Laserfiche WebLink
Pay Estimate Summary Sheet <br />Estimate Number: 1 Partial <br />Project Number: 21-12 <br />Project Name: 2021 Additional 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 $ 501,815,23 <br />Percent Complete 11 % <br />$ 563,416.59 <br />$ 563,416.59 <br />$ 61,601.36 <br />5 Retainage 5 % $ 3,080.07 <br />6 Previous Payment(s) $ <br />7 Deductions or Charges <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) $ 3,080.07 <br />Payment Due (Lines 4-8) <br />$ 58,521.29 <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 />\WkiL, I —SW., <br />Contractor Name <br />cg.----Q.C2-e-\ <br />Title <br />Le.,c1\t <br />Print Name <br />Signature <br />-'1A,raok <br />GeRkenNikviA tsi;bat <br />Date <br />City of Ramsey Approval <br />Signature (Project Engineer} Date <br />Signature (City Engineer) Date <br />Pay Estimate Page 1 of 2 <br />