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<br />ENGINEER>S COpy i <br /> <br />4- <br /> <br />Bonestroo <br /> <br />Owner: City of Centerville, 1880 Main St, Centerville, MN 55038 Date: June 17, 2009 <br />For Period: 5/20/2009 to 6117/2009 Request No: 2 <br />Contrador: Forest lake Contradinq, 14777 lake Dr., Forest lake, MN 55025 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />2009 STREET IMPROVEMENTS <br />BONESTROO FilE NO. 000616-09170-0 <br />CITY PROJECT NO. 2009.02 <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 />$ 0.00 <br />$ 0.00 <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br /> $ <br />2 $ <br /> <br />1 ,3S 1,73725 <br /> <br />1,351,73725 <br />126,946.00 <br />0.00 <br />126,946.00 <br />6,347.30 <br />120,598.70 <br />17,622.50 <br />000 <br />102,976.20 <br /> <br />Recommended for Approval by: <br />BONESTROO <br /> <br />~z- <br /> <br />Approved ontractor: <br /> <br />FOR~~NTRA~. I <br />~ . ~ 'L:../- <br /> <br />Approved by Owner: <br />CITY OF CENTERVILLE <br /> <br />Specified Contrad Completion Date: <br /> <br />Date: <br /> <br />61609170REa2.x1s <br /> <br />18 <br />