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<br />e <br /> <br />. <br /> <br />. <br /> <br />/' <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.4 <br /> <br />Project: <br /> <br />Booster Station Rehabilitation Project <br />Addendum No.1 <br />City of Arden Hills <br /> <br />Owner: <br />Owner No.: <br />Contractor: <br />BRW Job No.: <br /> <br />ENCOMM MIDWEST, INC. <br />37951.026-0201 <br /> <br />Application Date: <br /> <br />For Period Ending: <br /> <br />6/15/04 <br />6/11/04 <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 2.00% Retainage: <br />Amount Due To-Date: <br />Less Previous Payments: <br />Total Due This Application: <br /> <br />v' UFlS Copy <br />~ Copy <br />Ccnraclor Copy <br />Inspector Copy <br /> <br />$175,420.00 <br />$0.00 <br />$175,420.00 <br />$175,420.00 <br /> <br />$0.00 <br />$175,420.00 <br />$3,508.40 <br />$171,911.60 <br />$117,675.55 <br /> <br />$54,236.05 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br /> <br />Contractor: ENCOMM MIDWEST, IN,G. <br /> <br />By: ~A...ckJ~ <br />- <br /> <br />Date: <br /> <br />G, - /7' 0 ?C <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 />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />4'/6-0'1 <br /> <br />Date: <br /> <br />Page 1 of 4 <br />