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1 <br />l/l6one$troo <br />^Rosem <br />«vAndertik& <br />Afiodates <br />IngtRfCfs&ArctmefU <br />Owner City of Orono PO Box 66Crvstal Bay. MN. 55323-0066 Date:Septerrter 23.2003 <br />Fcr Period 7/16/2003 to 9/4/2003 Reouest No;3 A.N0 FIISIAL <br />Ccntractor Automatic Systems Company 2400 W Ctv Rd D PO Box 120359. St Paul. MN. 55112 <br />CONTRACTOR’S REQUEST FOR PAYMENT <br />ORONO SCAOA SYSTEM <br />BRA FILE NO. 139-01-113 <br />SUMMARY <br />1 <br />2 <br />3 <br />4 <br />5 <br />Original Ccr.tract Anxjunt <br />Change Order • Addition <br />Change Order - Deduction <br />Revised Contract AnxMjnl <br />Value Compleled to Date <br />6 Material on Hand <br />7 Amount Earned <br />8 Less Retainage 0% <br />Subtotal <br />Less Amount Paid Previously <br />Liquidated damages - <br />AMOUNT DUE THIS REQUEST FOR PAYMENT NO. <br />9 <br />10 <br />11 <br />12 <br />S <br />$ <br />6,546 00 <br />3.402 44 <br />3 AND FINAL <br />S <br />s <br />s <br />$ <br />$ <br />s. <br />$. <br />$. <br />$. <br />Recommended for Approval by: <br />BONESTROO, ROSENE. ANDERLIK & ASSOCIATES. INC. <br />See attached for signature <br />Approved by Contractor <br />AUTOMATIC SYSTEMS COMPANY <br />Approved by Owner <br />CITY OF ORONO <br />See attached for signature <br />Specified Ccr.tract Completion Date; <br />_____________December 16.2002 <br />Date: <br />UK 11 Ilia <br />174.328 00 <br />177.471 56 <br />177.471 56 <br />0.00 <br />177.471.56 <br />000 <br />177.471.56 <br />155.652 80 <br />0 00 <br />10.81876 <br />L <br />J