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<br />~ "". " 'OM <br /> <br />16:38 <br /> <br />BONESTROO ROSENE ANDERLIK <br /> <br />6516361311 <br /> <br />p.1 <br /> <br />J ~J Bonestroo <br />... Rosene <br />G AnderJik & <br />.~. AsJ;odates <br />Engineers Iii Architects <br /> <br />OWner: citv of Cenletville, 1880 Main SI., Centervllle, MN 55038 Date: Auausl 31, 2004 <br />For Period: 8/212004 10 8/3112004 . Reouesl No: 1 <br />Contractor. Allied Blackloo, 10503 89th Ave. N" Manle Grove, MN 55369 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />2004 SEAL COAT <br />BRA FILE NO. 616-04-137 <br /> <br />SUMMARY <br />1 Original Conlract Amount $ 67,183.50 <br />2 Change Order - Addibon $ 0.00 <br />.3 Change Order - Oeduction $ 0.00 <br />4 Revised Conlract Amounl $ 67,183.50 <br />5 Value Completed 10 Dale $ 77,932.86 <br />6 Material on Hand $ 0.00 <br />7 Amounl Eamed $ 77,932.86 <br />8 Less Relainage 5% $ 3,896.64 <br />9 Subtotal $ 74,036.22 <br />10 Less Amounl Paid Previously $ 0.00 <br />11 Liquidated damages - $ 0.00 <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 1 $ 74.036.22 <br /> <br />Recommended for Approval by: <br />BONESTROO, ROSENE, ANDERLlK & ASSOCIATES, INC. <br /> <br />Approvecl by Contractor: <br />ALLIED BLACKTOP <br /> <br />Approved by Owner: <br />CITY OF CENTERVllLE <br /> <br />Specified Contract Completion Date: <br />AuguSl 27, 2004 <br /> <br />Date: <br /> <br />To <br /> <br />7671 08108/3'/0'1 J'.8.s~ <br />Fro~ <br />co'l9~ <br /> <br />Phone *(p6)_/;{) _ K(./ <br />Fax # <br /> <br />Post-it" Fax Note <br /> <br />616D4137REQ1.Jds <br /> <br /> <br />;~t.:~:. ::>. \":/:>:' <br />