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■1REQUEST FOR PAYMENT <br />December 21. 1990 FOR PERIOD: <br />vn 4 M • <br />PLACEi Orono, Minnesota From: Nov. 30, 1990To: <br />PROJECT:Lift Station No. 8 Renovation SPECIFIED CONTRACT <br />PROJECT NO.:FILE NO.:13945 COMPLETION DATE: <br />CONTRACTOR:Northwest Mechanical. Inc.October 31. 1990 <br />ADIRESS:432 Mill Street. PO Box 4C <br />Long Lake. MN 55356 <br />REQUEST FOR PAYMENT NO.: 3 _ <br />SUHHARYt <br />1. Original Contract Amount <br />2. Change Order - ADDITION <br />3. Change Order - DEDUCTION <br />4. Revised Contract Amount <br />Value Completed to Date <br />Material on Hand <br />Amount Earned <br />0. Less Retainage 5 I <br />9. Sub-Total <br />$ <br />$ <br />$ <br />5. <br />6. <br />7. <br />10. Less Amount Paid Previously <br />11. AMOUNT DUE THIS REQUEST FOR PAYMENT NO.: <br />$ <br />$ <br />$ <br />$ <br />S <br />$ <br />$ <br />$ <br />Recommended for Approval by: <br />BONESTROO. ROSENE, ANDERLIK St <br />ASSOCIATES. INC. <br />By:0 / - // <br />OWNER APPROVAL: <br />By_ _ _ _ _ _ <br />By_ _ _ _ _ _ <br />48,000.00 <br />48.000.00 <br />48.000.00 <br />0.00 <br />48.000.00 <br />2.400.00 <br />45.600.00 <br />43.700.00 <br />1.900.00 <br />Date:Approved Bv: NORTHWEST MECHANICAL. INC. _ <br />Contractor <br />BY:ADnrovaI stated on attached AIA form <br />I394SPR