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WSB <br />CITY OF HUGO <br />14669 Fitzgerald Avenue North <br />Hugo, MN 55038 <br />Project 01904-93 - HUGO - 2017 Street and Utility Improvement Project <br />Pay Voucher No. 1 <br />Contract No. <br />Vendor No. <br />For Period: 6/7/2017 - 6/21/2017 <br />Warrant # Date <br />Funds Encumbered <br />Original 1 $1,273,990.06 <br />Additional I N/A <br />Total $1,273,990.06 <br />Work Certified Work Certified <br />This Pay Voucher To Date <br />Less Amount Less Previous <br />Retained Payments <br />Contractor: T. A. Schifsky & Sons, <br />Inc. <br />01904-93 <br />2370 East Hwy. 36 <br />$7,613.69 $0.00 <br />$144,660.06 <br />North St. Paul, MN <br />55109 <br />Contract Amounts <br />Amount Paid This Pay Voucher <br />Original Contract <br />$1,273,990.06 <br />Contract Changes <br />$0.00 <br />Revised Contract <br />$1,273,990.06 <br />Work Certified To Date <br />Base Bid Items <br />$152,273.75 <br />Backsheet <br />$0.00 <br />Change Order <br />$0.00 <br />Supplemental Agreement <br />$0.00 <br />Work Order <br />$0.00 <br />Material On Hand <br />$0.00 <br />Total <br />$152,273.75 <br />Contract No. <br />Vendor No. <br />For Period: 6/7/2017 - 6/21/2017 <br />Warrant # Date <br />Funds Encumbered <br />Original 1 $1,273,990.06 <br />Additional I N/A <br />Total $1,273,990.06 <br />This is to certify that the items of work shown in this certificate of Pay Voucher have been actually furnished for <br />the work comprising the above mentioned projects in accordance with the plans and specifications heretofore approved. <br />Approved By Approved By T. A. Schifsky & Sons, Inc. <br />County/City/Project Engineer <br />Contractor <br />Date <br />June 26. 2017 <br />Date <br />City of Hugo <br />Date <br />Page 1 <br />Work Certified Work Certified <br />This Pay Voucher To Date <br />Less Amount Less Previous <br />Retained Payments <br />Amount Paid <br />This Pay Voucher <br />Total Amount <br />Paid To Date <br />01904-93 <br />$152,273.75 $152,273.75 <br />$7,613.69 $0.00 <br />$144,660.06 <br />$144,660.06 <br />Percent Retained: 5% <br />Percent Complete: 11.9525% <br />Amount Paid This Pay Voucher <br />1 $144,660.06 <br />This is to certify that the items of work shown in this certificate of Pay Voucher have been actually furnished for <br />the work comprising the above mentioned projects in accordance with the plans and specifications heretofore approved. <br />Approved By Approved By T. A. Schifsky & Sons, Inc. <br />County/City/Project Engineer <br />Contractor <br />Date <br />June 26. 2017 <br />Date <br />City of Hugo <br />Date <br />Page 1 <br />