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CONTRACTOR'S PAY REQUEST DISTRIBUTION: <br /> 2015 STREET IMPROVEMENTS CONTRACTOR (1) <br /> CITY OF ELK RIVER OWNER (1) <br /> SAP 204-135-001, 204-107-007, 204-114-003, 204-116-002 ENGINEER (1) <br /> BMI PROJECT NO. N15.108340 BONDING CO. (1) <br /> TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $3,732,193.14 <br /> TOTAL, COMPLETED WORK TO DATE $479,211.07 <br /> TOTAL, STORED MATERIALS TO DATE $0.00 <br /> DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 <br /> TOTAL, COMPLETED WORK & STORED MATERIALS $479,211.07 <br /> RETAINED PERCENTAGE ( 5% ) $23,960.55 <br /> TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br /> NET AMOUNT DUE TO CONTRACTOR TO DATE $455,250.52 <br /> TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $0.00 <br /> PAY CONTRACTOR AS ESTIMATE NO. 1 $455,250.52 <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: North Valley, Inc. <br /> 20015 Iguana St NW # 100 <br /> Nowthen,MN 55330 <br /> By President <br /> Name Brad SJvdddzffiEr Title <br /> Date -Tv h e 2, 2015 <br /> CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br /> ENGINEER: BOLTON & MENK, INC., 7533 Sunwood Drive NW, Suite 206, Ramsey, MN 55303 <br /> By 41v;, , PROJECT ENGINEER <br /> Cody V. Holmes, P.E. <br /> Date <br /> APPROVED FOR PAYMENT: <br /> OWNER: <br /> By <br /> Name Title Date <br /> And <br /> Name Title Date <br />