HomeMy WebLinkAbout2015 Seal Coat-PR #1FPROJECT 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
1 (FINAL)
$0.00
CONTRACT CHANGE ORDER SUMMARY
LAKE ELMO, MN 55042
ATTN: JACK GRIFFIN, P.E., CITY ENGINEER
2015 SEAL COAT PROJECT
69
PROJECT NO. 2015.117
CITY OF LAKE ELMO
3800 LAVERNE AVENUE NORTH
No.Approval
Date
Amount
Additions Deductions
8/31/2015
7/17/2015
6/23/2015
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 $192,554.56
YES
NO
ORIGINAL DAYS
REVISED DAYS 0
REMAINING 31
$0.00
$0.000.0%
$200,049.52
$192,554.56
$0.00
$192,554.56
7/31/20157/6/2015FROM
$200,049.52
$0.00
PAY ESTIMATE SUMMARY
PEARSON BROTHERS, INC.
11079 LAMONT AVENUE N.E.
HANOVER, MN 55341
ATTN: JACK PEARSON, PRESIDENT
PAY ESTIMATE NO. 1 (FINAL)2015 SEAL COAT PROJECTCITY OF LAKE ELMO & WEST LAKELAND TOWNSHIPFOCUS PROJECT NO. 2015.117CONTRACT DATED MAY 19, 2015ITEM CONTRACT ACTUAL UNIT TOTALNO. QUANTITY QUANTITY UNIT PRICE AMOUNT1 108,990 106,667 SY 1.32$ 140,800.44$ 2 46,432 42,772 SY 1.21$ 51,754.12$ TOTAL192,554.56$ AND CRS‐2 EMULSIFIED ASPHALTCITY OF LAKE ELMOCITY OF WEST LAKELANDBITUMINOUS SEAL COAT WITH 1/8" DRESSER TRAP ROCKBITUMINOUS SEAL COAT WITH 1/8" DRESSER TRAP ROCKDESCRIPTIONAND CRS‐2P EMULSIFIED ASPHALT