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Attachment B <br />CONTRACTOR'S PAY REQUEST �II1 BO LTO N <br />DISTRIBUTION: <br />CONTRACTOR (1) <br />2022 SNELLING AVENUE NORTH STREET & UTILITY r 1 & MEN K <br />IMPROVEMENTS <br />OWNER (1) <br />Real People. Real Solutions. <br />ENGINEER (1) <br />CITY OF ARDEN HILLS - PW-20-0100 <br />BMI PROJECT NO. OT1.124965 <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$1,277,585.49 <br />TOTAL, COMPLETED WORK TO DATE <br />$1,190,063.50 <br />TOTAL, STORED MATERIALS TO DATE <br />$0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />$1,190,063.50 <br />RETAINED PERCENTAGE ( 3.5% ) <br />$41,652.22 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$1,148,411.28 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$1,068,654.48 <br />PAY CONTRACTOR AS ESTIMATE NO. <br />$79,756.80 <br />CERTIFICATE FOR PARTIAL PAYMENT <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices of work and material <br />shown on this Estimate are correct and that all work has been performed in full accordance with the terms and <br />conditions of the Contract for this project between the Owner and the undersigned Contractor, and as amended by <br />any authorized changes, and that the foregoing is a true and correct statement of the contract amount for the period <br />covered by this Estimate. <br />Contractor: T. A. Schifsky & Sons, Inc. <br />2370 E. Hwy 36 <br />North St. Paul, MN 55109 <br />By VP of Operations <br />Name Title <br />Date 11-21-2022 <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., 12224 NICOLLET AVE, BURNSVILLE, MN 55337 <br />By CONSULTING ENGINEER <br />Date 11 /21 /2022 <br />APPROVED FOR PAYMENT: <br />OWNER: <br />By <br />Name Title Date <br />And <br />Name Title Date <br />