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DATE: 12/12/2017 <br />CONTRACTOR'S PAY REQUEST NO. 4 and Final CONTRACTOR <br />Insiluform Tech USA <br />2016 Sanitary Sewer Improvements OWNER <br />City of Orono <br />BMI PROJECT NO. 013.111229 ENGINEER <br />Bolton & Monk <br />FOR WORK COMPLETED FROM 8/21/2017 THROUGH 10/30/2017 <br />TOTALAMOUNT BID................................................................................................................................................ <br />$ <br />215,177.90 <br />APPROVED CHANGE ORDERS +EXTRA WORK...................................................................................... <br />$ <br />4,165.00 <br />CURRENT CONTRACT AMOUNT .................................. ............. .......... .... .... ................... I....................... <br />$ <br />219,342.90 <br />TOTAL, COMPLETED WORK TO DATE..................................................................................................................... <br />$ <br />212,652.80 <br />TOTAL, STORED MATERIALS TO DATE................................................................................................................. <br />$ <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED................................................................. <br />$ <br />TOTAL, COMPLETED WORK & STORED MATERIALS............................................................................................. <br />$ <br />212,652.80 <br />RETAINED PERCENTAGE ( 0.0% )...................................................................................................... <br />$ <br />- <br />TOTAL AMOUNT OF OTHER DEDUCTIONS..........................................................................................I............... <br />$ <br />- <br />NET AMOUNT DUE TO CONTRACTOR TO DATE ..................... ........ ............................................................. I.......... <br />$ <br />212,652.80 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES.......................................................... ................ I........I............. <br />$ <br />202,020.16 <br />PAY CONTRACTOR AS ESTIMATE NO. 4 and Final................................................................................................ <br />$ <br />10,632.64 <br />Certificate (or Final Payment <br />I hereby certify that, to the best of my knowledge and belief, all items quantities and prices <br />of work and material shown on this Estimate are correct and that all work has been <br />performed In full accordance with the terms and conditions of the Contract for this project <br />between the Owner and the undersigned Contractor, and as amended by any <br />authorized changes, and that the foregoing Is a true and correct statement of the amount <br />for the Final Estimate, that the provisions of M. S. 290.92 have been complied with and that <br />all claims against me by reason of the Contract have been paid or satisfactorily secured. <br />Contractor: Insituform Technologies USA, LLC <br />17988 Edison Avenue <br />Ch to ' Id, MO 63005 <br />By <br />Name Title <br />Date <br />Contractor's Surety <br />By <br />Date <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />BOLTON & MENK, INC., ENGINEERS, 2638 SHADOW LN, SUITE 200, CHASKA MN 55318 <br />By PROJECT ENGINEER <br />Brian Simmons <br />Date 12/12/2017 <br />APPROVED FOR PAYMENT: <br />Owner: CITY OF/ORONO <br />By/ <br />me Title Date <br />