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f Pay Estimate Summary Sheet <br /> Estimate Number: 1 Partial <br /> Project Number: 21-10 <br /> Project Name: Fire Station No.1 Parking Lot Improvements <br /> Period Ending May 31, 2022 <br /> Contractor: North Valley, Inc. <br /> Address: 20015 Iguana Street NW, Suite 100, Nowthen, MN 55330 <br /> I Original Contract Amount $ 104,935.73 <br /> 2 Change Order(s) No. Thru No. <br /> 3 Total Funds Encumbered $ 104,935.73 <br /> 4 Value of Work Completed $ 124,197.48 <br /> 5 Retainage 5 % $ (61209.87) <br /> Percent Complete 100% <br /> 6 Deductions or Charges <br /> 7 Total Earned Less Retainage (Lines 4+5+5) $ 117,987.61 <br /> 8 Previous Payment(s) $ <br /> 9 Payment due (Lines 7-8) $ 117,987.61 <br /> 10 Total Balance to Finish, Including Retainage (Lines 3-7) $ 8,209.87 <br /> Certification of Partial 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 contract amount for the period covered by this estimate. <br /> Contractor Dame Print Name <br /> Title Signature <br /> - r AO Z <br /> Date <br /> City of Ramsey Approval <br /> Z ez- <br /> Signa fie(Project Engineer) Date <br /> e <br /> Signature(City Engineer) Date <br /> Pay Estimate Page I of 2 <br />