br />Siature (Project Engineer) Date <br />Si nature (City Engineer) Date <br />Pay Estimate Page 1 of 2 <br />