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Estimate Number. - <br />Project Number. - <br />Project Name: <br />Period Ending <br />Contractor; <br />Address: <br />Rai► Estimate Summary Sheet <br />4 Partial <br />23-01 (S.A.P. 190-123-001) <br />161 st Avenue Reconstruction <br />August 31, 2023 <br />-------------- <br />Northern Lines contracting, Inc. <br />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 95% <br />6 Deductions or charges <br />7 Total Earned Less Retainage (Lines 4+5+5) <br />8 Previous Payment(s) <br />9 Payment [due (Lines 7-8) <br />19 Total Balance to Finish, Including Retainage (Lines 3-7) <br />1,244,237.29 <br />$ <br />1,244,237.29 <br />$ <br />11176,372.70 <br />$ <br />NNW (58,818.64) <br />$ 1,117,554.06 <br />$ <br />762, 283.13 <br />$ <br />3551270-93 <br />$ <br />126,683.23 <br />.............. . <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 />.1 / <br />10ten � <br />�7� <br />Contractor Name Print Name <br />Title i u <br />Date( <br />City of Ramsey Approval <br />moo <br />Signat e (Project Engineer) Date <br />nature (City Enaineer <br />ate <br />Pay Estimate Page l of 8 <br />