HomeMy WebLinkAboutItem 8 - Section 34 PRV-PR #2PROJECT PAY FORM
PARTIAL PAY ESTIMATE NO.
PERIOD OF ESTIMATE
TO
PROJECT OWNER: CONTRACTOR:
1. Original Contract Amount
2. Net Change Order Sum
3. Revised Contract (1+2)
4. *Work Completed
5. *Stored Materials
6. Subtotal (4+5)
7. Retainage*
8. Previous Payments
9. Amount Due (6‐7‐8)
*Detailed Breakdown Attached
START DATE:ON SCHEDULE
SUBSTANTIAL COMPLETION:X
FINAL COMPLETION:
ENGINEER'S CERTIFICATION: FOCUS Engineering, inc.
DATE
CONTRACTOR'S CERTIFICATION: CONTRACTOR
DATE
APPROVED BY OWNER:CITY OF LAKE ELMO, MINNESOTA
DATE DATE
2
$0.00
CONTRACT CHANGE ORDER SUMMARY
LAKE ELMO, MN 55042
ATTN: JACK GRIFFIN, P.E., CITY ENGINEER
SECTION 34 PRESSURE REDUCING VALVE STATIONS
179
PROJECT NO. 2013.126
CITY OF LAKE ELMO
3800 LAVERNE AVENUE NORTH
No.Approval
Date
Amount
Additions Deductions
5/22/2015
12/19/2014
11/24/2014
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
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
now due.
BYBY
BY
ENGINEER
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
with the contract documents.
TOTALS
NET CHANGE
CONTRACT TIME
$0.00 $0.00 $2,596.35
YES
NO
ORIGINAL DAYS
REVISED DAYS 0
REMAINING ‐7
$83,948.65
$4,555.005.0%
$93,600.00
$91,100.00
$0.00
$91,100.00
5/29/201512/24/2014FROM
$93,600.00
$0.00
PAY ESTIMATE SUMMARY
GEISLINGER AND SONS, INC.
511 CENTRAL AVE S P.O. BOX 437
WATKINS, MN 55389
ATTN: JEFF GEISLINGER, PRESIDENT
06/02/2015
PARTIAL PAY ESTIMATE NO. 2
SECTION 34 PRESSURE REDUCING VALVE STATIONS
CITY OF LAKE ELMO, MINNESOTA
PROJECT NO. 2013.126
QUANTITY UNIT PRICE AMOUNT QUANTITY AMOUNT QUANTITY AMOUNT
1 LS 1 $91,100.00 $91,100.00 0.03 $2,733.00 1.00 $91,100.00
2 LS 1 $2,500.00 $2,500.00 0.00 $0.00 0.00 $0.00
$93,600.00 $2,733.00 $91,100.00
TOTALS ‐ BASE CONTRACT $93,600.00 $2,733.00 $91,100.00
ITEM DESCRIPTION OF PAY ITEM UNIT
CONTRACT THIS PERIOD TOTAL TO DATE
SUBTOTAL ‐ BASE BID
BASE BID ‐ HUDSON BOULEVARD PRV STATION
HUDSON BLVD PRV STATION
WATERMAIN BYPASS ‐ HUDSON BLVD PRV STATION