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REQUEST FOR PAYMENT <br />DATE: November 14, 1988 <br />PLACE: Orono Minnesota <br />PROJECT: 1988 Seal Coat Project <br />PROJECT NO.: FILE NO.: 13944 <br />CONTRACTOR: Allied Blacktop Company <br />ADDRESS: 10503 - 89th Avenue North <br />MaDle Grove, Minnesota 55369 <br />REQUEST FOR PAYMENT NO.: 1 <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 Retainage 5 Z <br />9. Sub -Total <br />10. Less Amount Paid Previously <br />11. AMOUNT DUE THIS REQUEST FOR PAYMENT NO.: 1 <br />OWNER APPROVAL: <br />By <br />By <br />FOR PERIOD: <br />From: Oct. 1, 1988 To: Oct. 31, 1988 <br />SPECIFIED CONTRACT <br />COMPLETION DATE: <br />$ 18,470.80 <br />$ 18,470.80 <br />$ 17,922.10 <br />$ <br />0.00 <br />$ 17,922.10 <br />$ <br />896.11 <br />$ 17,025.99 <br />j <br />0.00 <br />$ 17.025.99 <br />Approved By: BONESTR00, ROSENE, ANDERLIK 6 <br />ASSOC;XTES , INC. <br />By <br />Date: Approved By: Allied Blacktop Company <br />Contractor <br />BY: <br />PR13944 <br />