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MnDOT Contract No. 1028386 Work Order No. 1 <br />City of Elk River US 10 Corridor and Subarea Study <br />Exhibit E <br />Invoice <br />*If you are unable to support electronic submission of Invoices, you must contact the Authorized Representative for possible alternatives. <br />-1– <br />INVOICE NO._______ <br />Estimated Completion: ______% (from Column 6 Progress Report) <br />Final Invoice? Yes No <br />Invoice Instructions: <br />Contractor must: <br />1. Complete the invoice and, if applicable, the progress report, in their entirety <br />2. Sign the invoice and progress report <br />3. Attach supporting documentation <br />4. Scan the entire invoice package*, in the following order: <br />a. Completed, Signed Invoice Form <br />b. Completed, Signed Progress Report Form (if applicable) <br />c. Supporting Documentation <br />Note: Whenever possible, convert landscape pages to portrait pages and optimize the document to decrease the size. <br />5. E-mail the invoice package, in .pdf, to ptinvoices.dot@state.mn.us <br />MnDOT Contract No. 1028386 Work Order No. 1 Billing Period: From ___________ to ___________ <br />Contract Expiration Date: April 30, 2022 Invoice Date: _______________ <br />SP Number: 7101-66 TH Number: 10 <br />Total <br />Contract <br />Amount <br />Total <br />Billing <br />to Date <br />Amount <br />Previously <br />Billed <br />Billed <br />This <br />Invoice <br />1. Direct Labor Costs: <br /> (Attach Supporting Documentation) <br />$86,878.13 <br />2. Overhead Costs: Rate = 170% <br /> (Direct Labor*Overhead Rate) <br />$147,692.82 <br />3. Fixed Fee (Profit) Costs: Rate = 12% <br /> (Fixed Fee = $ * Percent Complete) <br />$30,494.22 <br />4. Direct Expense Costs: <br /> (Attach Supporting Documentation) <br />$4,856.25 <br />5. Subcontractor Costs: <br /> (Attach Supporting Documentation) <br />$10,684.60 <br />Net Earnings Totals: $280,606.02 <br />Total Amount Billed This Invoice: <br />Contributor Total Contribution Amount Total Billing to Date Billed This Invoice <br />Local Government/Agency $80,606.02 $ $ <br />State $200,000.00 $$ <br />Total $280,606.02 $ $ <br />Contractor: Complete this table when submitting <br />an invoice for payment <br />Source <br />Type <br />Total <br />Billing to <br />Date <br />Amount <br />Previously <br />Billed <br />Billed This <br />Invoice <br />1150 <br />Total** <br />**Must Match Net Earnings Totals Above <br />I certify that the statements contained on this invoice, and <br />its supporting documents, are true and accurate and that I <br />have not knowingly made a false or fraudulent claim, or <br />used a false or fraudulent record in connection with this <br />Invoice. I understand that this invoice is subject to audit. <br />Contractor:City of Elk River <br />Signature: <br />Print Name: <br />Title: