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4.3 SR 09-19-2022
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4.3 SR 09-19-2022
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9/16/2022 9:51:15 AM
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9/15/2022 3:31:14 PM
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9/19/2022
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I�arthwest �#sphalt, Inc. <br />1451 Stagecoach Road <br />Shakopee, MN. 55379 <br />Office: 952-445-1003 <br />Facsimile: 952-445-1056 <br />CHANGEORDER <br />REQUEST <br />�_� <br />Billing Date �uty <br />Proiect Name Trott Brook %nnis �,WA Job# ;_� _ 27��: <br />Proiect Location Elk River NWA Custamer# Z�'{33; <br />�Ceneral Contractor Proiect# NWA Chanae Order# <br />Proiect Owner City of Elk River <br />Ad r 13065 Orono Parkway <br />Elk River, MN 55330 <br />Descriotion of Work; Sasketbail court resu�fiacing per S/26/22 email <br />Work A�rtharization# <br />Date of work PerFormed: <br />Descriptian Unit Qly. Rate ExfensioR <br />U180R <br />1 $ - <br />2 Basketball court resurfacing Is 1.00 $ 6,720.40 $ 6,720.00 <br />3 $ - <br />4 $ - <br />5 $ - <br />6 $ - <br />7 $ - <br />8 $ - <br />9 $ - <br />10 SUBTOTAL LA60R & EQUIPMENT $ 6,720.00 <br />11 MATERIALS & MISC. <br />12 $ - <br />13 $ - <br />14 $ - <br />15 $ - <br />16 $ - <br />17 $ - <br />18 $ - <br />SUBTQTAL MATERIALS � - <br />Total Amount Due $ G�72�.�0 <br />After you have had a chance to review this request piease call with any questions or concems. Otherwise, we would greatly <br />appreciate payment for the amount requested as soon as possible or added to our current pay estimate. <br />Respectfully submitted, <br />Northwest Asphalt, Inc. <br />John .�lnderson <br />Project Manager <br />�ss� � z�u z-u� 8�41�D <br />6•720•�Q <br />
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