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Owner: Clry of Cenlervi{le, 1880 Main trest, Centen+ille, MN 55038-9794 Date: 7113h1 <br /> � 4 � t°n?�r•: For Period: 2/3I2011 to 7/1/11 Requeat: #3 <br /> Contractor: GM Contractin Inc. 19810 - 515th Avenue PO Box 736 Lake tal MN 56055 <br /> Contractor's Itequest For Payment <br /> CDBG Water servtces <br /> Summary <br /> 1 Originai ConVact Amaunt S 162,2U7.88 <br /> 2 Change Order- Addition $ 5,153.00 <br /> 3 Change Order - Deduction $ <br /> Q Revised Contract Amount $ 167,360.88 <br /> 5 Value Completed to Oate $ 151,099.92 <br /> 6 Mate�lal an Hantl g . <br /> 7 Amount Ear�ed $ 151,099.92 <br /> 8 Less Retainage 5i6 $ . <br /> 9 Subtotal $ 151,099.92 <br /> 10 Less Amount Previously Paid $ 130,937.41 <br /> 11 Liquidated Damages $ . <br /> 12 Amount Due 7'his Request #3 ���� $ 2� <br /> Recommended tor Approvai <br /> ^�y of Centerville - lead lnspector <br /> � bate • Q 11 <br /> Approved by Owner Approved by Contracior <br /> Gry df Centetvtlle - City ministrator GM Contractor, Inc. <br /> r �` ` ey: `v` �',�._,, �,�'°..�....�--'" ba et �.�._ � . .. � Date 7 � / � <br /> ✓. <br /> Approved for Payment <br /> Cily of Centerville • Finance Directar <br /> �'� �*7.� Date �/� <br /> P58 <br />