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REQUEST FOR PAYMENTDATE:_ _ _ _ _AuRUSt_22. 1990 <br />PLACEt_ _ _ _Orono, Minnesota <br />PROJECTI Lift Station Nos. 10 & 43 Replacement <br />PROJECT NO.t_ _ _ _ _ _ _ _ _ _ _ _ _ FILE NO.:_13940 <br />CONTRACTOR: Latour Construction Company <br />ADDRESSi RR 1 PO Box 76 <br />Maple Lake, MW 55358 <br />REQUEST FOR PAYMENT NO.:, <br />SUMMARY: <br />1. Original Contract Amount <br />2. Change Order - ADDITION $ _ _ _ _ <br />3. Change Order - DEDUCTION $ _ _ _ _ <br />4. Revised Contract Amount <br />5. Value Completed to Date <br />6. Material on Hand <br />7. Amount Earned <br />8. Less Retalnage 5 I <br />9. Sub-Total <br />10. Less Amount Paid Previously <br />11. AMOUNT DUE THIS REQUEST FOR PAYMENT NO.: <br />OVNER APPROVAL: <br />By_ _ _ _ _ _ <br />By_ _ _ _ _ _ <br />Date: <br />13940PR <br />Recommended for Approval by: <br />BONEST^'^'' ROSENE, ANDERLIK & <br />ASS '.IA«S, INC. <br />Approved By: LATOUR CONSTRUCTION CO <br />Contractor <br />By: