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<br />\~'tt'tGINEER'S copy <br /> <br />.n. Bonestroo <br />e Rosene <br />n Anderlik & <br />.~. Associates <br />Engineers &. Itrchitear <br /> <br />Owner. CitvofCenterville 1880 Main Street, Centerville, MN 55038-9794 Date: Januarv 14 2005 <br />For Period: 7/30/2004 to 1/14/2005 ReQuest No: 5 AND FINAL <br />Contractor. Dave Perkins Contractlno, Inc., 14230 Basalt Street NW, Anoka, MN 55303 <br /> <br />. CONTRACTOR'S REQUEST FOR PAYMENT <br />PELTIER PRESERVE UTILITY & STREET IMPROVEMENTS <br />BRA FILE NO. 616-03-129 <br /> <br />SUMMARY <br />1 Original Contract Amount $ 503,307.00 <br />2 Change Order - Addition $ 0.00 <br />3 Change Order - Deduction $ 14,906.30 <br />4 Revised Contract Amount $ 488,400.70 <br />5 Value Completed to Date $ 488,400.70 <br />6 Material on Hand $ 0.00 <br />7 Amount Eamed $ 488,400.70 <br />8 Less Retainage 0% $ 0.00 <br />9 Subtotal $ 488,400.70 <br />10 Less Amount Paid Previously $ 429,705.90 <br />11 Liquidated damages - $ 0.00 <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 5 AND FINAL $ 58.694.80 <br /> <br />Recommended for Approval by: <br />BONESTROO, ROSENE, ANDERLlK & ASSOCIATES, INC. <br /> <br /> <br />l~tftJWI;.~ ~. <br /> <br />~ <br />,~ / KI TINGINC <br /> <br />{,.. <br /> <br />Approved by Owner. <br />CITY OF CENTERVILlE <br /> <br />\J-w,~" <br />-- -... .'\ <br />rl'\.M...:.... ~ l..~ <br /> <br />Specified Contract Completion Date: <br />May 15, 2004 <br /> <br />Date: <br /> <br />~/o~ <br />( <br /> <br />61603129REQSAnal-3.x1s <br />