Fully signed PV1Pay Voucher
CITY OF SHOREWOOD
5755 Country Club Road
Shorewood, MN 55331 -8926
Project R- 011854 -000 - SHOR - 2018 Pavement Marking Project
Pay Voucher No. 1
Contractor: Sir Lines -A -Lot
2400 E 26th Street
Minneapolis, MN 55406
Contract Amounts
Original Contract
Contract Changes
Revised Contract
Work Certified To Date
Contract No.
Vendor No. N/A
For Period: 7/23/201 8 - 8/31/2018
Warrant # Date
Funds Encumbered
$28,546.70 Original
$0.00 Additional
$28,546.70 Total
Base Bid Items
$12,284.19
Backsheet
$0.00
Change Order
$0.00
Supplemental Agreement
$0.00
Work Order
$0.00
Material On Hand
$0.00
Total
$12,284.19
Page I of 3
$28,546.70
N/A
$28,546.70
This is to certify that the items of work shown in this certificate of Pay Voucher have been actually furnished for
the work comprising the above mentioned projects in accordance with the plans and specifications heretofore approved.
Approved By Approved By Sir Lines_ -A -Lot
roject Cngi{{neer scc \ Contractor
t
Date Date
Approved By
Work Certified
Work
Less
Less
Amount Paid
Total
This Pay
Certified
Amount
Previous
This Pay
Amount
Voucher
To Date
Retained
Payments
Voucher
Paid To Date
R- 011854-
$12,284.19
$12,284.19
$614.21
$0.00
$11,669.98
$11,669.98
000
Percent Retained: 5.0000%
Percent Complete: 43.0319%
Amount Paid This Pay VoucherT
$11,669.96
This is to certify that the items of work shown in this certificate of Pay Voucher have been actually furnished for
the work comprising the above mentioned projects in accordance with the plans and specifications heretofore approved.
Approved By Approved By Sir Lines_ -A -Lot
roject Cngi{{neer scc \ Contractor
t
Date Date
Approved By
Pay Voucher Page 2 of 3
CITY OF SHOREWOOD
5755 Country Club Road
Shorewood, MN 55331 -8926
Project No. R- 011854 -000
Pay Voucher No. 1
R- 011854 -000 Payment Summary
No. From Date To Date Work Certified Amount Retained Amount Paid
Per Pay Voucher Per Pay Voucher Per Pay Voucher
1 07/23/2018 08/31/2018 $12,284.19 $614.21 $11,669.98
Totals: $12,284.19 $614.21 $11,669.98
R- 011854 -000 Fundina Cateaory Resort
Funding
Work
Less
Less
Amount Paid
Total
Category
Certified
Amount
Previous
This
Amount Paid
No.
To Date
Retained
Payments
Pay Voucher
To Date
UNF
12,284.19
614.21
0.00
11,669.98
11,669.98
Totals: $12,284.19 $614.21 $0.00 $11,669.98 $11,669.98
R- 011854 -000 Fundina Source Resort
Accounting Funding Amount Paid
Revised
Funds
Paid To
No. Source This
Contract
Encumbered
Contractor
Pay Voucher
Amount
To Date
To Date
UNF Unfunded 11,669.98
28,546.70
28,546.70
11,669.98
Totals: $11,669.98 $28,546.70 $28,546.70 $11,669.98
Pay Voucher Page 3 of 3
CITY OF SHOREWOOD
5755 Country Club Road
Shorewood, MN 55331 -8926
Project No. R- 011854 -000
Pav Voucher No. 1
R- 011854 -000 Project Material Status
Quantity
Amount
Line
Item
Description
Units
Unit
Contract
This
This
Quantity
Amount
Price
Quantity
Pay
Pay
To Date
To Date
Voucher
Voucher
SCHEDULE A - CITY OF SHOREWOOD ROADWAY PAVEMENT MARKINGS
1
2021.501
MOBILIZATION
LS
$3,000.00
1
0.75
$2,250.00
0.75
$2,250.00
2
2582.518
PAVT MSSG
S F
$3.60
800
210
$756.00
210
$756.00
PAINT
3
2582.503
4" SOLID LINE
L F
$0.09
93500
76491
$6,884.19
76491
$6,884.19
PAINT
4
2582.503
12" SOLID LINE
L F
$2.40
700
0
$0.00
0
$0.00
PAINT
5
2582.503
24" SOLID LINE
L F
$3.60
700
449
$1,616.40
449
$1,616.40
PAINT
6
2582.503
4" BROKEN
L F
$0.09
130
0
$0.00
0
$0.00
LINE PAINT
7
2582.503
4" DBLE SOLID
L F
$0.18
22000
0
$0.00
0
$0.00
LINE PAINT
8
2582.518
CROSSWALK
SF
$2.70
1500
288
$777.60
288
$777.60
PAINT
Totals For Section SCHEDULE A - CITY OF SHOREWOOD
$12,284.19
$12,284.19
ROADWAY PAVEMENT MARKINGS:
SCHEDULE B. - CITY OF SHOREWOOD PARKING LOT IMPROVEMENTS
9
2021.501
MOBILIZATION
LS
$750.00
1
0
$0.00
0
$0.00
10
2582.518
PAVT MSSG
S F
$9.50
40
0
$0.00
0
$0.00
PAINT
11
2582.503
4" SOLID LINE
L F
$0.60
1500
0
$0.00
0
$0.00
PAINT
Totals For SCHEDULE B. - CITY OF SHOREWOOD PARKING
$0.00
$0.00
LOT IMPROVEMENTS:
Project Totals:
$12,284.19
$12,284.19