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CITY OF HUGO <br />14669 Fitzgerald Avenue North <br />Hugo, MN 55038 <br />Project 03288-190 - Water Tower No. 4 <br />Pay Voucher No. 11 <br />Contractor: CB&I, LLC City Project No. NA <br />PO Box 84627 For Period: 6/03/2020 -07/02/2020 <br />Dallas, TX 75284-6217 <br />Contract Amounts <br />Original Contract 3,510,500.00$ <br />Contract Changes (22,000.00)$ <br />Revised Contract 3,488,500.00$ <br />Work Certified to Date <br />Base Bid Items 2,646,718.45$ <br />Backsheet 0 <br />Change Order 0 <br />Supplemental Agreement 0 <br />Work Order 0 <br />Material on Hand 0 <br />Total 2,646,718.45$ <br />Less Amount <br />Retained <br />Less Previous <br />Payments <br />Amount Paid This <br />Pay Voucher <br />Total Amount <br />Paid to Date <br />132,335.92$ 2,464,602.53$ 49,780.00$ $ 2,514,382.53 <br />Percent retained 5% <br />Amount Paid This Pay Voucher $ 49,780.00 <br />Approved By: WSB Approved By: CB&I, LLC <br />Project Engineer Contractor <br />Date Date <br />Approved By: City of Hugo <br />City of Hugo <br />Date <br />Work Certified <br /> This Pay Voucher <br />Work Certified <br /> to Date <br />52,400.00$ 2,646,718.45$ <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 />Page 1 of 3 <br />K:\03288-190\Admin\Construction Admin\Pay Vouchers\ <br />03288-190 PV11 0708209 Cover <br />07/09/20July 9, 2020