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' . . . . . � � . ..:. 5. <br /> � �� <br /> � Owner: ' of Centerville 1880 Main St. Centerville MN 55038 Date: A ril 14 2011 <br /> For Period: 7 23 2010 to 4 14 2011 R uest No 11 AND FINAL <br /> Bonestroo �ntractor: Forest Lake Contradin 14777 Lake Dr. Forest Lake MN 55025 <br /> CONTRACTOR'S REQUEST FOR PAYMENT <br /> PELTIER LAKE DRNE 5TREEf AND UTILITY IMPROVEMENTS <br /> BONE CITY PROJECT N0o2009A1169-0 �� �� _( �Z(�'c3�� <br /> �-�.,.. <br /> SUMMARY <br /> 1 Original Contract Amount $ 1,534,085.11 <br /> 2 Change Order - Addition $ 282,325.01 <br /> 3 Change Order - _Deduction $ 0.00 <br /> 4 Revised Contract Amount $ 1,816,410.12 <br /> 5 Value Completed to Date $ 1,777,012.67 <br /> 6 Material on Hand $ 0.00 <br /> 7 Amount Earned $ 1,777,012.67 <br /> 8 Less Retainage 0% $ 0.00 <br /> 9 Subtotal $ 1,777,012.67 j <br /> 10 Less Amount Paid Previously $ 1,707,901.62 <br /> 11 Liquidated damages - $ 4,000.00 <br /> 12 AMOUNT DUE THIS REQUEST FOR PAYMENT N0. 11 AND FINAL $ 65,111.05 � <br /> Forest Lake Contracting and the Owner each acknowledge by signing this final payment that there are no unsettled <br /> claims as contemplated in 14.09.A.2. of the General Conditions of the Contract. <br /> Recommended for Approvai by: <br /> BONESTROO <br /> �� ..�d� <br /> Approved by Contractor: Approved by Owner: <br /> FOREST LAKE CONTRACTING CITY OF CENTERVILLE <br /> l v • I/r���..� <br /> Specified Contrad Completion Date: Date: <br /> 61609169RE�11 Final.�dsm n �� <br /> \� �•�-/ <br />