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Estimate Number: 4 <br />Pay Estimate Summary Sheet <br />Partial <br />Project Number: 21-04 <br />Project Name: 2021 Neighborhood Pavement Overlay Improvements <br />Period Ending October 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 $ 3,915.87 <br />Percent Complete 99% <br />5 Retainage 5 % <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 />$ 421, 410.74 <br />$ 421,410.74 <br />$ 417,494.87 <br />$ 20, 874.74 <br />$ 393,698.66 <br />$ 414,573.40 <br />$ 2,921.47 <br />Certification of Partial Payment <br />1 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 />Obrn <br />Contractor Name Print Name <br />Title <br />Signature <br />d $aoa� <br />Date <br />City of Ramsey Approval <br />Sig ture (Project Engineer) Date <br />Signature (City Engineer) µ ; Date <br />Pay Estimate Page 1 of 2 <br />