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<br /># <br /> <br />Bonestroo <br /> <br />Owner: City of Centerville, 1880 Main Street, Centerville, MN 55038-9794 Date: Mav 19, 2009 <br />For Period:' 5/4/2009 to 5/19/2009 Request No: 1 <br />Contractor: Forest lake Contractina, 14777 lake Drive, FOIes! lake, MN 55025 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />PElTIER lAKE DRIVE STREET AND UTILITY IMPROVEMENTS <br />BONESTROO FilE NO. 000616-09169-0 <br />CITY PROJECT NO. 2009.01 <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 /> <br />0.00 <br />0.00 <br /> <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br /> <br />Recommended for Approval by: <br />BONESTROO <br /> <br />~:P <br /> <br />Approved by Contractor: <br />FOREST LAKE CONT CTING <br /> <br /> <br />Approved by Owner: <br />CITY OF CENTERVILLE <br /> <br /> <br />$ <br /> <br />1,534,085.11 <br /> <br />1,534,08511 <br />41,002.21 <br />0.00 <br />41,002.21 <br />2,050.11 <br />38,952.10 <br />0,00 <br />0,00 <br />38,952,10 <br /> <br />Specified Contract Completion Date: <br /> <br />Date: <br /> <br />61609169REQ1.x1s <br /> <br />37 <br />