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<br />-#- <br /> <br />Bonestroo <br /> <br />Owner (Ily of (emelville, 1880 Main 5t, Centerville, MN 55038 Date Auaust 20, 2009 <br />For P~r,od 7/16/2009 to 8120/2009 Reauelt No 4 <br />(ontfador" fo",t lake (ontraCllna, 14777 lake Dr , forest lake, MN 55025 <br /> <br />CONTRACTOR'S REQUEST FOR PAYMENT <br />PEL TIER lAKE DRIVE \/REET AND UTILITY IMPROVEMENTS <br />BONESTROO FilE NO 000616-09169.0 <br />(ITY PROJECT NO 200901 <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 /> $ 1,534,085.11 <br />$ 265.418.85 <br />$ 0.00 <br /> $ 1.799,50396 <br /> $ 826,25361 <br /> $ 0.00 <br /> I 826,25361 <br /> $ 41.312.68 <br /> I 784,94093 <br /> $ 484,585,37 <br /> $ 0.00 <br />4 $ 300,35556 <br /> <br />Recommended 1m Approval by: <br />BONESTRoO <br /> <br />ApproVEd by Contractor: <br />FOREST LAKE CONTRACTING <br /> <br />Approved r>J Owner <br />CITY OF CENTERVILLE <br /> <br />Specified (ontract Completlnn Oat. <br /> <br />Dale <br /> <br />G~60916&REQ4 01:5 <br />