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. • <br />REQUEST FOR PAYMENT <br />D4TE:June 12. 1990 FOR PERIOD: <br />PLACE:From: Hay 1. 1990 <br />PROJECT:Municloal Well No. 3 16" Production Well SPECIFIED CONTRACT <br />& cwww a • <br />PROJECT NO. <br />CONTRACTOR: <br />ADDRESS: <br />FILE NO.: 13949 COMPLETION DATE: <br />Revs Well DrillinR Company June 15. 1990 <br />413 North Lexinaton Parkway <br />St. Paul. MN 55104 <br />TorMav 31. 1990 <br />REQUEST FOR PAYMENT NO.i. <br />SUMMARY! <br />1. Original 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 Retalnage 5 Z <br />Sub-Total <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />11. <br />Less Amount Paid Previously <br />AMOUNT DUE THIS REQUEST FOR PAYMENT NO.:. <br />70,155,00 <br />70.155.00 <br />45.044.00 <br />0.00 <br />45.044.00 <br />2.252.20 <br />42,791.80 <br />31.771.80 <br />11.020.00 <br />Recommended for Approval by: <br />BONESTROO, ROSENE, ANDERLIK fc <br />ASSOCIATES, INC. <br />)l^L <br />OWNER APPROVAL: <br />By_ _ _ _ _ _ <br />By_ _ _ _ _ _ <br />Date:Approved Bvr KEYS WELL DF.ILLING COMPANY <br />PR13949