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CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />CP Rail Bridge Trail Crossing <br />CITY OF ARDEN HILLS, MN <br />BMI PROJECT NO. T16.100325 <br />CONTRACTOR (1) <br />OWNER (1) <br />ENGINEER (1) <br />BONDING CO. (1) <br />TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$327,587.27 <br />TOTAL, COMPLETED WORK TO DATE <br />$309,885.61 <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 />$309,885.61 <br />RETAINED PERCENTAGE 5% <br />$15,494.28 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$294,391.33 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$152,316.97 <br />PAY CONTRACTOR AS ESTIMATE NO. 3 <br />$142,074.36 <br />Certificate for Partial Payment <br />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 <br />Name Title <br />Date <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENGINEER: BOLTON MENK, INC., ENGINEERS, 12224 NICOLLET AVE., BURNSVILLE, <br />By PROJECT <br />MN 55337. <br />ENGINEER <br />Date <br />APPROVED FOR PAYMENT: <br />OWNER: <br />By <br />Name Title Date <br />And <br />Name Title Date <br />