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CONTRACTOR'S PAY REQUEST DISTRIBUTION: <br />CONTRACTOR (1) <br />OWNER (1) <br />CITY OF ARDEN HILLS - PW-20-0100 ENGINEER (1) <br />BMI PROJECT NO. 0T1.124965 <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $1,277,585.49 <br />TOTAL, COMPLETED WORK TO DATE $1,196,427.71 <br />TOTAL, STORED MATERIALS TO DATE $0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS $1,196,427.71 <br />RETAINED PERCENTAGE (0.0%)$0.00 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS)$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE $1,196,427.71 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $1,148,411.28 <br />PAY CONTRACTOR AS ESTIMATE NO.5 $48,016.43 <br />Contractor:T. A. Schifsky & Sons, Inc. <br />2370 E. Hwy 36 <br />North St. Paul, MN 55109 <br />By <br />Name Title <br />Date <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 <br />APPROVED FOR PAYMENT: <br />OWNER: <br />By <br />Name Title Date <br />And <br />Name Title Date <br />2022 SNELLING AVENUE NORTH STREET & UTILITY <br />IMPROVEMENTS <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 amount for the Final Estimate, <br />that applicable provisions of the Iowa Code have been complied with and that all claims against me by reason of the <br />Contract have been paid or satisfactorily secured. <br />CERTIFICATE FOR FINAL PAYMENT <br />VP Operations <br />October 12, 2023 <br />10/13/2023