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CONTRACTOR'S PAY REQUEST <br />DISTRIBUTION: <br />OLD CRYSTAL BAY ROAD IMPROVEMENTS <br />CONTRACTOR (1) <br />OWNER (1) <br />SAP 152-102-017 <br />ENGINEER (1) <br />CITY OF ORONO, MN <br />BONING CO. (7) <br />BM[ PROJECT NO. C13.114606 <br />TOTAL. AMOUNT BID PLUS APPROVED CHANGE ORDERS <br />$3,073,421.24 <br />TOTAL, COMPLETED WORK TO DATE <br />$3,101,930.16 <br />TOTAL, STORED MATERIALS TO DATE <br />$0.00 <br />DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED <br />$0.00 <br />TOTAL, COMPLETED WORK & STORED MATERIALS <br />$3,101,930.16 <br />RETAINED PERCENTAGE ( 0%) <br />$0.00 <br />TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) <br />$0.00 <br />NET AMOUNT DUE TO CONTRACTOR TO DATE <br />$3,101,930.16 <br />TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES <br />$3,024,555.35 <br />PAY CONTRACTOR AS ESTIMATE NO, 8 <br />$77,374.81 <br />Certificate for 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: GMH Asphalt Inc. <br />9180 Laketown Road <br />Chaska, N 55318 <br />By 7 <br />Name Title <br />Date ` J-- 90 <br />Bond (€2272032 <br />Approved'VL26 <br />]North American Specialty insurance uompany,Contractor's Surety Sandra M. lEngstrum, ttarney-in- ac <br />CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: <br />ENG#NEER: BOLTON & MbENK, INC., 2638 SHADOW LANE, SUITE 200, CHASKA, MN 55318. <br />By —r). 7' T� , PROJECT MANAGER <br />DAVID P. MARTINI, P.E. <br />Date 11/22/2019 <br />APPROVED FOR PAYMENT: <br />OWNER.y <br />By City Engineer 5 Feb 20 <br />Name Title Date <br />And <br />Name Title Date <br />