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PROJECT PAY FORM <br />PARTIAL PAY ESTIMATE NO. <br />PERIOD OF ESTIMATE <br />TO <br />PROJECT OWNER:CONTRACTOR: <br />1. Original Contract Amount <br />2. Net Change Order Sum <br />3. Revised Contract (1+2) <br />4. *Work Completed <br />5. *Stored Materials <br />6. Subtotal (4+5) <br />7. Retainage* <br />8. Previous Payments <br />9. Amount Due (6-7-8) <br />*Detailed Breakdown Attached <br />START DATE:ON SCHEDULE <br />SUBSTANTIAL COMPLETION:X <br />FINAL COMPLETION: <br />ENGINEER'S CERTIFICATION:FOCUS Engineering, inc. <br />DATE <br />CONTRACTOR'S CERTIFICATION:CONTRACTOR <br />DATE <br />APPROVED BY OWNER:CITY OF LAKE ELMO, MINNESOTA <br />DATE DATE <br />BY <br />YES <br />NO <br />The undersigned Contractor certifies that to the best of their <br />knowledge, information and belief the work covered by this payment <br />estimate has been completed in accordance with the contract <br />documents, that all amounts have been paid by the contractor for <br />work for which previous payment estimates was issued and <br />payments received from the owner, and that current payment shown <br />herein is now due. <br />The undersigned certifies that the work has been reviewed and to <br />the best of their knowledge and belief, the quantities shown in this <br />estimate are correct and the work has been performed in accordance <br />with the contract documents. <br />ENGINEER <br />BY <br />6/11/2023 <br />6/30/2024 <br />REVISED DAYS <br />REMAINING <br />385 <br />0 <br />194 <br />10/15/2023 <br />ORIGINAL DAYS <br />CONTRACT CHANGE ORDER SUMMARY PAY ESTIMATE SUMMARY <br />6 <br />12/19/202311/1/2023FROM <br />OLD VILLAGE PH 7: STREET, DRAINAGE, & UTILITY IMPROVMENTS <br />PROJECT NO. 2022.119 <br />CITY OF LAKE ELMO <br />3880 LAVERNE AVENUE NORTH <br />LAKE ELMO, MN 55042 <br />ATTN: JACK GRIFFIN, CITY ENGINEER <br />MINGER CONSTRUCTION COMPANIES, INC. <br />620 CORPORATE DRIVE <br />JORDAN, MN 55352 <br />ATTN: RYAN BLAKE, PROJECT MANAGER <br />CONTRACT TIME <br />TOTALS $66,804.85 $0.00 $222,523.99 <br />NET CHANGE $66,804.85 <br />$104,346.195.0% <br />$1,760,053.59 <br />$0.00 <br />$2,086,923.77 <br />1 9/1/2023 $62,390.00 $2,363,463.60 <br />2 10/18/2023 $4,414.85 $2,086,923.77 <br />No.Approval <br />Date <br />Amount $2,296,658.75 <br />Additions Deductions $66,804.85 <br />FOCUS Engineering, inc.PROJECT PAYMENT FORM <br />12/19/2023 <br />12/20/23