HomeMy WebLinkAboutItem 4 - 2013 Crack Seal Pay Request No 1F PROJECT PAY FOR
PARTIAL PAY ESTIMATE NO. 1(FINAL) FOCUS ENGINEERING, inc.
I
2013 STREET CRACK SEAL PROJECT PERIOD OF ESTIMATE
PROJECT NO. 2011 19 FROM 10/7/2013 TO 10/31/2013
PROJECT OWNER: CONTRACTOR:
CITY OF LAKE ELMO GOPHER STATE SEALCOAT, INC.
3800 LAVERNE AVENI E NORTH 12519 RHODE ISLAND AVENUE S.
LAKE ELMO, MN 5504 SAVAGE, MN 55378
ATTN:JACK GRIFFIN,F.E.,CITY ENGINEER ATTN:CRAIG OLSON, PROJECT MANAGER
CONTRACT CHANGE ORDER SUMMARY PAY ESTIMATE SUMMARY
No. Approval Amount 1.Original Contract Amount $25,765.00
Date Additions Deductions 2. Net Change Order Sum $0.00
3. Revised Contract(1+2) $25,765.00
4. *Work Completed $25,765.00
5. *Stored Materials $0.00
6.Subtotal(4+5) $25,76S.00
7. Retainage* 0.0% $0.00
8. Previous Payments
TOTALS $0.00 $0.00 9.Amount Due(6-7-8) $25,765.00
NET CHANGE $0.00 *Detailed Breakdown Attached
CONTRACT TIME
START DATE: 10/7/2013 ORIGINAL DAYS 24 ON SCHEDULE
SUBSTANTIAL COMPLETION: N/A REVISED DAYS 0 YES FX
FINAL COMPLETION: 10/31/2013 REMAINING 0 NO F7
ENGINEER'S CERTIFICATION: FOCUS Engineering,inc.
The undersigned certifies that the work has been reviewed and to the
best of their knowledge nd belief,the quantities shown in this
re estimate a correct an the work has been performed in accordance ENGINEE
with the contract documents. 10� Zy _ 'Z 0 1 3
DATE
CONTRACTOR'S CERTIFICATION: CO TRACTOR
The undersigned Contractor certifies that to the best of their
knowledge,informationand belief the work covered by this payment
estimate has been completed in accordance with the contract BY
documents,that all amounts have been paid by the contractor for /U _ 2G 13
work for which previous payment estimates was issued and payments
received from the owner,and that current payment shown herein is DATE
now due.
APPROVED BY OWNER: CITY OF LAKE ELMO, MINNESOTA
BY BY
DATE DATE
FOCUS Engineering,inc. PROJECT PAYMENT FORM
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