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Page 2 <br />November 19, 1984 <br /> <br />Total Schedule 1.000 <br />Total Schedule 2.000 <br /> <br />rF-~S PREVIOUS PAYMf~rI~ - <br />WE REC~ FINAL PAYMenT OF - <br /> <br />Please verify the amount of previous payments, if any, a~d the receipt <br />of the following items prior to making payment. <br /> <br />1. Certificate of Claims Payment (Lien Waiver), <br />2. Affidavit for Payment of State Taxes (Minn. State Tax Form 134), <br />3. Letter of Consent from surety firm. <br /> <br />APPROVALS: <br /> <br />(~CIOR: <br /> <br />Certification by Contractor: I certify that all items <br />and amounts shown are correct for the work oa~leted to <br />date. <br /> <br />H&S ASPHALT (/IMPANY <br /> <br />Signed: <br /> <br />Title: <br /> <br />Date: <br /> <br />HAKANSON ANDERSON ASSOCIATES, INC. <br /> <br />Signed: <br /> <br />Title: <br /> <br />Date: <br /> <br />THE CITY OF I~SEY <br /> <br />Signed: <br />Title: <br />Date: <br /> <br />File: RA3:15-36 <br /> ~%3:15-37 <br /> <br /> $38,578.20 <br /> $91,935.69 <br /> <br />$130,513.89 <br /> <br />$114,768.05 <br />$ 15,745.8~ <br /> <br /> <br />