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89-905 WHITE - C1TY CLERK PINK - FINANCE COUACII CANARV - DEPARTMENT GITY O SAINT PAUL File NO. �' �` �0� BLUE - MA�OR Coun ' Resolution ��, � Presented By Referred To Committee: Date �!�� Out of Committee By Date W�iEREAS,The Ma�ar pwrsu�unt�a Sec�on 0.0 .1 af tbe Cha�ler of t?�e City of Saint Paul,does ceYtify �t Q�e are availabl�far approPriatian�otal in excess af�ase eslimal�eed in the 1989 budget;an�id WHEREAS,Cawdcil Fi1e 277510,adapted r 1, 1981,did es�ablish cerCai�n Speci�l Fmc�d Palici�s;and WHEBEA3,The May�nr recamr�ends�at fo �ing a�lditians�mede m the 1989 budget: Financing P1a�t C t wd et h�e Revised Budgei 250 Public ii�orks Equipr�ent Fvurod 12204 Eqtupment Far Resa�e � h��01 ��for Eqmt. Fvu�chases Speci�l Assessment Fumd 0.� 3,318.Ct0 3,318.Q0 All od�er Fi�cing 4 919.84 O.QO 4,?08,919.84 To�al 4 ,919.84 3,318.00 4,712,237.84 Spe�ding P1an tBud et �h�e Revised Btad�et 250-12244-�32 Equipment For Resabe 0.00 3,318.� 3,31$.00 No�,tt�erefare,be it RE30L�ED,th�t the City Gow�r�cil andopt�the b additians eo th�e 1�bvdget. AFPR4YED: _�� `�. ,� � B et D' c� � Di�ec�or of in�e axtid M e COUNCIL MEMBERS Yeas Nays Requested by Department of: Dimond ��g [n Fav r Goswitz Rettman B : . s�6e;be� _ Agains Y Sonnen Wilson �Y 1 � � Form A pr ved by City ttorney� Adopted by Council: Date ,i, Certified P•s ed by Council Secretary BY— � �/vJ By � ._ �J Approv May or Subm ion to Council Approve Mav . D e � ,� gy , 0 pUBIISI�ED J�N - 19 9 T - _ _ _ , . � C��l 1� DEPARTMENTlOFFICE/COUNqL DATE IN ATE 1416 Denartment of �u]��a�c �A�orks GREEN SHEET No. Cd�ITACT PERSON 8 PHONE 1NITiw DATE `��NdL INITIAUDATE A1 She tk a 2 9 2-6 6 7 6 � � �OITY ATTORNEY �CITY CLERK MUST BE ON CQUNGL NDA BY(DATE) BUDOET DIRECTOH FlN.Q MOT.BERVK�S DIR. � K �MAYOR(OR ASSISTMIT) % Yl a 1 r� F i n. '�'Ic7m t,� : mm TOTAL#�OF SIG{NATURE PAQES (CLIP A L L CATIONS FOR SIONATUR� ��y;� ACTION RE�UESTED: A�nrove rebudgetting o:� Advance f Eau�x�me�t��es �t �,�ov,t f�.na�, �ontract pavment. � � �P� 101989 .. . APR 11 �°8�•��' ;��' RECOMMENDATIONB:Approvs(A)a Reje�t(i� COUNC M11TEE/RESEA ANALY PHONE NO. _PLANNINO COMMI8810N _CIVII BERVICE COMMISSION _p6 OOMMITTEE _ COMME . _BTAFF _ _p��,� _ Co i of. Contract Estimates 2 and 3 attached,! 8UPPORTB WHICFI COUNpL OBJECTIVE? 5 iNm�nNO�oe�M,�ssue,o�ruNm�wno,wna,wr��,wn�►.,why�: n 9 8 7 it was determined that the Public _ , Works Street Renair & Cleaning S lt Storage Building located at � 939 Pleasant Ave. needed major r air due to vandalism. Due to the amount of u�ork necessarv, electrical e ice was connected at the same time. At this time the final pavments a e ue on this nroject and a budctet must be reestahlished in the activitv n object which made the initial navment. ' ADVANTAOE8 IF APPROVED: Amounts naid .f.or faork done to u' ldings wi11 be easilv sex�arated f.or examination. Full na�rnnent wil e made .from the funds desic�nated for this contract. RECEIVED DISADVANTA(�ES IF APPROVED: " F�lCE 0�THE �IRECi'OR � REC�IVED N/A EPARTMENT OF FINANCE A D MANAGEMENT SERVICES APR 4 1989 . BUDGET OfFiCE DI8ADVANTAOES IF NOT APPROVED: Funds will not be budqetted f. r inal navment of contractor, therefore �avment cannot he made