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Pay Estimate Summary Sheet <br />Estimate Number: 3 Partial <br />Project Number: 21-03 <br />Project Name: <br />Period Ending <br />Contractor: <br />Address: <br />Business Park 95 Street Reconstruction <br />September 30, 2021 <br />North Valley, Inc. <br />20015 Iguana Street NW, Suite 100, Nowthen, MN 55330 <br />1 Original Contract Amount <br />2 Change Order(s) No. 1 Thru No. 1 <br />3 Total Funds Encumbered <br />4 Value of Work Completed <br />Value of Work Remaining $ 1,563.24 <br />Percent Complete 100% <br />5 Retainage 5 °/v <br />6 Previous Payment(s) <br />7 Deductions or Charges <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) <br />$ 942,685,58 <br />$ 9,750.00 <br />$ 952,435.58 <br />$ 950,872.34 <br />47,543.62 <br />$ 869,338.66 <br />$ 916,882.28 <br />Payment Due (Lines 4-8) $ 33,990.06 <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 />theforegoing is a true and correct statement of the contract amount for the period covered by this estimate. <br />North Valley, Inc. <br />Contractor Name <br />Secretary/Treasurer <br />Title <br />Timothy P. Erickson <br />Print Name <br />21;0- <br />Signature <br />October 14, 2021. <br />Date <br />City of Ramsey Approval <br />Signature (Project Engineer) <br />Signature (City Engineer) <br />Date <br />Date <br />Pay Estimate Page 1 of 4 <br />