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i <br /> } Pay Estimate Summary sheet <br /> Estimate Number: 4 Final <br /> Project Number: 21-12 <br /> Project Name: 2021 Additional 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 $ 553,416.50 <br /> 2 Change Order(s) No. Thru No. <br /> 3 Total Funds Encumbered $ 553,416.59 <br /> 4 Value of Work Completed $ 600,022.41 <br /> Value of Work Remaining $ <br /> Percent Complete 100% � <br /> 5 Retainage 0 % $ <br /> l <br /> 5 Previous Payment(s) $ 5702021.29 <br /> } <br /> 7 Deductions or Charges <br /> 8 Total Retainage, Payments & Deductions (Lines 5+6+7) 570 021.29 <br /> $ <br /> F <br /> Payment Due (Lines 4-8) $ 30,001.12 <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 /> s <br /> i; <br /> N=ffi Lz! Ire. <br /> y <br /> Contractor Name Print Name == <br /> j <br /> Title Signature <br /> s <br /> gMML <br /> s'l4 202 <br /> Date <br /> F <br /> City of Ramsey Approval <br /> 2, <br /> i: <br /> Signature (Project Engineer) Date <br /> t, se� <br /> Signature (City Engineer) Date <br /> Pay Estimate Page 1 of 2 <br />