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CONTRACTOR'S PAY REQUEST <br />nisTR1suT1oN: <br />CONTRACTOR (1) <br />CP Rail Bridge Trail Crossing <br />CITY OF ARDEN HILLS, MN <br />BMI PROJECT NO. T16.100325 <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$312,587.27. <br />TOTAL, COMPLETED WORK TO DATE <br />$195,908.60 <br />TOTAL, STORED MATERIALS TO DATE <br />$0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$0.00 <br />TOTAL, COMPLETED WORK STORED MATERIALS <br />$195,908.60 <br />RETAINED PERCENTAGE 5% <br />$9,795.43 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$i86,113.17 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$33,796.19 <br />PAY CONTRACTOR AS ESTIMATE NO. 2 <br />$152,316.97 <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 />Contractor: Blackstone Contractors <br />7775 Corcoran Trail East <br />Corcoran, MN 55340 <br />By -,,e4„.„ <br />Name Title <br />Date 1 0 G� <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON MENK, INC., ENGINEERS, 12224 N1COLLET AVE., BURNSVILLE, MN 55337. <br />By E NG INEER <br />Date 1 6 /8/0 <br />APPROVED FOR PAYMENT: <br />OWNER: <br />By <br />Name Title Date <br />And <br />Name Title Date <br />