Pay Voucher No. 1Owner: City of Shorewood
5755 Country Club Road
Shorewood, MN 55331-8926
Date: 11/14/2016
For Period: 4/25/2016 to 11/14/2016 Request No.:1 & FINAL
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.:
Project Summary
1 Original Contract Amount $19,777.70
2 Contract Changes - 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 Liquidated Damages $0.00
12 AMOUNT 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: Construction Observer:
WSB & Associates, Inc.
__________________________________ __________________________________
Approved by Contractor: Approved by Owner:
Sir Lines-A-Lot City of Shorewood
__________________________________ __________________________________
__________________________________
Specified Contract Completion Date: Date:
__________________________________
Comment:
Page 1of 3Pay Voucher
Project Material Status
Item
No.
Item Description Units Unit Price Contract
Quantity
Quantity to
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 2582.502 24" 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 1440 1440 $3,024.00
Totals For Section SCHEDULE A - ROADWAY PAVEMENT MARKINGS: $20,242.57
SCHEDULE B - PARKING LOT PAVEMENT MARKINGS
9 2582.502 4" SOLID LINE PAINT L F $0.24 2860 2548 2548 $611.52
10 2582.501 PAVT MSSG PAINT S F $1.50 90 90 90 $135.00
11 2021.501 MOBILIZATION LS $500.00 1 1 1 $500.00
Totals For SCHEDULE B - PARKING LOT PAVEMENT MARKINGS: $1,246.52
Project Totals: $21,489.09
Page 2of 3Pay 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
No. Type Date Description Amount
Change Order Totals: $0.00
Payment Summary
No. From
Date
To Date Payment Total
Payment
Retainage
Per Payment
Total
Retainage
Total Payment
+ Retainage
Work Certified
Per Payment
Total Work
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: $21,489.09 $0.00 $21,489.09 $21,489.09
Project Summary
Material On Hand:$0.00
Total Payment to Date:$21,489.09 Original Contract:$19,777.70
Total Retainage:$0.00 Contract Changes:$0.00
Total Amount Earned:$21,489.09 Revised Contract:$19,777.70
Page 3of 3Pay Voucher