4.3. SR 12-19-2016 - Laserfiche WebLink

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CONTRACTOR'S PAY REQUEST DISTRIBUTION: 2015 STREET IMPROVEMENTS CONTRACTOR (1) CITY OF ELK RIVER OWNER (1) SAP 204-135-001, 204-107-007, 204-114-003, 204-116-002 ENGINEER (1) BMI PROJECT NO. N15.108340 BONDING CO. (1) TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $3,953,239.73 TOTAL, COMPLETED WORK TO DATE $4,038,191.27 TOTAL, STORED MATERIALS TO DATE $0.00 DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 TOTAL, COMPLETED WORK & STORED MATERIALS $4,038,191.27 RETAINED PERCENTAGE ( 0%) $0.00 TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 NET AMOUNT DUE TO CONTRACTOR TO DATE $4,038,191.27 TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES 1 $3,905,928.44 PAY CONTRACTOR AS ESTIMATE NO. 8 FINAL L $132,262.83 Certificate for Final Payment hereby certify that, to the best of my knowledge and belief, all items quantities and prices of work and material shown on this Estimate are correct and that all work has been performed in full accordance with the terms and conditions of the Contract for this project between the Owner and the undersigned Contractor, and as amended by any authorized changes, and that the foregoing is a true and correct statement of the amount for the Final Estimate, that the provisions of M. S. 290.92 have been complied with and that all claims against me by reason of the Contract have been paid or satisfactorily secured. Contractor: North Valley, Inc. 20015 Iguana St NW # 100 No_ hen MN 55330 y Presicimt »ead Name Title Date Dgomil er 6, 2016 Approved thi Contractor's Suret CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: ENGINEER: BOLTON & M N , INC., 7533 Sunwood Drive NW, Suite 206, Ramsey, MN 55303 a BY , PROJECT ENGINEER Cody L."Holmes, P.E. Date t .�-J-11 6 � 12-0 t 6 APPROVED FOR PAYMENT: OWNER: By Name Title Date And Name Title Date