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,;? 3 -16,R <br />Estimate Number: <br />Project Number: <br />Project Name: <br />Period Ending <br />Pay Estimate Summary Sheet <br />Partial <br />23-14 <br />2023 Critical Mill and Overlay Improvements <br />June 30, 2023 <br />Contractor: Diversified Paving <br />Address: 56 33rd Avenue S, #322, St. Cloud, MN 56301 <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 %�1. <br />Percent Complete 100% <br />6 Deductions or Charges $ <br />7 Total Earned Less Retainage (Lines 4+5+6) $ 290,051.04 <br />8 Previous Payment(s) $ .. <br />9 Payment Due (Lines 7-8) $ 290,051.04 <br />10 Total Balance to Finish, Including Retainage (Lines 3-7) $6'4) <br />310,671.88 <br />$ 310,671,88 <br />$ 305,316.88 <br />(15,26584) <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 />Qe,b, <br />Name Print Na e <br />Contractor <br />file <br />Sig ature <br />,2oz 3 <br />Date <br />City of Ramsey Approval <br />Signature (Project Engineer) <br />Date <br />Signature (City Engineer} ea <br />Pay Estimate Page 1 of 2 <br />