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^iBonestreo <br />^jfliosene <br />nAnderl(& <br />|\|| Associates <br />EngmtesftArcMccti <br />Ovwier Cttv of Oiono. P. O. Box 66. Orono. MN 55323-0066 Date: Novembra. 2003 <br />For Period: 11/30003 to 11/4/2003 Request No: <br />Contractor Red Pederson Utilities Inc., 100 Intertachen Rd- Hopkins. MN 55343 <br />CONTRACTOR S REQUEST FOR PAYMENT <br />PHILLIPS SANITARY SEWER EXTENSION <br />BRA FILE NO. 139-03-140 <br />SUMMARY <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />a <br />9 <br />10 <br />11 <br />12 <br />Original Contract Amount <br />Change Order - Addition <br />Change Order - Deduction <br />Revised Contract Amount <br />Value Completed to Dale <br />Material on Hand <br />Amount Earned <br />Less Relainage 5% <br />Subtotal <br />Less Amount Paid Previously <br />Liquidated damages • <br />AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br />S <br />S <br />0.00 <br />0.00 <br />Recommended (or Approval by: <br />BONESTROO, ROSENE, ANDERUK & ASSOCIATES, INC. <br />Approved by Contractor: <br />RED PEDERSON UTtLITlES INC <br />Approved by Owner. <br />CITY OF ORONO <br />Specified Contract Completion Date: <br />November 14.2003 <br />Date: <br />1 <br />25.90500 <br />25.985 00 <br />16.505 00 <br />000 <br />16.505 00 <br />825 25 <br />15.67975 <br />0.00 <br />000 <br />1567975 <br />119C3140RCQ1 1 <br />-----