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<br />n ~ OWner: C of Centerville 1880 Maln St, CenterviUe, MN 55038 Date: <br />8.:11 AnderIIk& For Period: 8/112005 to 101712005 R uest No: <br />U Associates Contractor: ire Iron Inc., 1610 N. Minnesota Ave., Sioux Falls. SO 57104 <br />B1gIneerS & Ard*eas <br /> <br />CONTRACTOR"S REQUEST FOR PAYMENT <br />500,000 GALLON ELEVATED WATER TOWER <br />BRA FILE NO. 000616-03130-0 <br /> <br />SUMMARY <br />1 Original Contract Amount <br />2 Change Order p Addition <br />3 Change Order p Deduction <br />4 Revised Contract Amount <br />5 Value Completed to Date <br />6 Material on Hand <br />1 Amount Earned <br />8 Less Retalnage 5% <br />9 Subtotal <br />10 Less Amount Paid Previously <br />11 liquidated damages p <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO- <br /> <br />$ <br /> <br />$ <br />$ <br /> <br />0.00 <br />55.500.00 <br /> <br />12 <br /> <br />$ <br />$ <br />S <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />Recommended for Approval by: <br />BONESTROO. ROSENE. ANDERUK & ASSOCIATES, INC, <br /> <br />(~k>w/~. <br /> <br />Approved by Contractor. <br />MAGUIRE IRON INC. <br /> <br />Approved by OWner: <br />crrv OF CENTERVILLE <br /> <br />0cI0ber 7, 2005 <br />12 <br /> <br />943,115.35 <br /> <br />887.615.35 <br />870.031.10 <br />0.00 <br />870.03 1.10 <br />43.50 1.56 <br />826.529.55 <br />820,577.79 <br />0.00 <br />5.951.75 <br /> <br />Specified Contract Comp1ellon Date: <br />July 17. 2005 <br /> <br />Date: <br /> <br />fj1llOS130 Req 12. <br /> <br />I{ <br />