Council Research Center ft1�Y " J ��'8� TOTAL AMOUNT OF TRANSACTION a 3 3�'H�O O W8T/REVENUE BUDOETED(CIRCLE ON� YES NO �N�� 2 5 0-12 2 0 4-9 5 5 3 Acr�vm NuMe�R 12 2 0 4 FlNANdALINFORMATION:(EXPUUI� �und 25� (P}zbli �* rks Faui�ment) is carr�yincx a liahilitv to public H]orks �treet Repair & C1 anina for monies trans_erred in x�rior vears for canital nurchases . . �� Whit� -Finana,�t•a• CITY 0/ SAINT IAUL Gn�ry—Contractor DEPAR ME T OF Public Woz'ks Pink -0f f ice CopY G.Rod-�uadruplicats DI ISI N OF NO. C NTRACT ESTIMATE FOR PAYMENT Construction CGNTRAGT , NATV�t O� 60MT11�6T DATE A ril 11 19 88 � � CAPITAL PROJECTS LEDGER U FUND-ACTIVITY-OBJECTd08 PERMAN�NT IMPROVEMENT EV LVING FUND II 250-12204-0532 ' O[iGRlr'TION OF CQN7IIAGT PROJECT NO. CONTRACT N7. Public Works Storage Garage 8538 2728 OATE OF PURCH,ORp,CONT. SPECIfI D TE CONTRAGT CXTENO[D TO AUTHOIIITY rOR[XT[NiION— p. OF COM LETI N 8 ADMIN.ORDER July �4 �0 87 October 0 ��87 �o LETTER l9 ESTIMATE NO. 3 and Final F R P RIOD FROM �a To �o NAME OF CONTRAGTpR ADDRESi OF CONTRACT011 Schreiber-Mullaney Co�s�-�uct-�.on Co I 2365 C2atary Ave. S. , Wood�ury,I�T. 55125 Value of Work Previously Complete 32,320.00 Value of Wor$ Completed this peri � Additions or Deductions: see Adm. de (D9731) 600.00 _ Total Value o! Work Completed to te 32,920.00 Leas: Previous Payments 31,320.00 Leas: Previous Retentions 1,000.00 I.esa: Preaent Retention � (1,000.00) Total 31,320.00 � Amount of this Estimate $ l,600.00 AMOUNT OF CONTRACT q I 31 H7 OO TOTAL AMOUNT OF CONTRACT 32 92O OO [%TRAS AUTMORI2CD D7�� I 1 O OO PREVIOUS ESTIt.IAT[f 31 32O OO TOTAL ( 32 9 O OO TFllt ESTIMATE 1. GOO OO I C11[DITi AUTMORIZ[O TOTA ESTIMATli 3Z 92O OO N[T TOTAI.CONTIIACT I 32 9 O OO SALANCE DUE ON CONTRACT — I O — 1 MERCBY CEI1TIFtl TMAT TNL AoOVE pp PAii[D FOII PAYM[NT: WORK HAS S[tN GOMPL[TED (N AC- CORDANCt WITM CONTRACT. P6ANs AND iPlGIFICATIONi. e� Y ARCM�T T F�NAL AUOIT � y ��.. � -� CUNSTqV �ON ENG�NEEN IV.MEAD AN�/OR OEPT.DIRECTOR oY fINAN Div _ d VOUCN6R NUMlER STATE OF MINNESOTA1 AFFIDAVIT C TRACTOR }.s. GOUNTY OR RAMSEY J `. beixy duly awom, depoaet axd aaya he is tks v-'�� ' _ oj � Contractor, axd aa aueh is dvly authorized to make tht JoUowiny aJJidavit: That all claims Jor A w/r�C and tabor performsd u��ove numbsssd eontraet jrom tiN eom- menu»eent oJ the work thereon unti! the � y oJ �D��., have 6eex Jully peid, and that there ia nothixy dua or t bs »te due l�erea/ter to any psraos Jor axy work o•labor psrJormed or matsrial _;[urniahtd u�on aaid eoxtraet prior to a id te.• - _n.i: �� . ...� . � �,�,�.v./..�I`�1= SU4f ED �EW011N TO S RL' T 1 DAY OI �. 1• _ -a . /� . .. MOTAII♦ ►Y�L �tr MINNq0/A `�/�'� V : . ' � CONT�IICTM .. :;,r„ ,.,;.. .., .,M,Y COMMIfilOPS[XPI11[ � . � J � � C ii O p O O O O O °r' n { >.3 0 n � ��,,, �= d' U o 0 0 0 0 ' � 'iti� � v V C .� Z = Z a� . p . . . . p �• O .. pA . 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L1S N ��, � < N � � c a� m $ v, r+ � �2 r �,� �►"'- 0 F.., E � H a� o a � � o�� U \ �""' � �- � � � V I U V � ca � m r' e1' U V� o � aci (n 1 ssy'� �' � Q q {r OC W v�L � 0 � � V C E � � � y � � �N V Z OC �y O Q � a`, c � � a� � �.� ! L{J 3 ocs �� V � Z � � w/ O � O t � �eCO CU a3 � < '"'� v•,�—n � a+ � 22 � ii O � � .