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<br />.- <br /> <br />Bonestroo <br /> <br />Owner. - City of Centerville, 1880 Main St, Centerville, MN55038 Date: Julv 17, 2007 <br /> .. <br />For Period: 7/112007 to 7117/2007 Reauest No: 1 <br />Contractor: Gustafson Excavatina Inc., 6610 41 Oth St, North Branch, MN 55056 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />2007 FAIRVlEW STREET IMPROVEMENTS <br />BONESTROO FILE NO. 000616-06148-0 <br /> <br />SUMMARY <br />1 Original C:ontract Amount <br />2 Change Order - Addition <br />3 Change Order - Deduction <br />4 Revised Contract Amount <br />5 Value Completed to Date <br />6 Material on Hand <br />7 Amount Earned <br />8 Less Retainage 5% <br />9 Subtotal <br />10 Less Amount Paid Previously <br />11 Liquidated damages- <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br /> <br />$ <br /> <br />$ <br />$ <br /> <br />0.00 <br />0.00 <br /> <br />1 <br /> <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />Recommended for Approval by: <br />BON ESTROO <br /> <br />_a7- <br /> <br />Approved by Contractor: <br />'GUSTAFSON EXCAVATING INe. <br /> <br />Approved by Owner: <br />CITY OF CENTERVILLE <br /> <br />'. <br /> <br />~ .-._--L'. _ <br />~ ~....- <br />~4 -'''' ~S'~ <br /> <br />218,721.25 <br /> <br />218,721.25 <br />157,669.10 <br />0.00 <br />157,669.10 <br />7,883.46 <br />149,785.65 <br />0.00 <br />0.00 <br />149,785.65 <br /> <br />Specified Contract Completion Date: <br /> <br />Date: <br /> <br />61606148REQ1.x1s <br /> <br />/f <br />