09-26-2001 Council Agenda - Laserfiche WebLink

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EXHIBIT C Invoice To: Melissa McGinnis Minnesota Department of Transportation Transportation Building, Mail Stop 680 395 John Ireland Boulevard St. Paul, MN 55155 Copy: Nancy Daubenberger Project Manager INVOICE NO. Re: Mn/DOT Agreement No. 81650 Contract Expiration Date: March 1, 2002 Mn/DOT Agreement No. 81650 Estimated Completion: (from Column 6 Progress Report) Period Ending: Invoice Date: Project Description: Joint Powers, Rice Street Crossings FOR STATE USE ONLY I hereby certify that the above statement is just and correct and payment has not been received. Governmental Units Signature: Print Name: Title: Billing Address: The City of Shoreview 4600 N. Victoria Street Shoreview, Minnesota 55126 Attn: Kathleen Nordine Telephone: (651) 490 -4682. Approved for Payment: Agreement Administrator Date Page 75 TOTAL CONTRACT AMOUNT TOTAL BILLING TO DATE AMOUNT PREVIOUSLY BILLED BILLED THIS INVOICE 1. LUMP SUM PAYMENT $7,800.00 NET EARNINGS TOTALS: $7,800.00 TOTAL AMOUNT DUE THIS INVOICE: FOR STATE USE ONLY I hereby certify that the above statement is just and correct and payment has not been received. Governmental Units Signature: Print Name: Title: Billing Address: The City of Shoreview 4600 N. Victoria Street Shoreview, Minnesota 55126 Attn: Kathleen Nordine Telephone: (651) 490 -4682. Approved for Payment: Agreement Administrator Date Page 75