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Pay Estimate Summary Sheet <br /> Estimate Number: 5 Partial <br /> Project Number; 23_01 (S.A.P. 199-123-001) <br /> Project Name: 761 st Avenue Deconstruction <br /> Period Ending September 30, 2023 <br /> Contractor: Northern Lines Contracting, Inc. <br /> Address: 11039 Lamont Avenue NE, Hanover, MN 55341 <br /> 1 Original Contract Amount $ 1,244,237.29 <br /> 2 Change Order(s) No. Thru No. <br /> 3 Total Funds Encumbered $ 1,244,237.29 <br /> 4 Value of Work Completed $ 1,204,394.87 <br /> 5 Retainage 1 % $ (12,043.95) <br /> Percent Complete 97% <br /> 6 Deductions or Charges <br /> 7 Total Earned Less Retainage (Lines 4+5+6) $ 1,192,350.92 <br /> 8 Previous Payment(s) $ 1 s 117,554.06 <br /> 9 Payment Clue (Lines 7-8) $ 74,796,.$6 <br /> 10 Total Balance to Finish, Including Retainage (Lines 3-7) $ 51,886.37 <br /> Certification of Partial Payment <br /> 1 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 /> 11A4Pf17 4"tes A �! <br /> Contractor Name Print N me <br /> Title ] <br /> Stg ature <br /> MOMS <br /> Date <br /> -------------- <br /> City of Ramsey Approval <br /> oh) lzo&� <br /> Si tur (Project <br /> e <br /> g Engineer) Date <br /> Z. <br /> Z�3 <br /> L,L <br /> Signature (City En inee Date <br /> Pay Estimate Page 1 of 3 <br /> f <br />