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Date: <br />7 & Final <br />Approved for Payment: <br />OMG Midwest, Inc. dba Minnesota Paving & Materials Signature Date <br />14475 Quiram Drive <br />Rogers, MN 55374 <br />Printed Name and Title <br />Checked and Approved as to <br />Quantities and Amount:Signature Date <br />Bolton & Menk, Inc. <br />3507 High Point Drive North Bldg. 1 Suite E130 <br />Oakdale, MN 55128 Printed Name and Title <br />Approved for Payment: <br />City of Little Canada <br />Name Date <br />all claims against me by reason of the Contract have been paid or satisfactorily secured. <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 />for the Final Estimate, that the provisions of M. S. 290.92 have been complied with and that <br />Title <br />Amount Due Contractor This Pay Request $14,595.86 <br />Certificate for Final Payment <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 />Total $741,161.20 <br />Deduction ($232.00) <br />Total Amount Paid on Previous Estimates $726,565.34 <br />Sub-Total $741,393.20 <br />Retained Percentage 0%$0.00 <br />Liquidated Damages $0.00 <br />Revised Contract Amount $732,791.21 <br />Completed Work to Date $741,393.20 <br />Stored Materials on Hand $0.00 <br />11/9/2021 <br />CONTRACTOR'S PAY REQUEST Pay Request No. <br />Allen Avenue Street Improvements <br />City of Little Canada, MN For Period Ending:11/9/2021 <br />$0.00 <br />Original Contract Amount $732,791.21 <br />BMI Project No. N15.119846 <br />Approved Change Orders