� C ' � � � � C '`QL � W� _ Z o � G h.. W �, �, � _ � o�r� _ �d _ � ��, � � 'J 3 V R" �Aoac Z Z �o o .�'a `' N s -�oRd >,'�°= ot � Et�c, � v°W` a p � ,C �C � Q �> � E o C " � EQ�� c � V °v °o �U �� a p � tUNO O D Ua < Z Z s° pA � a`, O �, C� '° ;, a� °' <_x Q f- � U V ►-.E u o..�.� U m Q �-o�.�� <.. G / �C-t3a � Minne ta epartmentof Revenue C��/�.� lp.�v.7i851 . Affidavit for Obtaining Fin I S ttlement of Contract with the State of � Minnesota and any of its Pol tical or Governmental Subdivisions Name of contractor Minnesota identification number (if none,read instructionsj Fred Richie Decorating � �� ;� -a �- 3 �� 995 Arcade Street Area code and telephone number Cily,town or post office State Zip code St. Paul i esota - 55106 ( 612 ) 7"14-463L Check the box which describes your involvement in thi pr ject(read definitions on other side) ❑ Prime contractor ❑ Contractor � Subcontractor Project bcadon Project or oontract number Period of contract(Month/Year) Public Works Garage- 939 Pleas t ve. 8538 From 7187 'ro 8/87 Name d Mimesota govemmeMal unk for which work was performed Total amouM ot oontrad Amount still due �Dept. of Public Works $1150.00 0 .00 Address of Minnesota govemmental unit Ciry,town or post office T-ip code 900 City Ha11 Annex St. Paul, 1�1 55102 �id you pay or supervise the payment of persons em loy d on this contract? �Yes � No If yes,did you withhold Minnesota income tax from t e ages of each employee as required by Minnesota Statute 90. 2? � Yes ❑ No Have you filed all required withholding returns and d s ed Minnesota tax withheld with ' the Department of Revenue as required by Minnesot St utes 290.92 and 290.97? � Yes ❑ No Do you authorize the Department to inform the prim co ractor upon it's request whether your form IC-134 has bee ce ified? � Yes � No If you are a subcontractor, list your prime contractor' b iness name and address. Name: S�:hreiber-Mullaney Const. C . nc. 2:365 So. Century Ave. WoodburY. MN If you are a contractor or subcontractor,skip the nex se tion of this form and sign below. 5S 125 If you are a prime contractor, fill in the names and dr sses of all your subcontractors. If you need more space to list your subcontractors,attach a separate sheet. Also you m st ttach certi�ed affidavits of your subcontractors and sign below. Name and address Name and address - Name and address Name and address Name and address Name and address 1 dedare under the penakies of criminal liability for williully m ing false statement, that the above statements are true and correct to the best of my I�oMAed�e and belief. � -� ^ S�g� . � - ��y �� Y e�re T�8 oate Certificate of Complian e ith Minnesota Statutes 290.92 and 290.97 Based on the facts stated in the above affidavit an the facts in the files and records of the Departme�t of Revenue, the above contractoNsubcontractor has properly complied wit all f the provisions of Minnesota Statute 290.92 relating to the withholding of income tax on wages paid to employees and Min esota Statute 290.97 relating to contract services with the State of Minnesota or f its governmental or political su divi ions. �� .�.c�� F�� 7 � S"i�re d auBwr'v:ed oep�4nens ot Re+reru,e rep�enlative oere t�� . --'�n�ss 7riist TaX ic.