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f a Bonestroo Owner: Royal Oaks Realty Date: November 18, 1999 <br /> Rosen <br /> VI o Ander Ilk & For Period: 9/22/99 to 11/18/99 Request No: 1 <br /> Assodates <br /> Engineers 6 Architects Contractor. Burschville Construction, Inc., 11440 8th Street NE, Hanover, MN 55341 <br /> REQUEST FOR PAYMENT <br /> Fairview Street Utility and Streete Improvements <br /> File No. 616-99-110 <br /> SUMMARY <br /> 1 Original Contract Amount $ 134,110.00 <br /> 2 Change Order - Addition $ <br /> 3 Change Order - Deduction $ <br /> 4 Revised Contract Amount $ 134,110.00 <br /> 5 Value Completed to Date $ 135,283.66 <br /> 6 Material on Hand $ <br /> 7 Amount Eamed $ 135,283.66 <br /> 8 Less Retainage 5% $ 6,764.18 <br /> 9 Subtotal $ 128,519.48 <br /> 10 Less Amount Paid Previously $ <br /> 11 Liquidated Damages $ 0.00 <br /> 12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. 1 $ 128.519.48 <br /> Recommended for Approval by: I <br /> BON TROO, ROSENE, ANDERLIK & ASSOCIATES, INC. <br /> /I L i t i . t .7 �.A ._/ <br /> Approved by Co rector.. Approved by Owner. <br /> Burschville Constr A to Inc. Royal Oaks Realty <br /> ,Ili. i 61 t 1 1 11: Ir♦. <br /> Specified Contract Completion Date: Date: <br /> requesn.4s <br />