Laserfiche WebLink
/aterial l Contract Amount' $ <br /> 271 , 552. 50 <br /> Total Amount Earned $ 27 , 095 . 70',1 <br /> Suitably Stored on Site, Not Incoporated. into Work $ <br /> Percent_Complete $ <br /> Contract Change Order No. :I <br /> Contract Change Order No. <br /> Percent-Complete $ <br /> Contract Change Order No. <br /> Percent Complete $ <br /> GROSS AMOUNT DUE. . .. . . . . . . . . . . . $ 271, 095.70 <br /> —0'— <br /> LESS __2 _% RETAINAGE. . . ... . . . . $ <br /> AMOUNT DUE TO DATE. . . . . . . . . . . .. $ 271, 095.70 <br /> LESS PREVIOUS APPLICATIONS. . . .•. $ 265, 673.79 ✓ <br /> AMOUNT DUE THIS APPLICATION. .. . $ 5, 421.91 <br /> CONTRACTOR'S AFFIDAVIT <br /> The undersigned Contractor hereby swears under <br /> ofpeworktperformeduunder that <br /> thelcontract referred progress. <br /> payments received from the Owner on account P <br /> above have been applied by the undersigned to discharge in full all obligations of the under- <br /> signed incurred in connection with work covered by prior Applications for Payment <br /> contract, <br /> material and equipment incorporated �cleardof Project or securityninterestse d an this <br /> Application for Payment are free and <br /> encumbrances. <br /> April 23, 19 87 Bituminous Roadwa s Inc. <br /> Dated Contractor <br /> By � <br /> Name and Title <br /> Edward J. tremba, Treasurer. <br /> COUNTY OF Henne in SS <br /> STATE OF Minnesota <br /> April i l 19 87 personally appeared <br /> Before me on this 23rd day of P sown to me, w o being <br /> sworn, did depose <br /> Edward J Otremba reasurer - of the Contractor above mentioned; <br /> and say that he is the Off{ce <br /> that he executed the above Application for hPayment an Affidavitctn nehalf of said Contractor; <br /> and that al l of the statements conta�bed t .� DOROTHY M. FRITZ[ <br /> A) NOTARY PUS - <br /> My Commission Expires: Feb. 20, 1990 N0 y Pu N IN COUNTY <br /> igr ComnsW*MR fi-OM Fad 20, <br /> The undersigned has checked the Contractor's Application for Payment shown above. <br /> this Application is the Contractor's stating his ayments in <br /> under this Contract have been applied by him to <br /> connection with the work covered by all prior Applications for Payment. <br /> In accordance <br /> with the Contract, the undersigned approves payment to the Contractor of the <br /> Amount Due. C. <br /> SHORT E TT HEN ICKSO , <br /> Date <br /> S� 1 S? By <br /> 4 4 <br /> I page of <br />