-��a • Minne ta partment of Revenue /�� r�� IRev.7G851 Affidavit for Obtaining Fin 1 S ttlement of Contract with the State of �� -�� a`� Minnesota and any of its ol ical o�Governmentai Subdivisions 3:?�1 1�"� Name of contractor Minnesota idenbfication number 5chre i ber•-Mu 11 aney Cons t. Co. I c. (��e.read inswctior,$) eusiness address 3 618 0 71 2365 50. Century Ave. nrea code and te�epnone number City,town or post oBice State Zrp cade Woodbury Mi ne ota 55125 ( 612 ) 738-"1983 Check the box which describes your involvement in thi pr ect(read definitions on other side) � P�ime contractor ❑ Contractor ❑ Subcontractor pnpject Ipcation Project or contrad number Period of contract lMonth/Year) Public Warks Garage- 939 Pleasan ve. 8538 p�,7/87 To 12/87 Name of Minnesota govemmental unit tor which work was perfom�ed Total amount of contract Amount still due Dep�. c�t Public Works $32, 920. 00 53318. U� Address of Minnesota govemmeMal unit City,town or post office Z.ip code 900 C:ity Hall Annex St . Paul , MN 55102 Did you pay or supervise the payment of persons em oy d on this contract? � Yes ❑ No If yes,did you withhold Minnesota income tax from t e ges of each employee as required by Minnesota Statute 0. 2T � Yes ❑ No Have you filed all�equired withholding returns and de si ed Minnesota tax withheld with the Department of Revenue as required by Minnesot St utes 290.92 and 290.97? 0 Yes ❑ No Do you authorize the Department to inform the prime con ractor upon it's request whether your form IC-134 has bee ce ified? � Yes ❑ No If you are a subcontractor, list your prime contractor' bu iness name and address. Name: N•A• If you are a contractor or subcontractor,skip the nex se ion of this form and sign below. If you are a prime contractor, fill in the names and a dr ses of all your subcontractors. If you need more space to list your subcontractors,attach a separate sheet.Also you m st ttach certified affidavits of your subcontractors and sign below. Name and address Name and address -� R.C. Const. Standard Electric Co. Inc. 559 Brunson Street 2672 Maplewood Drive � St. Paul, MN 55101 Maplewood, MN 55109 Name and address Name and address C.O. Carlson Air Conditioning . Fred Richie Decorating 1203 Bryant Ave. North _ 995 Arcade Street _ Minneapolis, NIN 55411 St. Paul, NIId 55106 Name a�d address Name and address - K 8 K Door �ystems 1':O. Hox 1643'I Minneapolis, MN 55416 I dedare under the penalties of criminal liability for wiltfuly m ing false statement, that the above statements are true and coRect to the best of my knowledge and belief. Slgn a� � Vice President 2/7/89 H@� Your signature Title Date Certificate of Complian e th Minnesota Statutes 290.92 and 290.97 Based on the facts stated in the above affidavit and the acts in the files and records of the Department of Revenue, the above contractoNsubcontractor has properly complied with all f the provisions of Minnesota Statute 290.92 relating to the withholding of income ax on wages paid empl yee a in esota Statute 290.97 �elating to contract services with the State of Minn a Of%��Ve t I I' u ivi ions. FE g 2 i �� i�� , S'igna�e d autl�aaed Deparunent of Revenie rep�esernativ�e Oe6e ;�-�3a � Minne ta partment of