Laserfiche WebLink
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: 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 $381,004.40 <br />Additions Deductions -$27,439.70 <br />2 11/29/2024 $27,439.70 $353,564.70 <br />1 8/9/2024 $0.00 $0.00 $353,564.70 <br />$353,564.70 <br />$0.00 <br />$335,886.47 <br />$0.000.0% <br />CONTRACT TIME <br />TOTALS $0.00 $27,439.70 $17,678.23 <br />NET CHANGE ($27,439.70) <br />CONTRACT CHANGE ORDER SUMMARY PAY ESTIMATE SUMMARY <br />2 (Final) <br />9/30/20249/1/2024FROM <br />15TH ST SEGMENT IMPROVEMENTS <br />PROJECT NO. 2023.121 and SAP 206-110-002 <br />CITY OF LAKE ELMO <br />3880 LAVERNE AVENUE NORTH <br />LAKE ELMO, MN 55042 <br />ATTN: CHAD ISAKSON, P.E., PROJECT ENGINEER <br />BITUMINOUS ROADWAYS, INC. <br />3080 LEXINGTON AVE SO <br />EAGAN, MN 55121 <br />ATTN: PAUL HILDESTAD, PROJECT MANAGER <br />8/5/2024 <br />10/1/2024 <br />REVISED DAYS <br />REMAINING <br />57 <br />0 <br />1 <br />9/15/2024 <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 />12/3/2024 <br />12/3/2024 <br />Mark Rohweder Digitally signed by Mark Rohweder <br />DN: C=US, E=mark.rohweder@kljeng.com, <br />CN=Mark Rohweder <br />Date: 2024.12.03 12:13:22-07'00' <br />PAUL HILDESTAD Digitally signed by PAUL HILDESTAD <br />DN: C=US, E=PAUL.HILDESTAD@BITROADS.COM, <br />CN=PAUL HILDESTAD <br />Date: 2024.12.03 13:24:36-06'00'