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If I Bonestroo <br />Rosene <br />Anderlik & <br />I Associates <br />Engineer 14 Af:h4!ecii <br />Date: Dece'r'ter 21 .2004uwner wuj <br />For Penod.7/30.'20C4 to 12/2V2004 Request No*1 <br />Contractor.E J Wavers. 21360 LarVin Road. Corcoran V.N 55340 <br />CONTRACTOR’S REQUEST FOR PAYMENT <br />CASCO COVE STORM SEWER IMPROVEMENTS <br />BRA FILE NO. 139-04-147 <br />SUMMARY <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />OrvQ.nal Contract Amount <br />Change Order • Addition <br />Change Order - Deduction <br />Revised Contract Amount <br />Value Completed to Date <br />Material on Hand <br />Amount Earned <br />Less Retamage 5% <br />Subtotal <br />Less Amount Paid Prev ously <br />Liquidated damages - <br />AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br />S <br />$ <br />000 <br />000 <br />Recommended tor Approval by. <br />BONESTROO, ROSENE, ANDERLIK & ASSOCIATES, INC, <br />Approved by Owner <br />CITY OF ORONO <br />f <br />Specified Contract Completion Date: <br />September 30, 2004 <br />Dale <br />24.375 00 <br />> 24 375 00 <br />i 18 990 00 <br />S 000 <br />s 18.990 00 <br />s 949 50 <br />s 18 040 50 <br />s 0 00 <br />s 000 <br />s 10.040.50 <br />laaigfei