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REQUEST FOR PAYMENT <br />DATE: January 21, 1985 <br />PLACE: Orono, Minnesota <br />PROJECT: 1984 Seal Coat Project <br />PROJECT NO.: FILE NO.: 13924 <br />CONTRACTOR: Buffalo Bituminous, Inc. <br />ADDRESS: Box 337 <br />Buffalo, Minnesota 55313 <br />REQUEST FOR PAYMENT NO.: 2 <br />SUMMARY: <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />8. <br />9. <br />10. <br />11. <br />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 Retainage 3 2 <br />Sub -Total <br />Less Amount Paid Previously <br />AMOUNT DUE THIS REQUEST FOR PAYMENT NO.: 2 <br />OWNER APPROVAL: <br />By ` <br />By <br />Date: <br />264 3c <br />FOR PERIOD: <br />From: Oct. 16, 1984To Jan. 1, 1985 <br />$ 67,422.00 <br />$ 67,422.00 <br />$ 71,427.78 <br />$ <br />0.00 <br />$ 71,427.78 <br />$ 2,142.83 <br />$ 69,284.95 <br />$ 59,087.42 <br />$ 1(.197.53 <br />Approved By: BONESTROO, ROSENE, ANDERLIK 6 <br />ASSOCIATES, INC. <br />By: 2 C.s--,Z,- <br />Approved By: Buffalo Bituminous, Inc. <br />Contractor <br />By: <br />