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From: PEMBER COMPANIES, INC. N4449 469th Street Menomonie, WI 54751-5436 <br />REQUEST FOR PAYMENT <br />To: City of Arden Hills 1245 Hwy. 96 W. Arden Hills, MN 55112 <br />Invoice: 11598 Draw: 705 Invoice date: 6/19/2020 Period ending date: 6/19/2020 <br />Project: 19-0536-01 ARDEN HILLS, MN -COLLEEN AVE <br />REQUEST FOR PAYMENT: <br />Original Contract Amount: <br />Net Change Orders: <br />Revised Contract Amount: <br />Contract Completed to Date: <br />Retainage: <br />Less Previous Requests: <br />Current Request for Payment: <br />$250,247.00 <br />$ /0, / 3.3.10 <br />$260,380.10 <br />$259,943.35 <br />$0.00 <br />$252,586.22 <br />$7,357.13 <br />I hereby certify that the work performed and the materials supplied to date, as shown on the above represent the actual value of the accomplishment under the terms of the Contract (and all authorized changes thereof) between the undersigned and the City of Arden Hills relating to the above referenced project. I also certify that the contractor has <br />paid all amounts previously billed and paid by the owner. <br />CONT ES, INC. <br />By:_�----"---o:;_=:;_�,,_..-L..=...------- <br />Date: (17--/ 9' -Z O 2» <br />PAYMENT RECOMMENDED: <br />Engineer Signature <br />Printed Name and Title <br />Date: <br />State Of Wisconsin County Of Dunn <br />202. ()Subscribed and s� to before me this p day of ::lfA '1 ..R.. <br />Notary Public "���--7'-�-� _, .. ,,�,,,,. M . . . _ .. �o.i GAP.Fp:::, A "t � y comm1ss1on expires: /-2 9 ,. '2..P-z_/ ,:��:-:--·';;:;: •&, PAYMENT APPROVED: <br />Owner Signature <br />Printed Name and Title <br />Date: <br />I I -. ,. ; l NOTARY \ ·,� <br />�*i -•- !1'�� \ PUBLIC / 1,. . � � •.�---· _..I',§',:' . ;,;::-__,.,. ��, -,,, c OF W\sc.o •• -'''""'�•