Laserfiche WebLink
Code: 406-4-8080-4530 <br />Z-ONTRACTOR'S PAY REQUEST NO 1 DISTRIBUTION: <br />WINDSOR PARK 3RD ADDITIONSEWER XT SI CONTRACTOR (1) <br />CITY OF ELK RIVER, MN OWNER (1) <br />1 PROJECT NO. R1 ®122405 ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $1,094,582.00 <br />TOTAL, COMPLETED WORK TO DATE $172,170.40 <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 $172,170.40 <br />RETAINED PERCENTAGE ( 5%) $8,608.52 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $163,561.88 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $0.00 <br />PAY CONTRACTOR AS ESTIMATE NO. $163,561.88 <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: G.F.Jedlicki Inc. <br />2471 Galpin Court, Suite 110 <br />Chanhassen, MN 55317 <br />By Z2 <br />Name Title <br />Date d <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MlENK, INC., 7533 SUNWOOD DRIVE NW 206, RAMSEY, MN 55330. <br />By W , PROJECT MANAGER <br />Date 41712021 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF ELK RIVER <br />By C �a,PgA� Chief 4-8-21 <br />Name Title Date <br />And <br />Name Title Date <br />