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CITY OF HUGO <br />14669 Fitzgerald Avenue North <br />Hugo, MN 65038 <br />Wsb Project 03288-190 - Water Tower No. 4 <br />Pay Voucher No. 5 <br />Contractor: CB&1, LLC City Project No. NA <br />PO Box 84627 For Period: 07/02/19 - 08123/19 <br />Dallas, TX 75284-6217 <br />Contract Amounts <br />Original Contract <br />$ <br />3,510,500.00 <br />Contract Changes <br />$ <br />Revised Contract <br />$ <br />3,510,500.00 <br />Work Certified to Date <br />Base Bid Items <br />$ <br />1,400,628.94 <br />Backsheet <br />0 <br />Change Order <br />0 <br />Supplemental Agreement <br />0 <br />Work Order <br />0 <br />Material on Hand <br />0 <br />Total <br />$ <br />1,400,628.94 <br />Work Certified <br />Work Certified <br />Less Amount <br />Total Amount <br />Less Previous <br />Amount Paid This <br />This Pay Voucher <br />1 <br />to Date <br />Retained <br />Payments <br />Pav Voucher <br />Paid to Date <br />$ 423,978.19 <br />$ <br />1,400,628.94 <br />1 $ 70,031.45 <br />$ 927.818.21 <br />$ 402.779.28 <br />$ 1.330.597.49 <br />E Amount Paid This Pay Voucher J $ 402,779.28 <br />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 <br />mentioned projects in accordance with the plans and specifications heretofore approved. <br />Approved By: WSB Approved By: CB&I, LLC <br />Project Engineer Contr&.'Ior <br />_September 5, 2019 <br />Date <br />Approved By: City of Hugo <br />City of Hugo <br />Date <br />Date <br />K:W W6-1@ftdmInlConatruefren Adinkfy VoucMral <br />Pape / of 3 0 218-190 PVd amlavo 5 Cover <br />