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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:X <br />ENGINEER'S CERTIFICATION: KLJ Engineering, inc. <br />DATE <br />CONTRACTOR'S CERTIFICATION: CONTRACTOR <br />DATE <br />APPROVED BY OWNER:CITY OF LAKE ELMO, MINNESOTA <br />DATE DATE <br />No.Approval <br />Date <br />Amount $2,074,539.72 <br />Additions Deductions $13,217.41 <br />$1,729,185.23 <br />1 11/8/2024 $13,217.41 $2,087,757.13 <br />$1,729,185.23 <br />$0.00 <br />$878,696.33 <br />$86,459.265.0% <br />CONTRACT TIME <br />TOTALS $13,217.41 $0.00 $764,029.64 <br />NET CHANGE $13,217.41 <br />CONTRACT CHANGE ORDER SUMMARY PAY ESTIMATE SUMMARY <br />3 <br />11/30/202411/1/2024FROM <br />HUDSON BOULEVARD IMPROVEMENTS <br />PROJECT NO. 2023.120 (S.A.P. 206-120-002) <br />CITY OF LAKE ELMO <br />3880 LAVERNE AVENUE NORTH <br />LAKE ELMO, MN 55042 <br />ATTN: CHAD ISAKSON, P.E., PROJECT ENGINEER <br />DRESEL CONTRACTING <br />24044 JULY AVENUE <br />CHISAGO CITY, MN 55013 <br />ATTN: CRAIG MEYER, PROJECT MANAGER <br />6/18/2024 <br />10/11/2024 <br />REVISED DAYS <br />REMAINING <br />115 <br />0 <br />-50 <br />9/20/2024 <br />ORIGINAL DAYS <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 />BY <br />FOCUS Engineering, inc.PROJECT PAYMENT FORM <br />12/31/24 <br />Mark Rohweder Digitally signed by Mark Rohweder <br />DN: C=US, E=mark.rohweder@kljeng.com, <br />CN=Mark Rohweder <br />Date: 2024.12.31 09:59:50-07'00'