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CITY OF HUGO <br />WSB 14669 Fitzgerald Avenue North <br />Hugo, MN 55038 <br />Project 01687-58 - HUGO - 129th Street Bridge Improvements <br />- Final Pay Voucher No. 5 <br />& lissociares, firs. <br />Contractor: Pember Companies, Inc. <br />N4449 469th Street <br />Menomonie, WI 54751 <br />Contract Amounts <br />Original Contract $616,090.97 <br />Contract Changes $29,969.95 <br />Revised Contract $646,060.92 <br />Backsheet <br />$0.00 <br />Change Order <br />$0.00 <br />Supplemental Agreement <br />$0.00 <br />Work Order <br />$29,969.95 <br />Material On Hand <br />$0.00 <br />Total <br />$634,433.49 <br />Contract No. <br />Work Certified <br />This Pay Voucher <br />Vendor No. <br />Less Amount I Less Previous <br />Retained Payments <br />For Period: 3/15/2016 - <br />5/31/2016 <br />Warrant # Date <br />$19,060.70 <br />Funds Encumbered <br />$0.001 $584,604.161 <br />Original <br />1 $634,433.49 <br />$616,090.97 <br />Additional <br />N/A <br />Total <br />$49,829.34 <br />$616,090.97 <br />I hereby cedify that a Final Examination has been made of the noted Contract, that the Contract has been completed, <br />that the entire amount of Work Shown in this Final Voucher has been performed and the Total Value of the Work Performed <br />in accordance with, and pursuant to, the terms of the Contract is as shown in this Final Voucher. <br />Approved By Approved By Per C ponies, Inc. <br />County/City/Project Engineer <br />; Z';' , Contractor <br />y` -- G- /3-/L <br />Date <br />Date <br />City of Hugo <br />�11J&/ <br />Date <br />Page I <br />�,S <br />Work Certified <br />This Pay Voucher <br />Work Certified <br />To Date <br />Less Amount I Less Previous <br />Retained Payments <br />Amount Paid <br />This Pay Voucher <br />Total Amount <br />I Paid To Date <br />01687-58 <br />$19,060.70 <br />$634,433.49 1 <br />$0.001 $584,604.161 <br />$49,829.34 <br />1 $634,433.49 <br />Percent Retained: 0% <br />Amount Paid This Final Pay Voucher <br />$49,829.34 <br />I hereby cedify that a Final Examination has been made of the noted Contract, that the Contract has been completed, <br />that the entire amount of Work Shown in this Final Voucher has been performed and the Total Value of the Work Performed <br />in accordance with, and pursuant to, the terms of the Contract is as shown in this Final Voucher. <br />Approved By Approved By Per C ponies, Inc. <br />County/City/Project Engineer <br />; Z';' , Contractor <br />y` -- G- /3-/L <br />Date <br />Date <br />City of Hugo <br />�11J&/ <br />Date <br />Page I <br />�,S <br />