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4.3 SR 10-18-2021
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4.3 SR 10-18-2021
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2/14/2022 1:14:53 PM
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10/18/2021
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CONTRACTOR'S PAY REQUEST NO 6 <br />DISTRIBUTION: <br />WINDSOR PARK 3RD ADDITION SEWER EXTENSION <br />CONTRACTOR <br />(1) <br />CITY OF ELK RIVER, MN <br />OWNER <br />(1) <br />BMI PROJECT NO. R19.122405 <br />ENGINEER (1) <br />BONDING <br />CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$1,094,S82.00 <br />TOTAL, COMPLETED WORK TO DATE <br />$973,932.72 <br />TOTAL, STORED MATERIALS TO DATE <br />$68,164.93 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$68,164.93 <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />$973,932.72 <br />RETAINED PERCENTAGE ( S% ) <br />$48,696.64 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0 00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$92S,236.08 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$903,126.97 <br />PAY CONTRACTOR AS ESTIMATE NO. 5 <br />$22,109.11 <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 />Name <br />Title <br />�+. <br />Date <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 7533 SUNWOOD DRIVE NW #206, RAMSEY, MN 55330. <br />By , PROJECT MANAGER <br />Date 10/8/2021 <br />APPROVED FOR PAYMENT: <br />OWNER: CITY OF ELK RIVER Code: Trunk Sewer Fund <br />By �Chief 10-11-21 <br />Name Title Date <br />And <br />Name Title Date <br />
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