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<br />CONTRACTOR"S cut" T <br />FOR YOUR FILE <br /> <br /># <br /> <br />Bonestroo <br /> <br />Owner: Citv of Centerville, 1880 Main 51., Centerville, MN 55038 Date'. SeptembN 21, 2009 <br />For Period: 8/21/200910 9/21/2009 Request No: 5 <br />Contractor: Forest Lake Contractino, 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 /> $ 1,351)3725 <br />$ 51,30716 <br />$ 000 <br /> $ 1,403,04441 <br /> $ 666,49936 <br /> $ 000 <br /> $ 666,49936 <br /> $ 33,32497 <br /> $ 633,17439 <br /> $ 584,156 78 <br /> $ 0.00 <br />5 $ 49,01761 <br /> <br />Recommended lor Approval by: <br />BONESTROO <br /> <br />~A- <br /> <br />Approved by Contractor' <br />FOREST LAKE CONTRACTING <br /> <br />Approved Dy Owner: <br />CITY OF CENTERVILLE <br /> <br />Specified Contract Completion Date <br /> <br />Date <br /> <br />61609170REQ5xJs <br /> <br />63 <br />