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<br />In I Bonestroo <br />If! Rosene <br />'iii Anderlik & <br />,~, Associates <br />Engineers & Architects <br /> <br />Owner: Cit of Centerville, 1880 Main Street Centerville, MN 55038-9794 <br />For Period: 5/8/2004 to 6/9/2004 <br /> <br />Date: <br />Re uest No: <br /> <br /> <br />Contractor: Northdale Construction Com an Inc., 14450 Northdale Blvd. Ro ers, 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 />SUMMARY <br />1 Originai 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 />$ 0.00 <br />$ 0.00 <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> <br />598,749.66 <br /> <br />2 <br /> <br />598,749.66 <br />276,976.86 <br />0.00 <br />276,976.86 <br />13,848.84 <br />263,128.01 <br />113,493.46 <br />0.00 <br />149,634.55 <br /> <br />Recommended for Approvai by: <br />BONESTROO, ROSENE, ANDERlIK & ASSOCIATES, INC. <br /> <br />L/<../ &- t/ICf)O-3to <br /> <br />(Iww,k W~ ~ <br /> <br />Approved by Contractor: <br />~RUCTION COMPANYINC <br /> <br />_.~ <br /> <br />l-- <br /> <br />",-"",~- ~ <br />I~N~ <br />&ft A~ <br /> <br />Specified Contract Completion Date: <br />August 20, 2001 <br /> <br />Date: ~. . Z-tJocf <br />U14. I~ <br /> <br />61603132RE02.x1s <br />