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<br />CONTRACTOR'S PARTIAL PAY REQUEST <br />2009 PAVEMENT MANAGEMENT PROGRAM <br />CITY OF ARDEN HillS, MINNESOTA <br />BMI PROJECT NO.: T16~100326 <br /> <br />DISTRIBUTION: <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />$1,196,405.98 <br />$558,486.00 <br />$0.00 <br />$0.00 <br />$558,486.00 <br />$27,924.30 <br />$0.00 <br />$530,561.70 <br />$340,458.69 <br />$190,103.01 <br /> <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />TOTAL, COMPLETED WORK TO DATE <br />TOTAL, STORED MATERIALS TO DATE <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />RETAINED PERCENTAGE ( 50/0 ) <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />PAY CONTRACTOR AS ESTIMATE NO. 4 <br />Certificate for Partial Payment <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices <br />of work and material shown on this Estimate are correct and that all work has been <br />performed in full accordance with the terms and conditions of the Contract for this project <br />between the Owner and the undersigned Contractor, and as amended by any <br />authorized changes, and that the foregoing is a true and correct statement of the <br />contract amount for the period covered by this Estimate. <br /> <br />Contractor: <br /> <br />Frattalone Companies, Inc. <br />3205 Spruce Street <br />St. Paul, MN 55117 <br /> <br />By <br /> <br />Name <br /> <br />Title <br /> <br />Date <br /> <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON & MENK, INC., ENGINEERS, 12224 NICOLLET AVENUE, BURNSVILLE, MN~ <br /> <br />By <br />Travis Winter, P.E. <br /> <br />, PROJECT ENGINEER <br /> <br />Date <br /> <br />APPROVED FOR PAYMENT: <br />OWNER: City of Arden Hills <br /> <br />By <br /> <br />Name <br /> <br />Title <br /> <br />Date <br /> <br />And <br /> <br />Name <br /> <br />Title <br /> <br />Date <br />