Laserfiche WebLink
Date: <br />Approved for Payment: <br />Forest Lake Contracting, Inc.Signature Date <br />14777 Lake Drive <br />Forest Lake, MN 55025 <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 />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 amount <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 $65,360.50 <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 />all claims against me by reason of the Contract have been paid or satisfactorily secured. <br />Retained Percentage 0%$0.00 <br />Liquidated Damages $0.00 <br />Total $65,360.50 <br />Deduction $0.00 <br />Completed Work to Date $65,360.50 <br />Stored Materials on Hand $0.00 <br />Sub-Total $65,360.50 <br />BMI Project No. 0N1.124810 <br />Original Contract Amount $68,062.50 <br />Approved Change Orders $0.00 <br />Revised Contract Amount $68,062.50 <br />11/2/2021 <br />CONTRACTOR'S PAY REQUEST Pay Request No. 1st & Final <br />Spooner Park Storm Sewer Improvements <br />City of Little Canada, MN For Period Ending:11/2/2021 <br />DocuSign Envelope ID: 5E596FBD-CAAB-4416-8A64-971A77BB2C46 <br />Robert D. VollhaberPresident <br />December 7, 2021 <br />PMEric Seaburg <br />December 7, 2021 <br />December 7, 2021Bill Dircks Public Works Director