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Pay Estimate Summary Sheet <br />Estimate Number: <br />Project Number: <br />Project Name: <br />Period Ending <br />Partial <br />23-01 (S.A.P. 199-123-001) <br />161st Avenue Reconstruction <br />June 30, 2023 <br />Contractor: Northern Lines Contracting, Inc. <br />Address: 11039 Lamont Avenue NE, Hanover, MN 55341 <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 22% <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 />1,244,237.29 <br />$ 1,244,237.29 <br />277,659.75 <br />$ (13,882.99) <br />$ 263,776.76 <br />$ 38,022.04 <br />$ 225,754.72 <br />$ 980,460.53 <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 />2d/1g irctaf <br />Contractor Name Print Name <br />LE-af Title ) <br />Date <br />be:trZik/4" <br />City of Ramsey Approval <br />Signature (Project Engineer) <br />3/124 <br />Date <br />7 /13 <br />Signature (City Engineer) Date <br />Pay Estimate Page 1 of 3 <br />