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Date: <br />Approved for Payment: <br />T.A. Schifsky & Sons, Inc.Signature Date <br />2370 East Hwy 36 <br />North St. Paul, MN 55109 <br />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 Name and Title <br />Approved for Payment: <br />City of Little Canada <br />Name Date <br />7/7/2021 <br />CONTRACTOR'S PAY REQUEST Pay Request No. 1 <br />2021 Street Improvements <br />City of Little Canada, MN For Period Ending:7/2/2021 <br />Revised Contract Amount $593,729.91 <br />Completed Work to Date $250,402.42 <br />BMI Project No. 0N1.122720 <br />Original Contract Amount $593,729.91 <br />Approved Change Orders $0.00 <br />Deduction $0.00 <br />Stored Materials on Hand $0.00 <br />Sub-Total $250,402.42 <br />Retained Percentage 5%($12,520.12) <br />Liquidated Damages $0.00 <br />Total $237,882.30 <br />Total Amount Paid on Previous Estimates $0.00 <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 />Title <br />Amount Due Contractor This Pay Request $237,882.30 <br />Certificate for Partial 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 />DocuSign Envelope ID: CA716765-52E1-4C0C-B6FD-75E957C01340 <br />VP Jonathan Hager <br />July 7, 2021 <br />PMEric Seaburg <br />July 8, 2021 <br />July 8, 2021Bill Dircks Public Works Director