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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 $3,805,372.62 <br />TOTAL, COMPLETED WORK TO DATE $1,815,926.37 <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 $1,815,926.37 <br />RETAINED PERCENTAGE ( 5%) $90,796.32 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $1,725,130.05 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $1,536,230.60 <br />PAY CONTRACTOR AS ESTIMATE NO. 3 $188,899.45 <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 rc ? (- <br />Name Title <br />Date <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & M NK, INC., 7533 Sunwood Drive NW, Suite 206, Ramsey, MN 55303 <br />� J <br />By , PROJECT ENGINEER <br />Cody . Holmei, P.E. <br />Date <br />APPROVED FOR PAYMENT: <br />OWNER: <br />By <br />Name Title Date <br />And <br />Name Title Date <br />