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Estimate Number: <br />Project Number: <br />Project Name: <br />Period Ending <br />Contractor: <br />Pay Estimate Summary Sheet <br />3 <br />23-01 (S.A.P. 199-123-001) <br />Partial <br />l6lst Avenue Reconstruction <br />July 31, 2023 <br />Northern Lines Contracting, Inc. <br />atanrenimbihmione <br />Address: 11039 Lamont Avenue NE, Hanover, MN 55341 <br />1 Original Contract Amount <br />2 Change Order(s) No. <br />3 Total Funds Encumbered <br />4 Value of Work Completed <br />5 Retainage 5 ° <br />Percent Complete 64% <br />Thru No. <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 />$ 802,403, 30 <br />(40,120.17) <br />762,283.13 <br />$ 263, 776.76 <br />$ 498,606.37 <br />$ 431, 954.16 <br />Certification of Partial Payment <br />1 hereby certify that, to the bestof 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 />A/0/- <br />Contractor Name <br />Title Li <br />City of Ramsey Approva <br />�Signat re (P oject Engineer) <br />Date <br />63 <br />( az:3 <br />Signature (Cit r Engineer date <br />Pay Estimate Page I of 3 <br />