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<br />~JUl 15 2004 12:28 <br /> <br /> <br />:: <br />. <br /> <br />J!]f Bonestroo <br />-=- Rosene <br />U. Anderli<& <br />.~. A5saciates <br />Engfnten&A,thhea1 <br /> <br />BON EST ROO ROSENE ANDERLIK 6516361311 <br /> <br />p.1 <br /> <br />Owner; Cltvof Cenlervi/le,18Sa Main St., Centerville, MN 55038 Date; Julv 2, 2004 <br />For Period: 6J10J20041o 7J2J2004 Renuest No; 3 <br />Convactor; Northdale Construction Company Ino., 14450 Northdale Blvd" Ron<>rs, MN 55374 . <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />HUNTERS CROSSING 2ND ADDITION PHASE 1 UTILITY AND STREET IMPROVEMENTS <br />BRA FILE NO. 616-03-132 <br /> <br />t.f l./{p-llll 'fo - ;SDb <br /> <br />SUMMARY <br />1 Original ContiaCl Amount $ 596,749.66 <br />2 Change Order - AddlUon $ .0.00 <br />3 Change Order - Deduction $ 0.00 <br />4 Revised Contract Amount $ 598,749.66 <br />5 Value Completed'lo Dele $ 391,631.42 <br />6 M91erial on Hand $ 0.00 <br />7 Amount Earned $ 391,631.42 <br />6 .Less Relalnage 5% $ 19,591.57 <br />9 Subtotal $ 372,239.85 <br />10 Less Amount Paid Previausly $ 263,128.01 <br />11 Liquidated damages - $ 0.00 <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 3 $ 109.111.84 <br /> <br />Recommended for Approval by: <br />aONESTROO, ROSENE, ANDERLlK & ASSOCIATES, INC. <br /> <br />Approved by Con tractor; <br />NORTH DALE CONSTRUCTION COMPANY INe <br /> <br />-"'~~ ~ <br />'~~- ~ <br />. / <br />&?:y 1Um~~~r <br /> <br />Specified Contract Completion Date; <br />August 20. 2001 <br /> <br />Dale; <br /> <br />~. /1/ UJO~ <br /> <br />Post-it" Fax NOla 7671 <br />To Ie <br />Co..lDep <br /> <br />Phone. 4 <br /> <br /> <br />eo.&m <br />Phone ',",51- e - -tBfo'b <br />Fax # <br /> <br />Fax It k51-~q - f"'~ <br /> <br />61603132RE03.x/s <br /> <br />1_ _ <br />