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Pay Esti at-e- Summary Sheet <br />`.2-/_12�� <br />_ <br />24-04 <br />Ford Brook Estates Drainage <br />Septem.ber 30 2024 <br />mprovements <br />Twin Cit'l'es Utilities LLC <br />Address: 38547 Holm Avenue, North Branch, M-N 55056 <br />1 Orig'inal Contract Amount <br />' Change Order(s) No. <br />. Total Funds Encumbered <br />_ Value of Work Completed <br />. Retainage, . % <br />Percent Complete <br />6 Deductions or Charges <br />- Total Earned Less Reta*inage (Lines 4+5+6) <br />. Previous Payment(s) <br />' Payment ue (LEines 7w8) <br />,p Total Balan ;e till Finish, Including eta in a g e (Lines'31 7) <br />34% <br />207509-84 <br />$ 207)509.84 <br />$ 69,833-68 <br />$ (31491.68) <br />661342000 <br />' <br />' 66)342000 <br />$ 141,167.84 <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 per -formed - full accordance with the terms and conditions ' 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 ofthe contract amount for the period covered ^^ this estimate. <br />Twin <br />..` ||.. ''.'Rene'Garcia ...S,-..`~_— <br />Contractor Name Print <br />. <br />resident <br />^Date <br />S 0 ignature <br />10,08w2 ` <br />City of Ramsey Approval <br />Signature (Project <br />Engineer)v <br />Signature (City Engineer) <br />Pay Estimate Page I of 3 <br />