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<br />please verify the a~unt of previous payments, if any, and the receipt <br />by the city of the following items from the contractor prior to making <br />payment. <br /> <br />1. Certificate of Claims payment (Lien Waiver) , <br />2. Affidavit for payment of State Taxes (Minn. state Tax FOrm 134) , <br />3. Letter of consent from surety firm. <br /> <br />M?PRfNALS : <br /> <br />CONTRACTOR: Certification by COntractor: I certify that all items <br />and amounts shown are correct for the IoOrk completed to date. <br /> <br />AS'I'OCH SURFACE TOCH. CORP. <br /> <br />Signed : <br /> <br />ENGINEER: <br /> <br />Title: <br />[)ate: I <br />I <br />HAKANSON ANDERSON ASSOCIATES, INC. <br /> <br />signed: <br /> <br />CMNER: <br /> <br />Title: <br />[)ate: I <br />I <br />TIlE CITY OF RAMSEY <br />signed:1 <br /> <br />Title: <br /> <br />[)ate: <br /> <br />File: RA):Ol-96 <br /> <br />20 <br />