Revenue �a ,�"" (Rev.71$51 . Affidavit for Obtaining Fin I S ttlement of Contract with the State of ' Minnesota and any of its ol tical or Governmental Subdivisions Name oi conVactor Minnesota identification number R.C. Cons•truct ion (if none,read insWCtions) Sole Proprieter Business ad�ress - - 7 559 Brunson St T'e�t Area code a►M telephone number Ciry.fown or post ot('�ce State Zip oode St. Paul, Mi e ota SS101 ( 61 ?. ) '/7 I -"L38b Check the box which describes your invoivement in thi pr "ect(read definitions on other side) ❑ Prime contractor ❑ Contractor � Subcontractor Projsc;t bcadon Project or oontrad number Period of contract(Month/Year) Public Works Garage- 939 YZeas i. ve. 8538 p,�, 7/8% To 8/87 Name af Minnesota govemmental unit for which Mrork was pertormed Total amouM ot contrad Amount still due Dept. of Public Works $920 .00 O . UO Address oi Minnesota govemmeMai unit City,town w post off'�ce .T�P code 900 City Hall Annex St . PauJ , MN �`�102 Did you pay or supervise the payment of persons em loy d on this contract? �' Yes � No If yes,did you withhold Minnesota income tax from t e ages � of each employee as required by Minnesota Statute 0. 2? � Yes ❑ No Have you filed all required withholding returns and de os ed Minnesota tax withheld with the Department of Revenue as required by Minnesot St utes 290.92 and 290.97? � Yes ❑ No Do you authorize the Department to inform the prime co ractor upon it's request whether your form IC-134 has bee ce ified? � Yes ❑ No If you are a subcontractor, list your prime contractor' bu iness name and address. Name: Schr�eiber-Mullaney Const. C . nc. 2365 So. Century Ave. Woodbury, MN If you are a contractor or subcontractor,skip the nex se tion of this form and sign below. 55125 If you are a prime contractor, fill in the names and a dr sses of all your subcontractors. If you need more space to list your subcontracto�s,attach a separate sheet. Also you m st ttach certified affidavits of your subcontractors and sign below. Nameaf►d address - Name and address Name and address Name and address Name and address Name and address I dedare under the nalties i criminal liabiliry for willfutly m i� false statement, that the above statements are true and correct to the best of my knowled98 Sign Owner 2/7/89 Here "� r�ne oace Ce�tificate of Complian th Minnesota Statutes 290.92 and 290.97 Based on the facts stated in the above affidavit and the acts in the files and records of the Department of Revenue, the above contractor/subcontractor has properly complied with all f the provisions of Minnesota Statute 290.92 relating to the withholding of income ta�c on wages paid to employees and in esota Statute 290.97 relating to contract services with the State of Minnesota or an of its governmental or political su ivi ions. FEB 13 1939 . Sigr�lure d • r�SentaLive De�e 'C-t 3a • Minne ta epartment of Revenue ��'' �B� IRev.7/851 . Affidavit for Obtaining Fin 1 S ttlement of Contract with the State of ' Minnesota and any of its Po tical or Governmental Subdivisions N��{�� Minnesota identification number (if none,reed instruCtiona) C.O. Car•lson Air Conditioning eus�ss address 8269633 1 203 Bryant Ave. North nrea code and telepnone number City.town u post office State Z�p code Minneapol is -Mi sota 5541 1 ( 612 ) 521 •-"J694 Check the box which describes your involvement in thi pr ject(read definitions on other side) ❑ Prime contractor ❑ Contractor � Subcontractor projed bcati�on Project or conuact number Period of contract(Month/Year) Public Works GaracJe- 939 Pleas t Ave. 8538 . From 8/87 To 9/87 Name d Minnesota govemmental unit for which work was periormed Total amouM of contract ArtwuM sUll due Dept. nf Public Works $697. 