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Pay Estimate Summary Sheet <br />Estimate Number; 3 Partial <br />Project Number: 22-04 <br />Project Name: <br />Period Ending <br />2022 Neighborhood Pavement Overlay Improvements <br />October 31, 2022 <br />Contractor: North Valley, Inc. <br />Address: 20015 Iguana Street NW, Suite 100, Nowthen, MN 55330 <br />1 Original Contract Amount <br />2 Change Order(s) No. Thru No. <br />3 Total Funds Encumbered <br />4 Value of Work Completed <br />5 Retainage 5 % <br />Percent Complete 96% <br />6 Deductions or Charges <br />7 Total Earned Less Retainage (Lines 4+5+6) <br />8 Previous Payment(s) <br />9 Payment Due (Lines 7-8) <br />10 Total Balance to Finish, Including Retainage (Lines 3-7) <br />732,929.10 <br />$ 732,929.10 <br />$ 699, 998.52 <br />$ (34,999.93) <br />$ 664,998.59 <br />$ 528,217.49 <br />$ 136,781.10 <br />$ 67,930,51 <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 />Neg4\ (LA <br />Contractor Name <br />e ., \ ; L <br />ir+ <br />iA)-13N' <br />-(-1)-\00r11\ <br />Print Name <br />Title Signature <br />Ct <br />Date <br />City of Ramsey Approval <br />�r 4 <br />Sigyiature (Project Engineer) <br />„I? <br />Signature (City Engineer) <br />Date <br />Date <br />Pay Estimate Page 1 of 2 <br />