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<br />~', t <br /> <br />f, <br /> <br />ENGwBrs eOPv~ <br /> <br />.. <br /> <br />Bonestmo <br /> <br /> . <br />Owner: City of Centerville, 1880 Majn Street Centerville, MN 55038-9794 Date: Auqust 16, 2007 <br />For Period: 11/23/2006 to 8/16/2007 Request No: 5 <br />Contractor: Burschville Construction, Inc., 11440 8th Street NE, P.O. Box 65, Hanover, MN 55341 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />BACKAGE ROAD AND 121ST AVENUE UTILITY AND STREET IMPROVEMENTS <br />BONESTROO FILE NO. 000616-05143-0 <br /> <br />SUMMARY <br />1 Original Contract 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 Uquidated damages - <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br /> <br />$ <br />$ <br /> <br />40,039.16 <br />0.00 <br /> <br />5 <br /> <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />Recommended for Approval by: <br />BONESTROO <br /> <br />i%;Z- <br /> <br />Approved by Contractor: <br />BURS HVlUE CONSTRUCTION, INC. <br /> <br />Approved by Owner: <br />CITY OF CENTERVlLLE <br /> <br /> <br />$ <br /> <br />1,'118,251.90 <br /> <br />1,158,291.06 <br />1,058,916.82 <br />0.00 <br />1,058,916.82 <br />52,945.84 <br />1,005,970.98 <br />807,559.00 <br />0.00 <br />198,411.98 <br /> <br />Spedfled Contract Completion Date: <br /> <br />Date: <br /> <br />61605143REQ5.x1s <br /> <br />-------- ------~------ <br /> <br />/1 <br />