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CONTRACTOR'S PAY REQUEST _....m..__ <br />I DISTRIBUTION: <br />MAIN STREET FORCEMAIN RELOCATION CONTRACTOR (1) <br />OWNER (1) <br />CITY OF ELK RIVER, MN ENGINEER (1) <br />BMI PROJECT NO R13.120817 BONDING CO. (1) <br />T6TAIAMOUNT BID PLUS TOTAL, COMPLETED WORK TOPDATEVED CHANGE ORDERS $163,314.29 <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 $163,314.29 <br />RETAINED PERCENTAGE 5% <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $155 148.58 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $0.00 <br />PAY CONTRACTOR AS ESTIMATE NO. 1 $155,148.58 <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: GM Contracting, Inc. <br />19810 515th Avenue, <br />P.O BOX 736 <br />Lake Crystal, MN 56055 <br />Name Title <br />Date e f"7 9 0 <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 PROJECT MANAGER <br />I <br />Date 8/19/2020 <br />I <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF LK RIVER, MINNB" <br />BY. � <br />Name Title Date <br />And <br />Name Title Date <br />go 4 , q " 1010- H53o <br />