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Estimate Number: <br />Pay Estimate Summary Sheet <br />4 Final <br />Project Number: 22-02 <br />Project Name: <br />Period Ending August 31, 2023 <br />Contractor: GMH Asphalt Corporation <br />Address: <br />Autumn Heights Street Reconstructions <br />..... ... _ . <br />9180 Laketown Road, Chaska, MN 55318 <br />1 Original Contract Amount <br />2 Change Order(s) No. Thru No. <br />641111.0.1.1 <br />3 Total Funds Encumbered <br />4 Value of Work Completed <br />5 Retainage 0 % <br />Percent Complete 100% <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 />897, 894.48 <br />897,894.48 <br />856,190.13 <br />4049,93 <br />860,240.06 <br />824, 867.93 <br />35,372.13 <br />Certificaiton of Final 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 />thls 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 amount for the Final Estimate, the provisions of M.S. 290.92 have been <br />compiled with and that all claims against me by reason of the contract have been paid or satisfactorily secured. <br />Ifnv\ 7.--)c--0,01Orn. c <br />Contractor Name Print N •-^ <br />\1 <br />Title <br />City of Ramsey Approval <br />ure (Project Engineer) <br />Signature (City Engineer) <br />Signature <br />Date <br />�Ta <br />Date <br />2- <br />Date <br />Pay Estimate Page 1 of 3 <br />