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<br />~ili <br />1~~R8~t~s <br />Eii9ij)~fi&Nthii~# <br /> <br />Owner: City of Centerville, 1880 Main St., Centerville, MN 55038 Date: November 22, 2006 <br />For Period: 1 0/18/2006 to 11/22/2006 Request No: 4 <br />Contractor: Burschville Construction, Inc., 11440 8th St. NE, P. O. Box 65, Hanover, MN 55341 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />BACKAGE ROAD AND 21ST AVENUE UTILITY AND STREET IMPROVEMENTS <br />BRA FILE NO. 000616-05143-0 <br /> <br />SUMMARY <br /> Original Contract Amount $ 1,118,251.90 <br />2 Change Order - Addition $ 13,103.16 <br />3 Change Order - Deduction $ 0.00 <br />4 Revised Contract Amount $ 1,131,355.06 <br />5 Value Completed to Date $ 850,062.11 <br />6 Material on Hand $ 0.00 <br />7 Amount Earned $ 850,062.11 <br />8 Less Retainage 5% $ 42,503.11 <br />9 Subtotal $ 807,559.00 <br />10 Less Amount Paid Previously $ 533,859.44 <br />11 Liquidated damages - $ 0.00 <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 4 $ 273,699.56 <br /> <br />Recommended for Approval by: <br />BONESTROO, ROSENE, ANDERLlK & ASSOCIATES, INC. <br /> <br />cU~ <br /> <br />Approved by Contractor: <br />BURSCHVILLE CONSTRUCTION, INC. <br /> <br />Approved by Owner: <br />CITY OF CENTERVILLE <br /> <br />Specified Contract Completion Date: <br /> <br />Date: <br /> <br />61605143REQ4.xls <br /> <br />11 <br />