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<br />~Y <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />Project: <br /> <br />Owner: <br />Owner No.: <br />Contractor: <br />BRW Job No.: <br /> <br />2003 Seal Coating <br />City of Arden Hills <br /> <br />,( URS Copy <br />City Copy <br />Contractor Copy <br />Inspector Copy <br /> <br />PEARSON BROS., INC. <br />37951-025-0101 <br /> <br />FINAL PAYMENT <br /> <br />Application Date: <br />For Period Ending: <br /> <br />8/25/03 <br />8/15/03 <br /> <br />Original Contract Amount: <br /> <br />Contract Amendments: <br />Contract Amount To Date: <br /> <br />Total Amount of Work Complete To Date: <br />Material Suitably Stored On-Site but not <br />Incorporated into Work: <br /> <br />Gross Amount Due To-Date: <br /> <br />less 0.00% Retainage: <br />Amount Due To-Date: <br /> <br />Less Previous Payments: <br /> <br />Total Due This Application: <br /> <br />$33,300.64 <br />$0.00 <br />$33,300.64 <br />$33,056.76 <br /> <br />$0.00 <br />$33,056.76 <br />$0.00 <br />$33,056.76 <br />$0.00 <br />$33,056.76 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br /> <br />Contractor: PEARSON BROS., INC. <br /> <br />By: Date: <br /> <br />The work on this project and the application-for payment have been reviewed and the <br />amount shown is recommended for payment. <br /> <br /> <br />By: <br /> <br />Date: <br /> <br />?l-/'l-t:? 3 <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page 1014 <br />