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Pay Estimate Summary sheet <br /> Estimate Number: I Final <br /> Project Number; 22-08 <br /> Project Name: 2022 Crack Seal Improvements <br /> Period Ending May 31, 2022 <br /> Contractor: Northwest Asphalt & Maintenance <br /> Address: 11560 190th Street NE, Thief river Falls, MN 56701 <br /> I Original Contract Amount $ 108,779.90 <br /> 2 Change Order(s) No. Thru No. <br /> 3 Total Funds Encumbered $ 198,779.90 <br /> 4 Value of work Completed $ 97,38 1.80 <br /> 5 Retainage 0. % $ - <br /> Percent Complete 100% <br /> 6 Deductions or Charges $ (750.00) <br /> 7 Total Earned Less Retainage (Lines 4+5+6) $ 96,631,80 <br /> 8 Previous Payment(s) $ <br /> 9 Payment Due (Lines 708) $ 96 631,80 <br /> 10 Total Balance to Finish, Including Retainage (Lines 3-7) $WA <br /> M <br /> Certificalton of Final Payment <br /> l hereby certify that,to the best of my Itnowledge and belief,all items,quantities and prices of work and material shown on <br /> this Estimate are correct and that all worlt 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 /> K <br /> WL&U2LL _T�m UA <br /> Contractor Name Print Name <br /> Title nature <br /> Gate <br /> r <br /> City of Ramsey Approval <br /> o <br /> Si re Prvaect En ineer date <br /> 9n i g <br /> Si nature (City Engineer) Gate . <br /> Pay Estimate Page I of 2 ; <br /> I <br />