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Estimate Number: 2 <br />Pay Estimate Summary Sheet <br />Final <br />Project Number: 21-06 <br />Project Name: <br />Period Ending <br />Contractor: <br />2021 Crack Seal Improvements <br />September 30, 2021 <br />Northwest Asphalt and Maintenance <br />Address: 11560 190th Street NE, Thief River Falls, MN 56701 <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 <br />Percent Complete <br />5 Retainage 0 % <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 />(8,768.43) <br />100% <br />$ 110,428.07 <br />$ 110,428.07 <br />$ 119,196.50 <br />$ 113,236,67 <br />$ 113,236.67 <br />$ 5,959,83 <br />Certificaiton of Final 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 amount for the Final Estimate, the provisions of M.S. 290.92 have been <br />complied with and that all claims against me by reason of the contract have been paid or satisfactorily secured. <br />/Joritlawes <br />Contractor Name <br />Title <br />der 3-DA <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 2 <br />