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Pay Estimate Summary Sheet <br />Estimate Number: 3 Partial <br />Project Number: 21-05 <br />Project Name: 2021 MSA Pavement Overlay Improvements <br />Period Ending August 31, 202'I <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 $ 36,740.27 <br />Percent Complete 82% <br />$ 206,395,58 <br />$ 206,395.58 <br />169,655,31 <br />5 Retainage 5 % $ 8,482.77 <br />6 Previous Payment(s) $ 155,333.51 <br />7 Deductions or Charges <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) $ 163,816.28 <br />Payment Due (Lines 4-8) <br />$ 5,839.03 <br />Certification of Partial. Payment <br />I 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 />1\lif3A"\t‘ raket e)C 6 Lee V <br />e 4,4'anYY) <br />Contractor Name ,O Print Name <br />\V\ e a(RczesN\d-e <br />Title <br />Signature <br />GDate D <br />City of Ramsey Approval <br />Signature (Project Engineer) Date <br />Signature (City Engineer) Date <br />Pay Estimate Page 1 of 2 <br />