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(Owner: City of Centerville, 1880 Main St., Centerville, MN 55038 Date: July 22, 2010 <br />For Period: 4/24/2010 to 7/22/2010 Request No 10 <br />Bariestra0 (Contractor: Forest Lake Contractin 14777 <br />q, Lake Dr., Forest Lake, MN 55025 <br />CONTUCTOR'S REQUEST FOR RkYMENT <br />PELTIER LAKE DRIVE STREET AND UTILITY IMPROVEMENTS <br />BONESTROO FILE NO. 000616 - 09169 -0 <br />CITY PROJECT NO. 2009.01 <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 2% <br />9 Subtotal <br />10 Less Amount Paid Previously <br />it Liquidated damages - <br />12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br />$ <br />1,534,085.11 <br />$ 282 ,325.01 <br />$ 0.00 <br />$ <br />1,816,410.12 <br />$ <br />1,774,822.67 <br />$ <br />0.00 <br />$ <br />1,774,822.67 <br />$ <br />35,496.45 <br />$ <br />1,739,326.22 <br />$ <br />1,515,634.37 <br />$ <br />24,000.00 <br />10 $ <br />199.691.85 <br />Approved by Owner: <br />CITY OF CENTERVILLE <br />Specified Contract Completion Date: <br />Date: <br />61609169RE010.x1sm 13 <br />Recommended for Approval by: <br />BONESTROO <br />