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o o <br /> a0 Roselle Owner: City of Centerville 1880 Main StCenterville, MN, 55038 Date: December 15, 1999 <br /> sene <br /> Andedik& For Period: 10/26/99 to 12/15/99 Request No: 2 <br /> or <br /> Associ <br /> Englneers6 Architects Contractor: W 8 Miller Inc 6701 Norris Lake Rd NW, Elk River, MN, 55330 <br /> REQUEST FOR PAYMENT <br /> WATER INTERCONNECT <br /> BRA FILE NO. 616 -98 -809 <br /> CLIENT PROJECT NO. <br /> CLIENT CONTRACT NO. <br /> SUMMARY <br /> 1 Original Contract Amount $ 57,894.50 <br /> 2 Change Order - Addition $ 0.00 <br /> 3 Change Order - Deduction $ 0.00 <br /> 4 Revised Contract Amount $ 57,894.50 <br /> 5 Value Completed to Date $ 59,701.75 <br /> 6 Material on Hand $ 0.00 <br /> 7 Amount Earned $ 59,701.75 <br /> 8 Less Retainage 5% $ 2,985.09 <br /> 9 Subtotal $ 56,716.66 <br /> 10 Lass Amount Paid Previously $ 52,390.60 <br /> 11 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 2 $ 4.326.06 <br /> Recommended for Approval by: <br /> BONESTROO, ROSENE, ANDERLIK & ASSOCIATES, INC. <br /> AI 4 Lamps., <br /> Approved by Contractor: Approved by Owner: <br /> W B MILLER INC CITY OF CENTERVILLE <br /> Specified Contract Completion Date: Date: <br /> October 29, 1999 <br /> request2 <br />