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WSBI CITY OF HUGO 14669 Fitzgerald Avenue North Hugo, MN 55038 Project 01904-93 - HUGO - 2017 Street and Utility Improvement Project Pay Voucher No. 4 Contract No. Vendor No. For Period: 8/24/2017 - 9/17/2017 Warrant # Date Funds Encumbered Original $1,273,990.06 Additional N/A Total $1,273,990.06 Work Certified This Pay Voucher Work Certified To Date Contractor: T. A. Schifsky & Sons, Inc. Amount Paid This Pay Voucher 2370 East Hwy. 36 01904-93 North St. Paul, MN 55109 Contract Amounts $131,464.61 Original Contract $1,273,990.06 Contract Changes $0.00 Revised Contract $1,273,990.06 Work Certified To Date Base Bid Items $911,713.38 Backsheet $0.00 Change Order $0.00 Supplemental Agreement $0.00 Work Order $0.00 Material On Hand $0.00 Total $911,713.38 Contract No. Vendor No. For Period: 8/24/2017 - 9/17/2017 Warrant # Date Funds Encumbered Original $1,273,990.06 Additional N/A Total $1,273,990.06 This is to certify that the items of work shown in this certificate of Pay Voucher have been actually furnished for the work comprising the above mentioned projects in accordance with the plans and specifications heretofore approved. Approved By County/City/Project Engineer Approved By T. A. Schifsky & Sons, Inc. September 27, 2017 Date City of Hugo Date Contractor Date Page 1 Work Certified This Pay Voucher Work Certified To Date Less Amount Less Previous Retained Payments Amount Paid This Pay Voucher Total Amount Paid To Date 01904-93 $138,383.80 $911,713.38 $45,585.67 $734,663.10 $131,464.61 $866,127.71 Percent Retained: 5% Percent Complete: 71.5636% Amount Paid This Pay Voucher $131,464.611 This is to certify that the items of work shown in this certificate of Pay Voucher have been actually furnished for the work comprising the above mentioned projects in accordance with the plans and specifications heretofore approved. Approved By County/City/Project Engineer Approved By T. A. Schifsky & Sons, Inc. September 27, 2017 Date City of Hugo Date Contractor Date Page 1