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` Pay Estimate Summary Sheet <br /> Estimate Number: 5 Final <br /> Project Number: 21-04 <br /> Project Name: 2021 Neighborhood Pavement overlay Improvements <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 $ 421,410.74 <br /> 2 Change Order(s) No. Thru No. <br /> 3 Total Funds Encumbered $ 421,410.74 <br /> 4 Value of Work Completed $ 41 7,494.87 <br /> Value of Work Remaining $ <br /> Percent Complete 1 00 0�o <br /> 5 Retainage ❑ % <br /> 5 Previous Payment(s) $ 396,620.13 <br /> 7 Deductions or Charges <br /> 8 Total Retainage, Payments & Deductions (Lines 5+5+7) $ 395,520.13 <br /> Payment Due (Lines 4-8) $ 20,874.74 <br /> Certlficaiton of Final 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 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 /> f. <br /> North va11Fyr inc- IesI1e A. Blom <br /> Contractor Name Print Name <br /> Title Signature <br /> Ja u ary 14, 2022 <br /> Date <br /> City of Ramsey Approval <br /> 1. <br /> Signa4ire (Project Engineer) Date <br /> Signature (City Engineers Gate <br /> Pay Estimate Page 1 of <br />