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STATE OF MIN-NESOTA - DEPARTMENT OF TRANSPORTATION <br /> <br />S.TATEMENT OF WORK C E RT I F I ED <br /> <br /> BAC KS HE ET AD J'US T M ENTS <br /> (NOT ASSOCIATED WITH CbL~_NGE ORDERS) <br /> <br />Sheet NO: 23 i <br /> <br />Voucher No. 12 For Work Performed up to Augusz 26, 2003 on Conzract Z00516 <br /> <br /> Unit Mul& To Date To Oats Fed <br /> I~em Number Descripaion Uni~ Price Factor Ouanti~y Amounz PAR/NON <br /> <br /> Type of Work: Other Category: O~her Pa~zments / Credits Per Specs. <br /> <br /> 0000.O00-00000 DELseY ~ EX%~P~A WORK CLAIM (S.A.#4). L.S. 795.78 1.0000 1.00 795.78 <br /> <br /> This i:~m is justified by Specification 1403 <br /> <br /> CLAIMS DU~ ROM DELAYS A~ EXT?~ WORK O~DERD BY T~ STATE A~ T~E <br /> <br /> CITY OF ~EY. <br /> <br /> Subtotal for Group 005 is $8,057.15 <br /> <br />Group Number: 007 <br /> ~"~;pe of Work: Other Category: Miscellaneous <br /> 2521.501-00060 150 mm CONC. WAJ~K m2 29.66 1.0600 21.00 ~22.86 <br /> This item is ju~t!fied by O~her <br /> ADD 150 mm CONC. WAJ~K TO GROUP 007. <br /> <br />~;pe of Work: O=her <br /> <br />2531.501-02315 CONC. C&G DES. B618 <br /> <br />This i~em is justified by O~her <br /> <br /> ADD CONC. C&G DEE. R618 TO GROUP 0~7. <br /> <br /> CategOry: Miscellaneous <br /> <br />M 22.85 !.0000 2~.00 502.70 <br /> <br />Type of Work: Finishin~/Agr~cul&ure <br /> <br />~575.$01-00010 SEEDING <br /> <br />This i~em is justified by Other <br /> <br /> ADD SEEDING TO GROUP 7. <br /> <br />Category: Miscellaneous <br /> <br /> 300.00 1.0000 <br /> <br />0.20 60.00 <br /> <br />Type of Work: Fini:~hing/Agr~cul=ura <br /> <br />257S.502-0O302 SZ~D MIXTUR~ ~0A (MOD) <br />This i~em is jus=ified by O=her <br /> ADD SE~D MLXTURE 3UA (MOD) TO GROUP 7. <br /> <br /> Ca=egory: Miscellaneous <br /> <br />KG 18.25 1.0000 11.00 200.75 <br /> <br />'l~pe of Work: Finishing/Agri~ul=ure <br /> <br />2575.SI1-00010 ~.K3LCH MATERIAL TYPE 1 <br /> <br />This i~em is jus~£fi~d by Other <br /> <br /> ADD ~C~ MATERIAL TYPE i TO GROUP 7. <br /> <br /> Category: Miscellaneous <br /> <br />T 110.00 1.0000 <br /> <br />1.10 121.00 <br /> <br />LOW S.P. NLR4BER 199-010-03 <br /> <br />FOR WORK COMPLETED AS OF 08/26/2003 <br /> <br />Contract Number: <br /> <br />-262- <br /> <br /> <br />