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FI�AL PAY REQUEST DiS7'F218UilON: <br />C� Rail Bridge Trail Crossing cor�TRAC�OR (�) <br />CITY O� ARDEN HI�LS, MN pW��R �� } <br />BMI PROJECT NO. T16.1(30325 ENGINEER {1 } <br />BONDING GO. (9) <br />TOTA� AMOUNT BID PLUS APPROVED CHANGE ORDERS $327,5$7.27 <br />TOTAt, COMPL�TE� WORK TO DATE $333,204.29 <br />T�TA�, STORED MAiER1ALS TO DA�"E $� p� <br />DEDUCTION �OR STORED MATERIALS US�D iN WOR�( COM�LETED $0.04 <br />TOTA�, COMPLETED WORK & STQRED MATERIALS $333,204.29 <br />RETAWED PERCENTAG� ( 0% ) R�leased �p.pp <br />TOTAL AMOUNT O� OTH�R PAYMENTS OR (DEDUCiIONSj $p_pp <br />[�ET AMOUNT DU� TO CON�CRACTOR �O DAT� $333,204.29 <br />TOTAL AMOUNi PAI� ON PREViOUS �STiMATES $328,187.52 <br />PAY CONTRACTOR AS FiNA� ESTIMATE NO. 4 $5,016_77 <br />Certifcafe far �inal Payrn�r�t <br />I hereby certify that, to the best of my knowledge and befief, al1 iterr�s quantities and prices <br />of work and maferial shown on this Esfirnate are correct and #hat all work has iaeen <br />perForm�d in fuEl accordance with the terms and conditions af the Coniract for this project <br />between the Own�r and fhe undersigned Contractor, and as amended by any <br />authorized cF�anges, and thai the foregoing is a frue and correct statement of the arno�nt <br />for the �ina1 Estimate, that the provisions of M. S. 290.92 Y�ave �een corriplied with and that <br />ail dair�s agai�st me by reason of the Contract have been paic� or satisfiactorily s�cured. <br />Contracior: Biackstflne Contraciors <br />7775 Carcaran Trail EasE <br />Cor aran, MN 55340 <br />E3y g-;.%� .r�-�� � `�- �� <br />i�` <br />Name Titie <br />Date � � � � <br />Gran'te Re, In . <br />Approved <br />Cor�trac#ar's Sure Jonathan Pa e <br />CHECKED AND APP�OVED A5 TO QUANTfTfES AND AMOUNT: <br />EiVGIN�ER: BOLTON & MENK, INC., ENG[NEERS, 12224 NICOLLET AVE., BURlVSVILLE, MN 55337. <br />BY , PROJECT ENGlNEER <br />Date � d��j " <br />APPROVED FOR PAYMENT: <br />OV3INER: <br />By <br />Name Title Date <br />And <br />N��� Title Date <br />