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PAY REQUEST <br />DISTRIBUTION: <br />CONTRACTOR'S <br />NW SANITARY SEWER AND •WATERMAIN EXTENSION <br />CITY OF RAMSEY <br />BMI PROJECT NO.: C12.35976 <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$6,693,820.17 <br />TOTAL, COMPLETED WORK TO DATE <br />$4,717,363.18 <br />$31,302.74 <br />TOTAL, STORED MATERIALS TO DATE <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$18,015.80 <br />$4,730,650.12 <br />$236,532.51 <br />$183,361.90 <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. 5 <br />$53,170.61 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$4,494,117.61 <br />$3,483,876.14 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />PAY CONTRACTOR AS ESTIMATE NO. 5 <br />$1,010,241.47 <br />Certificate for Partial Payment <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices <br />of work and material shown on this Estimate are correct and that all 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 />Contractor: LaTour Construction <br />1234 Country Road 8 Northwest <br />Maple lake, MN 55358 ,,�/ l <br />By \ t I d3f T / ✓ /r¢n/d1 e <br />. <br />lai Name Title <br />Date o -:05 to <br />CHECKED AND APPROVED AS TO QUANTITIES AND - AMOUNT: <br />ENGINEER: B+LTON & MEN NC., ENGINEERS, 7333 SUNWOOD DRIVE, <br />By i- , PROJECT <br />RAMSEY, MN. <br />ENGINEER <br />Just Femrite, P. <br />Date _1 -0 L • <br />APPROVED FOR PAYMENT: <br />OWNER: City of Ramsey <br />By ,f' f w K /o <br />Y <br />Name Title ate <br />And <br />Name Title Date <br />