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<br />)lease verify the amount of previous payments, if any, and the receipt <br />)y the city of the following items from the contractor prior to making <br />)ayment. <br /> <br />certificate of Claims Payment (Lien Waiver), <br />~. Affidavit for Payment of Statte Taxes (Minn. state Tax Form 134), <br />3. Letter of Consent from surety firm. <br /> <br />.:...PPROVALS: <br /> <br />:ONTRACTOR: certification by Contractor: I certify that all items <br />and amounts shown are correct for the work completed to date. <br /> <br />FOREST LAKE CONTRACTING, INC. <br /> <br />Signed: <br /> <br />Title: <br /> <br />Date: <br /> <br />':':NGINEER: <br /> <br />HAKANSON ANDERSON ASSOCIATES, INC. <br /> <br />Signed: <br /> <br />Title: <br /> <br />Date: <br /> <br />)WNER: <br /> <br />CITY OF RAMSEY <br /> <br />signed: <br />Title: <br /> <br />Date: <br /> <br />-ile: RA3:15-91 <br /> <br />30 <br />