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<br />APPLICATION FOR PAYMENT <br />PAYMENT NO.3 <br /> <br />lJRS Copy <br />..,( {';,.. r>,c.;y <br />1'--1 -u-t <br />Ccnif3:tor Copy <br />In!p''/,;;r Copy <br /> <br />. <br /> <br />Project: <br />Owner: <br />Owner No,: <br />Contractor: <br />URS Job No,: <br />Application Date: <br />For Period Ending: <br /> <br />2006 Pavement Management Program 1 Ridgewood Neighborhood <br />City of Arden Hills <br /> <br />Amt Construction <br />31809837 <br />9119/2006 <br />9/15/2006 <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 />$1,808,584,32 <br />-$105,270,16 <br />$1,703,314,16 <br />$967,887,88 <br /> <br />$0,00 <br />$967,887,88 <br />$48,394,39 <br />$919,493.49 <br />$747,339.71 <br />$172,153,78 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed <br />to date, <br /> <br />By: <br /> <br /> <br />. <br /> <br />Date: <3 ~ ....2-0- 0(;, <br /> <br />The work shown on this project and the application for payment have been reviewed <br />and the amount shown is recommended for payment <br /> <br />By: <br /> <br /> <br />Date: if - /,0-0 (, <br /> <br />APPROVED FOR PAYMENT <br /> <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />. <br /> <br />1 of 10 <br />