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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. 3 <br />Contract No. <br />Vendor No. <br />For Period: 7/22/2017 - 8/23/2017 <br />Warrant # Date <br />Funds Encumbered <br />Original $1,273,990.06 <br />Additional N/A <br />Total $1,273,990.06 <br />Work Certified <br />This Pay Voucher <br />Work Certified <br />To Date <br />Contractor: T. A. Schifsky & Sons, Inc. <br />Less Previous Amount Paid Total Amount <br />Payments This Pay Voucher Paid To Date <br />2370 East Hwy. 36 <br />$319,359.18 <br />North St. Paul, MN <br />55109 <br />Contract Amounts <br />Percent Retained: 5% <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 />$773,329.58 <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 />$773,329.58 <br />Contract No. <br />Vendor No. <br />For Period: 7/22/2017 - 8/23/2017 <br />Warrant # Date <br />Funds Encumbered <br />Original $1,273,990.06 <br />Additional 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 />August 31, 2017 <br />Date <br />City of Hugo <br />Date <br />Contractor <br />Date <br />Page 1 <br />Work Certified <br />This Pay Voucher <br />Work Certified <br />To Date <br />Less Amount <br />Retained <br />Less Previous Amount Paid Total Amount <br />Payments This Pay Voucher Paid To Date <br />01904-93 <br />$319,359.18 <br />$773,329.58 <br />$38,666.48 <br />$431,271.88 $303,391.22 $734,663.10 <br />Percent Retained: 5% <br />Percent Complete: 60.7014% <br />Amount Paid This Pay Voucher $303,391.22 <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 />August 31, 2017 <br />Date <br />City of Hugo <br />Date <br />Contractor <br />Date <br />Page 1 <br />