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<br />APPLICATION FOR PAYMENT <br />PAYMENT NO.9 <br /> <br />URS Copy <br />/ Cny Copy <br />Contractor Copy <br />Inspector Copy <br /> <br />Project: <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />2002 Sanitary Sewer and Water Main Rehabilitation Project <br /> <br />City of Arden Hills <br /> <br />FINAL PAYMENT <br /> <br />VISU-SEWER CLEAN & <br />SEAL, INC, <br />37951-022-0101 <br /> <br />BRW Job No.: <br /> <br />Application Date: <br /> <br />For Period Ending: <br /> <br />10/27/03 <br />9/30/03 <br /> <br />Original Contract Amount: <br />Contract Amendments: <br />Contract Amount To Date: <br />Total Amount of Work Complete To Date: <br />Material Suitably Stored On-Site but not <br />Incorporated into Work: <br />Gross Amount Due To-Date: <br />Less 0.00% Retainage: <br />Amount Due To-Date: <br />Less Previous Payments: <br /> <br />Total Due This Application: <br /> <br />$246,435.50 <br />$84,992.50 <br />$331,428.00 <br />$323,696,11 <br /> <br />$0.00 <br /> <br />$323,696.11 <br />$0,00 <br />$323,696,11 <br />$285,637.47 <br /> <br />$38,058.64 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br />Contractor: VISU-SEWER CLEAN & SEAL, INC. <br />By: ~~ ~ ~~~___ Date: //-/7-03 <br />The work on this project and the application for payment have been reviewed and the <br />amount shown is recommended for payment. <br />URS cor~n J? IJ~ Date: //-) ?-c/3 <br />By: , .~ ~. <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br />By: Date: <br /> <br />Page 1 of 5 <br /> <br />.... <br /> <br />. <br /> <br />. <br /> <br />. <br />