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<br />-# <br /> <br />Bonestroo <br /> <br />Owner: City of Centerville ,1880 Main Street, Centerville, MN 55038-9794 Date: Seotember 11, 2008 <br />For Period: 9/2/2008 to 9/11/2008 Reauest No: 1 <br />Contractor: Allied Blacktop, 10503 89th Avenue North, Maple Grove, MN 55369 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />2008 STREET SEAL COAT <br />BONESTROO FILE NO. 000616-08166-0 <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 Liquidated damages - <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br /> <br />$ <br /> <br />104,975.00 <br /> <br />$ <br />$ <br /> <br />0.00 <br />0.00 <br /> <br />1 <br />e.1C'~-~~ <br />fi~ <br /> <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />104,975.00 <br />85,235.00 <br />0.00 <br />85,235.00 <br /> <br />--. <br />_.~./5 <br />~ <br />0.00 <br />0.00 <br />~5'- <br />~, '2..~S <br /> <br />Recommended for Approval by: <br />BONESTROO <br /> <br />/I<f./~ <br /> <br />Approved by Contractor: <br /> <br />Jt.BlACKTOP <br />, ~{l~ <br /> <br />Approved by OWner: <br />CITY OF CENTERVILLE <br /> <br />Specified Contract Completion Date: <br /> <br />Date: <br /> <br />61606188REQ1>ds <br />