Pay VoucherPay Voucher
Owner: City of Shorewood
5755 Country Club Road
Shorewood, MN 55331 -8926
For Period: 4/25/2016 to 11/14/2016
Contractor: Sir Lines -A -Lot
2400 E 26th Street
Minneapolis, MN 55406
Pay Voucher
SHOR - 2016 Pavement Marking Project
Client Contract No.:
Project No.: 02925 -07
Client Project No.:
Page 1 of 3
Date: 11/14/2016
1
10riginal Contract Amount
$19,777.70
2
Contract Chai;gcs - Addition
$0.00
3
Contract Changes - Deduction
$0.00
4
Revised Contract Amount
$19,777.70
5
Value Completed to Date
$21,489.09
6
Material on Hand
$0.00
7
Amount Earned
$21,489.09
8
Less Retainage
$0.00
9
Subtotal
$21,489.09
10
Less Amount Paid Previously
$0.00
11
ILiquidated Damages
$0.00
12
JAMOUNT DUE THIS PAY VOUCHER NO. 1 & FINAL
$21,489.09
I HEREBY CERTIFY THAT A FINAL EXAMINATION HAS BEEN MADE OF THE ABOVE NOTED CONTRACT, THAT THE
CONTRACT HAS BEEN COMPLETED, THAT THE ENTIRE AMOUNT OF WORK SHOWN IN THE FINAL VOUCHER HAS
BEEN PERFORMED AND THE TOTAL VALUE OF THE WORK PERFORMED IN ACCORDANCE WITH, AND PURSUANT TO,
THE TERMS OF THE CONTRACT IS AS SHOWN IN THIS FINAL VOUCHER.
Recommended for Approval by:
WSB & Associates, Inc.
Specified Contract Completion Date:
Comment:
Construction Observer:
Date:
Pay Voucher
Project Material Status
Page 2 of 3
Item
No.
Item
Description
Units
Unit Price
Contract
Quantity to
IQuantity Date
Current
Quantity
Amount to
Date
SCHEDULE
A - ROADWAY PAVEMENT MARKINGS
1
2021.501
MOBILIZATION
LS
$1,000.00
1
1
1
$1,000.00
2
2582.501
PAVT MSSG PAINT
S F
$2.10
1000
840
840
$1,764.00
3
2582.502
4" SOLID LINE PAINT
L F
$0.07
54840
75689
75689
$5,298.23
4
2582.502
12" SOLID LINE PAINT
L F
$2.00
510
544
544
$1,088.00
5
2582.502124"
SOLID LINE PAINT
L F
$2.30
530
672
672
$1,545.60
6
2582.502
4" BROKEN LINE PAINT
L F
$0.07
550
0
0
$0.00
7
2582.502
4" DBLE SOLID LINE PAINT
L F
$0.14
45000
46591
46591
$6,522.74
8
2582.503
CROSSWALK PAINT
S F
$2.10
1400
14401
14401
$3,024.00
Totals For Section SCHEDULE A - ROADWAY PAVEMENT MARKINGS:
$20,242.57
SCHEDULE B - PARKING LOT PAVEMENT MARKINGS
9
2582.60214" �
SOLID LINE PAINT
L F
1 $0.241
28601
2548
2548
x;611.52
10
2582.501
PAVT MSSG PAINT
S F
$1.50
90
90
90
$135.00
11
2021.5011
MOBILIZATION
LS
1 $500.00
11
1
1
$500.00
Totals For SCHEDULE B - PARKING LOT PAVEMENT MARKINGS:
$1,246.52
Project Totals:
$21,489.09
Pay Voucher
Project Payment Status
Owner: City of Shorewood
Client Project No.:
Client Contract No.:
Project No.: 02925 -07
Contractor: Sir Lines -A -Lot
Contract Changes
Page 3 of 3
No: IType
Date
Description
JAmount
Change Order Totals:
1 $0.00
Payment Summary
No.
From
To Date
Payment
Total
Retainage
Total
Total Payment
Work Certified
Total Work
Date
Payment
Per Payment
Retainage
+ Retainage
Per Payment
Certified
1 &
FINAL
4/25/2016
11/14/2016
$21,489.09
$21,489.09
$0.00
$0.00
$21,489.09
$21,489.09
$21,489.09
Payment Totals:
1 $21,489.09
$0.00
$21,489.09
$21,489.09
Project Summary
Material On Hand:
Total Payment to Date:
Total Retainage:
Total Amount Earned:
$0.00
$21,489.09 Original Contract:
$0.00 Contract Changes:
$21,489.09 Revised Contract:
$19,777.70
$0.00
$19,777.70