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Estimate Number: 1 <br />Pay Estimate Summary Sheet <br />Partial <br />Project Number: 22-02 <br />Project Name: Autumn Heights Street Reconstructions <br />Period Ending <br />September 30, 2022 <br />Contractor: GMH Asphalt Corporation <br />Address: 9180 Laketown Road, Chaska, MN 55318 <br />I Original Contract Amount $ 897,894.48 <br />2 Change Order(s) No. Thru No. <br />3 Total Funds Encumbered $ 897,894.48 <br />4 Value of Work Completed $ 200,555.95 <br />5 Retainage 5 % $ (10,027.80) <br />Percent Complete 22% <br />6 Deductions or Charges <br />7 Total Earned Less Retainage (Lines 4+5+6) $ 190,528.15 <br />8 Previous Payment(s) <br />9 Payment Due (Lines 7-8) $ 190,528.15 <br />I 0 Total Balance to Finish, Including Retainage (Lines 3-7) $ 707,366.33 <br />Certification of Partial Payment <br />1 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 />blOY10101A <br />Contractor Name Print111 <br />0W1 4111), <br />C'. <br />\ft <br />u.60t,e- <br />Title Signature <br />u)--(0-ga <br />Date <br />City of Ramsey Approval <br />Signature (Project Engineer) <br />Signature (City Engineer) <br />12 <br />Date <br />Date <br />Pay Estimate Page 1 of 3 <br />