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'11 Bonestroo <br /> Rosene Owner: City of Centerville 1880 Main StCenterville, MN, 55038 Date: July 28, 1999 <br /> 0 <br /> Andedik & For Period: 6/7/99 to 7/28/99 Request No: 1 <br /> Associates <br /> Eng(neers& Architiat Contractor: Allied Blacktop Co. 10503 89th Ave NMaple Grove, MN, 55369 <br /> REQUEST FOR PAYMENT <br /> 1999 SEAL COAT <br /> BRA FILE NO. 616 -99 -103 <br /> SUMMARY <br /> 1 Original Contract Amount $ 37,923.00 <br /> 2 Change Order - Addition $ 0.00 <br /> 3 Change Order - Deduction $ <br /> 4 Revised Contract Amount $ 37,923.00 <br /> 5 Value Completed to Date $ 38,434.13 <br /> 6 Material on Hand $ 0.00 <br /> 7 Amount Earned $ 38,434.13 <br /> 8 Less Retainage 5% $ 1,921.71 <br /> 9 Subtotal $ 36,512.42 <br /> 10 Less Amount Paid Previously $ 0.00 <br /> 11 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 1 $ - 36,512.42 <br /> Recommended for Approval by: <br /> B ROSENE, ANDERLIK & ASSOCIATES, INC. <br /> Approved by Contractor:. Approved by Owner. <br /> ALLIED BLACKTOP CO. CITY OF CENTERVILLE <br /> Specified Contract Completion Date: Date: <br /> July 7, 1999 <br /> Requestids <br />