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CONTRACTOR'S PAY REQUEST <br />NW SANITARY SEWER AND WATERMAIN EXTENSION <br />CITY OF RAMSEY <br />BMI PROJECT NO.: C12.35976 <br /> <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />TOTAL, COMPLETED WORK TO DATE <br />TOTAL, STORED MATERIALS TO DATE <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />TOTAL RETAINED PERCENTAGE (5%) <br />TOTAL AMOUNT RETAINED ON PREVIOUS ESTIMATES <br />PAY RETAINAGE ACOUNT AS ESTIMATE NO. 3 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />PAY CONTRACTOR AS ESTIMATE NO, 3 <br /> Certificate for Partial Payment <br /> <br />DISTRIBUTION: <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br /> $6,693,820.17 <br /> $2,469,344.09 <br /> $18,015.80 <br /> $18,015.80 <br /> $2,469,344.09 <br /> $123,467.20 <br /> $46,880.73 <br /> $76,586.47 <br /> $0.00 <br /> $2,345,876.89 <br /> $890,733.86 <br /> $1,455,143.03 <br /> <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices <br />of work and matedal shown on this Estimate are correct and that ail work has been <br />performed in full accordance with the terms and conditions of the Contract for this project <br />between the Owner and the undersigned Contractor, and as amended by any <br />authorized changes, and that the foregoing is a true and correct statement of the <br />contract amount for the period covered by this Estimate. <br /> <br />Contractor: <br /> <br />LaTour Construction <br />1234 Country Road 8 Northwest <br />Maple lake, MN 55358 <br /> <br /> Name Title <br /> <br />Date /~. 7- ~C, <br /> <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: B~['~~ON & MENK, INC.,_. / NEERS, 7333 SUNWOOD DRIVE, RAMSEY, MN. <br /> By Justid/cemrite, P.E. JJ , PROJECT ENGINEER <br /> Date ~"-~, -(...) ~., <br /> <br />APPROVED FOR PAYMENT: <br />OWNER: City of Ra_msey ~ <br /> <br />Title <br /> <br />And <br /> Name Title Date <br /> <br />-91- <br /> <br /> <br />