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<br />. <br /> <br />. <br /> <br />. <br /> <br />. <br />( . <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />Project: <br /> <br />X UPS Copy <br />City Cqy <br />C'Jntrac:~;~~r <br /> <br />Booster Station Rehabilitation Project <br />Addendum No.1 <br />City of Arden Hills <br /> <br />Owner: <br /> <br />Owner No.: <br />Contractor: <br />BRW Job No.: <br /> <br />ENCOMM MIDWEST, INC. <br />37951-026-0201 <br /> <br />Application Date: 1/6/04 <br />For Period Ending: 1/6/04 <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 5.00% Retainage: <br />Amount Due To-Date: <br />Less Previous Payments: <br />Total Due This Application: <br /> <br />$175,420.00 <br />$0.00 <br />$175,420.00 <br />$2,250.00 <br /> <br />$0.00 <br /> <br />$2.250.00 <br />$112.50 <br />$2,137.50 <br />$0.00 <br /> <br />$2,137.50 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br />Contractor: ENCOMM MIDWEST, INC. <br />By: Date: <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 Corporation >~I ) <br /> / <br /> I /I' /)1?1~--L .~ ! /7 Ie' ( <br />By: .~ ,./ ,: f..' ~ I. r / Date: <br />. ;;y <br />... . / <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br />By: Date: <br /> <br />Page 1 of4 <br />