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PROJECT: <br />LOCATION: <br />PROJECT NO: <br />FOR PERIOD: <br />SUMMARY: <br />REQUEST FOR PAYMENT <br />ESTIMATED QUANTITIES <br />July 2, 1988 <br />Mounds View Business <br />Mounds View, MN <br />86-106 <br />6/1/88 to 7/2/88 <br />Pk CONTRACTOR: <br />ADDRESS: <br />1. Original Contract Amount <br />2. Change Order - ADDITION 043,884.25 <br />3. Change Order - DEDUCTION $51,727.32 <br />- NET <br />4. Revised Contract Amount <br />S. Value Completed To Date <br />6. Material on Hand <br />7. Amount Earned <br />8. Less Retainage 5% <br />9. Subtotal <br />10. Less Amount Previously Paid <br />11. AMOUNT DUE THIS REQUEST FOR PAYMENT <br />C. W. Houle, Inc. <br />1300 West Cty Rd I <br />Shoreview, MN 55126 <br />0872,535.62 <br />(87,843.07) <br />9864,692.55 <br />$728,043.96 <br />00.00 <br />$728,043.96 <br />$36,402.20 <br />$691,641.76 <br />$550,825,98 <br />$140,815.78 <br />I hereby certify that this partial payment request reflects that work has <br />been completed and the stated materials have been delivered to the site <br />in conformance with the plans and specifications for Project No. 86-106. <br />Recommended for Approval By: <br />MERILA AND ASSOC7 TES, INC. <br />By: <br />Reg. No.:./� // ��J�¢3Y <br />Date: opr <br />Approved By Owner: <br />CITY OF MOUNDS VIEW <br />By: <br />Date: <br />Payment Requested By: <br />C.W. HOULE, INC. <br />By: <br />Date: <br />