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<br />.~. Bonestroo <br />9 Rosene <br />'II Anderlik & <br />.~. Associates <br />Engineers & Architects <br /> <br />Owner: Cilvof Centerville,,1880 Main St., Centerviile, MN 55038 Date: December 23, 2004 <br />For Period: 9/1/2004 to 12/23/2004 Reouest No: 2 AND FINAL <br />Contractor. Ailied Blacktop, 10503 89th Ave. N., Maple 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 Contract Amount $ 67,183.50 <br />2 Change Order - Addition $ 10,749.36 <br />3 Change Order - Deduction $ 0.00 <br />4 Revised Contract Amount $ 77,932.86 <br />5 Value Completed to Date $ 77,932.86 <br />6 Material on Hand $ 0.00 <br />7 Amount Earned $ 77,932.86 <br />8 Less Retainage 0% $ 0.00 <br />9 Subtotal $ 77 ,932.86 <br />10 Less Amount Paid Previously $ 74,036.22 <br />11 Liquidated damages - $ 0.00 <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 2 AND FINAL $ 3,896.64 <br /> <br />Recommended for Approvai by: <br />BONESTROO, ROSENE, ANDERLIK & ASSOCIATES, INC. <br /> <br /> <br />(4I/1il1~: <br /> <br />.~ <br /> <br />Approved by Contractor: <br /> <br />~T~~ <br /> <br />Approved by Owner: <br />CITY OF CENTERVILLE <br />~(;J 'V\A~~ <br /> <br />-f(~-( ~l~ <br /> <br />Specified Contract Completion Date: <br />August 27, 2004 . <br /> <br />Date: <br /> <br />l/r:"(Q) <br />( <br /> <br />61604137REQ2.xl$ <br />