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<br />APPLICATION FOR PAYMENT <br />PAYMENT NO.5 <br /> <br />URS Copy <br />City Copy <br />Cotllractor Copy <br />Inspector Copy <br /> <br />. <br /> <br />Project: <br /> <br />Booster Station Rehabilitation Project <br />Addendum No, 1 <br />City at Arden Hills <br /> <br />Owner: <br />Owner No,: <br />Contractor: <br />BRW Job No,: <br /> <br />FINAL PAYMENT <br /> <br />ENCOMM MIDWEST, INC, <br />37951-026-0201 <br /> <br />Application Date: <br />For Period Ending: <br /> <br />3/31/2005 <br />3/31/2005 <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 />Total Due This Application: <br /> <br />$175,420,00 <br />$0,00 <br />$175,420,00 <br />$175,420,00 <br /> <br />$0,00 <br /> <br />$175,420,00 <br />$0,00 <br />$175,420,00 <br />$171,911.60 <br /> <br />$3,508.40 <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, 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 pen!. <br /> <br /> <br />By: <br /> <br />Date: <br /> <br />1- / <6-05 <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />. <br /> <br />Page 1 of 4 <br />