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M <br />Pay Estimate Summary Sheet <br />Estimate Number: 3 Final <br />Project Number: IP 23-06 (S.A.P. 199-114-001) <br />Project Name: 2023 MSA Pavement Overlay Improvements <br />Period Ending November 30, 2023 <br />Contractor: North Valley, Inc. <br />Address: 20015 Iguana Street NW Suite 100, Nowthen, <br />MN 55330 <br />I Original Contract Amount <br />$ <br />498,917.55 <br />2 Change Order(s) No. Thru No. <br />3 Total Funds Encumbered <br />$ <br />498,917.55 <br />4 Value of work Completed <br />$ <br />512)998.27 <br />5 Retainage 0 % <br />$ <br />Percent Complete 100% <br />6 Deductions or Charges <br />7 Total Earned Less Retainage (Lines 4+5+6) <br />$ <br />512,998.27 <br />8 Previous Payment(s) <br />$ <br />507,868.29 <br />9 Payment Due (Lines 7-8) <br />$ <br />5,129.98 <br />10 Total Balance to Finish, Including Retainage (Lines 3-7) <br />$ <br />- <br />Certlficalton 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 />North Valley, Inc. <br />Contractor Name <br />President <br />Title <br />F <br />f Ramsey Approval <br />t e (Project Engineer) <br />Signature (City Engineer). <br />Leslie A. Bloom <br />Print Name <br />Signature <br />December 5, 2023 <br />Date <br />Date <br />Date <br />Pay Estimate Page 1 of 2 <br />