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Pay Estimate Summary Sheet <br />Estimate Number: 3 Partial <br />Project Number: 21-04 <br />Project Name: 2021 Neighborhood Pavement Overlay improvements <br />Period Ending August 31, 2021 <br />Contractor: North Valley, Inc. <br />Address: 20015 Iguana Street NW, Suite 100, Nowthen, MN 55330 <br />1 Original Contract Amount <br />2 Change Order(s) No. Thru No. <br />3 Total Funds Encumbered <br />4 Value of Work Completed <br />Value of Work Remaining $ 6,991.10 <br />Percent Complete 98% <br />5 Retainage 5 °Io <br />6 Previous Payment(s) <br />7 Deductions or Charges <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) <br />Payment Due (Lines 4-8) <br />$ 421,410.74 <br />$ 421,410.74 <br />$ 414,419.64 <br />$ 20,720,98 <br />$ 387,748, 8'1 <br />$ 408,469.79 <br />5,949.85 <br />Certification of 'Partial Payment <br />I hereby certify that, t❑ 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 />North Valley, Inc. <br />Leslie A. Bloom <br />Contractor Name Print Name <br />Vice President <br />Title <br />mature <br />September 15, 2021 <br />Date <br />City of Ramsey Approval <br />Sign6ture (Project Enginieer) <br />Signature (City Engineer) <br />Date <br />Date <br />Pay Estimate Page 1 of 2 <br />