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CONTRACTOR'S PAY REQUEST <br />Little Canada Road Streetscape Improvements <br />City of Little Canada, MN <br />BMI Project No. NlS.118933 <br />lloriginal Contract Amount <br />Approved Change Orders <br />Revised Contract Amount <br />Completed Work to Date <br />Stored Materials on Hand <br />Sub-Total <br />Retained Percentage 5% <br />Deduction <br />Liquidated Damages <br />Total <br />Total Amount Paid on Previous Estimates <br />Amount Due Contractor This Pay Request <br />Certificate for Partial Payment <br />!Date: 4/30/2020 <br />Pay Request No. 1 <br />For Period Ending: 4/30/2020 <br />$525,020.00 <br />$5,478.67 <br />$530,498.67 <br />$176,509.20 <br />$0.00 <br />$176,509.20 <br />($8,825.46) <br />$0.00 <br />$0.00 <br />$lu,,~�--, .. <br />$0.00 <br />$167,683.74 <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices <br />of work and material shown on this Estimate are correct and that all work has been <br />performed in full accordance with the terms and conditions of the Contract for this project <br />between the Owner and the undersigned Contractor, and as amended by any <br />authorized changes, and that the foregoing is a true and correct statement of the <br />contract amount for the period covered by this Estimate. <br />Approved for Payment: <br />s� <br />M flit s--1-1-02.0 <br />Custom Builders, Inc. Date <br />12383 -234th Street <br />Cold Spring, MN 56320 .::Tettn� � Re-/te.r I Pre. 5, -de I\ t CBI. <br />Printed Name and Title <br />Checked and Approved as to <br />Quantities and Amount: Signature Date <br />Bolton & Menk, Inc. <br />2035 County Road D East <br />Maplewood, MN 55109 Printed Name and Title <br />Approved for Payment: <br />City of Little Canada, MN <br />Name Title Date <br />5-1-2020 <br />Mark D. Kasma, City Engineer