HomeMy WebLinkAboutItem 12 - Pay Request No 2 Final PROJECT PAY FORM
PARTIAL PAY ESTIMATE NO. 2(FINAL) FOCUS ENGINEERING, inc.
2012 RAIN GARDEN PROJECT PERIOD OF ESTIMATE
FROM 11/20/2012 TO 10/31/2013
PROJECT OWNER: CONTRACTOR:
CITY OF LAKE ELMO ST.CROIX VALLEY LANDSCAPING
3800 LAVERNE AVENUE NORTH _ 389 280TH STREET
LAKE ELMO,MN 55042 OSCEOLA,WI 54020
ATTN:JACK GRIFFIN, P.E.,CITY ENGINEER
CONTRACT CHANGE ORDER SUMMARY PAY ESTIMATE SUMMARY
No. Approval Amount 1.Original Contract Amount $46,501.16
Date Additions Deductions 2. Net Change Order Sum $1,341.13
1 11/20/2012 $1,341.13 3. Revised Contract(1+2) $47,842.29
4. *Work Completed $45,901.29
5. *Stored Materials $0.00
6.Subtotal (4+S) $45,901.29
7. Retainage* 0.0% $0.00
8. Previous Payments $42,341.29
TOTALS $1,341.13 $0.00 9.Amount Due(6-7-8) $3,560.00
NET CHANGE $1,341.13 *Detailed Breakdown Attached
CONTRACT TIME
START DATE: 9/17/2012 ORIGINAL DAYS 44 ON SCHEDULE
SUBSTANTIAL COMPLETION: 10/31/2012 REVISED DAYS 0 YES EX
FINAL COMPLETION: 10/31/2013 REMAINING 0 NO
ENGINEER'S CERTIFICATION: FOCUS En ineering,inc.
The undersigned certifies that the work has been reviewed and to the
best of their knowledge and belief,the quantities shown in this
estimate are correct and the work has been performed in accordance ENGIN ER
with the contract documents. zZ3cj/j`3
DATE
CONTRACTOR'S CERTIFICATION: CONTRACTOR
The undersigned Contractor certifies that to the best of their
knowledge,information and 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
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