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<br />\ <br /> <br />ENGINEER'S COpy <br /> <br />~ Bonestroo <br />-=- Rosene <br />1\1 Anderlik & <br />1 ~ 1 Associates <br />Engineers & Architects <br /> <br />Owner: Citv of Centerville, 1880 Main St., Centerville, MN 55038 Date: Auqust 15, 2005 <br />For Period: 8/12/2005 to 8/15/2005 Reauest No: 4 AND FINAL <br />Contractor: American Tank Services Inc. DBA Holte Contractinq, 3174 Ryan Ln., St. Paul, MN 55117 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />POND AND DITCH IMPROVEMENTS <br />BRA FILE NO. 000616-04140-0 <br /> <br />SUMMARY <br /> Original Contract Amount $ 77,725.00 <br />2 Change Order - Addition $ 5,107.96 <br />3 Change Order - Deduction $ 9,335.70 <br />4 Revised Contract Amount $ 73,497.26 <br />5 Value Completed to Date $ 73,497.26 <br />6 Material on Hand $ 0.00 <br />7 Amount Earned $ 73,497.26 <br />8 Less Retainage 0% $ 0.00 <br />9 Subtotal $ 73,497.26 <br />10 Less Amount Paid Previously $ 69,822.40 <br />11 Liquidated damages - $ 0.00 <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 4 AND FINAL $ 3,674.86 <br /> <br />Recommended for Approval by: <br />BONESTROO, ROSENE, ANDERLlK & ASSOCIATES, INC. <br /> <br /> <br />I ~<LJwffJA/L- ~ <br /> <br />Approved by Contractor: <br /> <br />e~~ET~~;:~~" <br />~o. t-_ '-> I , <br />"" <br /> <br />Approved by Owner: <br /> <br />CITY OF CENTERVILLE <br /> <br />Specified Contract Completion Date: <br />May 27, 2005 <br /> <br />Date: <br /> <br />61604140REQ4.xls <br />