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Pay Estimate Summary Sheet <br />Estimate Number: 2 Partial <br />Project Number: 21-02 <br />Project Name: Tiger Street Reconstruction <br />Period Ending September 30, 2021 <br />Contractor: North Valley, Inc. <br />Address: 20015 Iguana Street NW, Suite 100 Nowthen, MN 55330 <br />1 Original Contract Amount $ 224,552.19 <br />2 Change Order(s) No, 1 Thru No. 1 $ 41,039.00 <br />3 Total Funds Encumbered $ 265,591.19 <br />4 Value of Work Completed $ 252,298.04 <br />Value of Work Remaining $ 13,293.15 <br />Percent Complete 95% <br />5 Retainage 5 °/o $ 12,614.90 <br />6 Previous Payment(s) $ 214,486.53 <br />7 Deductions or Charges <br />8 Total Retainage, Payments & Deductions (Lines 5+6+7) $ 227,101.43 <br />Payment Due (Lines 4-8) <br />$ 25,196.61 <br />Certification of Partial Payment <br />l 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 />North Valley, Inc. Timothy P. Erickson <br />Contractor Name <br />Secretary/Treasurer <br />Title <br />Print Name <br />7:2 <br />.r� <br />Signature <br />October 14, 2021 <br />Date <br />City of Ramsey Approva <br />SIg ature (Project Engineer) <br />c)„,3 <br />Signature (City Engineer) <br />Date <br />Date <br />Pay Estimate Page 1 of 2 <br />