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CITY OF HUGO <br />14669 Fitzgerald Avenue North <br />Hugo, MN 55038 <br />Project 01904-93 - HUGO - 2017 Street and Utility Improvement Project <br />Final Pay Voucher No. 5 <br />Contract No. <br />Vendor No. <br />For Period: 9/18/2017 -10/24/2017 <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 Less Amount <br />To Date I Retained <br />Contractor: T. A. Schifsky & Sons, Inc. <br />Amount Paid <br />This Pay Voucher <br />2370 East Hwy. 36 <br />01904-93 <br />North St. Paul, MN <br />55109 <br />Contract Amounts <br />$74,457.45 <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 />$940,585.16 <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 />$940,585.16 <br />Contract No. <br />Vendor No. <br />For Period: 9/18/2017 -10/24/2017 <br />Warrant # Date <br />Funds Encumbered <br />Original $1,273,990.06 <br />Additional N/A <br />Total $1,273,990.06 <br />hereby certify 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 County/City/Project Engineer Approved By T. A. Schifsky & Sons, Inc. <br />November 14, 2017 <br />Date <br />City of Hugo <br />Date <br />Contractor <br />Date <br />Work Certified <br />This Pay Voucher <br />Work Certified Less Amount <br />To Date I Retained <br />Less Previous <br />Payments <br />Amount Paid <br />This Pay Voucher <br />Total Amount <br />Paid To Date <br />01904-93 <br />$28,871.78 <br />$940,585.16 1 $0.00 <br />$866,127.71 <br />$74,457.45 <br />$940,585.16 <br />Percent Retained: 0% <br />Amount Paid This Final <br />Pay Voucher $74,457.45 <br />hereby certify 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 County/City/Project Engineer Approved By T. A. Schifsky & Sons, Inc. <br />November 14, 2017 <br />Date <br />City of Hugo <br />Date <br />Contractor <br />Date <br />