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} Pay Estimate Summary Sheet <br /> Estimate Number: 4 Final <br /> Project Number: 21702 <br /> Project Name: Tiger Street Reconstruction <br /> Period Ending December 31, 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 $ 253,902.26 <br /> Value of Work Remaining $ <br /> o <br /> Percent Complete 100/0 <br /> 5 Retainage 0 % <br /> 6 Previous Payment(s) $ 241,207.15 <br /> c <br /> a <br /> 7 Deductions or Charges <br /> 8 Total Retainage, Payments & Deductions (Lines 5+5+7) $ 241,207.15 <br /> Payment Due (Lines 4-8) $ 12,695.11 <br /> Certificaiton of Final Payment <br /> I hereby certify that,to the best of m knowledge and belief,all items quantities and prices of work and material shown o Y ,q p n <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 /> _ I <br /> NMww� Inc, <br /> Zlie A. Blacm <br /> Contractor Name Print Name <br /> Pbasident <br /> Title Signature <br /> Jmuary 14, 2022 <br /> Date <br /> City of Ramsey Approval <br /> l'l <br /> r y ' <br /> Signaty a (Project Engineer) Date <br /> Ag- i <br /> �.� <br /> Signature (City Engineer) ^ Date <br /> Pay Estimate Page l of 2 !' <br />