Laserfiche WebLink
Estimate Number: <br />Project Number: <br />Project Name: <br />Period Ending <br />Contractor: <br />Address: <br />Pay Estimate Summary Sheet <br />1 Final <br />24-08 <br />2024 Crack Seal Improvements <br />June 30,2024 <br />Northwest Asphalt & Maintenance <br />11560 190th St. NE, Thief River Falls, MN 56701 <br />1 Original Contract Amount $ 128,714.88 <br />2 Change Order(s) No. Thru No. <br />3 Total Funds Encumbered $ 128,714.88 <br />4 Value of Work Completed $ 130,320.00 <br />5 Retainage 0 % $ <br />Percent Complete 100% <br />6 Deductions or Charges <br />7 Total Earned Less Retainage (Lines 4+5+6) $ 130,320.00 <br />8 Previous Payment(s) $ <br />9 Payment Due (Lines 7.8) $ 130,320.00 <br />10 Total Balance to Finish, Including Retainage (Lines 3-7) <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 />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 amount for the Final Estimate, the provisions of M.S. 290.92 have been <br />complied with and that all claims against me by reason of the contract have been paid or satisfactorily secured. <br />T lostin,,ts1- A-0a,tf JYcw C) . Wevi'ck <br />Contractor Name Print Name <br />PIVStAS <br />Title <br />Ltd n. elfc-m4 <br />nature <br />6-t3-41 <br />Date <br />City of Ramsey Approval <br />Sign lire (Project Engineer) <br />6 1 `6 2_3Zy <br />Date <br />C (1��ZaZ4 <br />Signature (City Engineer <br />Date <br />Pay Estimate Page 1 of 2 <br />