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CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />MAIN STREET FORCEMAIN RELOCATION <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />CITY OF ELK RIVER, MN <br />BONDING CO. (1) <br />BMI PROJECT NO R13.120817 <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$201,796.06 <br />TOTAL, COMPLETED WORK TO DATE <br />$163,314.29 <br />TOTAL, STORED MATERIALS TO DATE <br />$0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />$163,314.29 <br />RETAINED PERCENTAGE ( 0%) <br />$0.00 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$163,314.29 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$155,148.58 <br />PAY CONTRACTOR AS ESTIMATE NO. <br />$8,165.71 <br />Certificate for Final 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 amount <br />for the Final Estimate, that the provisions of M. S. 290.92 have been complied with and that <br />all claims against me by reason of the Contract have been paid or satisfactorily secured. <br />Contractor: GM Contracting, Inc. <br />19810 515th Avenue, <br />P.O BOX 736 <br />Lake Crystal, MN 56055 <br />By :::��2�Z= <br />Name Title <br />Date 9/10/2020 <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 jopo�-f jt% ��L , PROJECT MANAGER <br />Date 9/10/2020 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY ELK R, MIN TA <br />By pu�l,'(- W..:, 0,a -- � -11 <br />Nate Title Date <br />And <br />Name Title Date <br />q06- y ., 16 (0 - K45-30 <br />