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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: <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 />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 payments <br />received from the owner, and that current payment shown herein is <br />now due. <br />The undersigned certifies that the work has been reviewed and to the <br />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 />4/2/2024 <br />BY <br />4/18/2022 <br />5/25/2023 <br />REVISED DAYS <br />REMAINING <br />402 <br />0 <br />-312 <br />10/14/2022 <br />ORIGINAL DAYS <br />CONTRACT CHANGE ORDER SUMMARY PAY ESTIMATE SUMMARY <br />11(FINAL) <br />4/1/20249/1/2023FROM <br />WHISTLING VALLEY UTILITY AND STREET IMPROVEMENTS <br />PROJECT NO. 2020.123 <br />CITY OF LAKE ELMO <br />3800 LAVERNE AVENUE NORTH <br />LAKE ELMO, MN 55042 <br />ATTN: JACK GRIFFIN, CITY ENGINEER <br />JACON, LLC <br />3900 LABORE ROAD <br />VADNAIS HEIGHTS, MN 55110 <br />ATTN: DANN REZABEK <br />CONTRACT TIME <br />TOTALS $173,260.35 $94,248.90 $74,339.16 <br />NET CHANGE $79,011.45 <br />CO-5 12/20/2022 $0.00 $0.00 $0.000.0% <br />CCO-6 4/2/2024 $94,248.90 $2,275,278.74 <br />CO-3 7/19/2022 $2,802.29 $0.00 $0.00 <br />CO-4 9/2/2022 $12,432.00 $0.00 $2,349,617.90 <br />CO-1 3/15/2022 $141,959.85 $0.00 $2,349,617.90 <br />CO-2 6/7/2022 $16,066.21 $0.00 $2,349,617.90 <br />No.Approval <br />Date <br />Amount $2,270,606.45 <br />Additions Deductions $79,011.45 <br />FOCUS Engineering, inc.PROJECT PAYMENT FORM <br />Account Manager <br />10/10/2024