14 0. 00 Address ol Minnesote govemmeMal unit City,town or post office ZiP code 900 City Hall Annex St. Paul, NII�T 55102 Did you pay or supervise the payment of persons em loy d on this contract? �} Yes ❑ No If yes,did you withhotd Minnesota income tax from t e ages of each employee as required by Minnesota Statute 90. 2? (� Yes ❑ No Have you fi�ed all required withholding returns and d po ted Minnesota tax withheld with the Department of Revenue as required by Minnesot St tutes 290.92 and 290.97? � Yes ❑ No _ Do you authorize the Department to inform the prim co tractor upon it's request whether your form IC-134 has bee ce ifiedt � Yes ❑ No If you are a subcontractor,list your prime contractor s b siness name and address. �.•ame: 5chr•eiber-Mullaney Const. C . nc. 2365 So. Century Ave. Woodbur hIIV If you are a contractor or subcontractor,skip the ne se tion of this form and sign below. 55125 If you are a prime contractor, fill in the names and ddr sses of all your subcontractors. If you need more space to list your subcontractors,attach a separate sheet.Also you ust ttach certified affidavits of your subcontractors and sign below. Name and address -� Name and address Name and address Name and address Name and address � Name and address 1 dedare under the penames of criminal rability r willtully m king a false statement, that the above statements are true and correct to the best of my lo�owledge f. . Slgn `�"�� /L�� . � � � H� r signature e oate Certificate of Complia e ith Minnesota Statutes 290.92 and 290.97 Based on the facts stated in the above affidavit an th facts in the files and records of the Department of Revenue, the above contractoNsubcontractor has properly complied wit all f the provisions of Minnesota Statute 290.92 relating to the withholding of income tax on wages paid to employees and Mi esota Statute 290.97 relating to contract seroices with the State of Minn ta or any of it�,governmental or political su iv ions. �. FEB 13 1989 Si��aAae d aulhorized DepertrneM of Rerenie repre�ntative De1e i�-�3a � ' Minne ta partment of Revenue ��—�� IPev.71a51 , Affidavit fo� Obtaining Fin I S ttlement of Contract with the State of Minnesota and any of its Pol tical or Governmental Subdivisions Name of conUada Minnesota identification number (if none,read instructions) K 8 K Doa�r Systems / Business aderess �� - b� �� P.O. Box 1 6437 Area code and teiephone number CitY.town a post otfice State Zip code Minneapc�lis M"nn sota 55411 E612 ) 929-0411 Check the box which describes your involvement in thi pr 'ect(read de�nitions on other side) ❑ Prime contractor ❑ Contractor � Subcontractor project bcation Project or contrad number Period of contract(Month/Year) Public Works Garage- 939 Pleas t ve. 8538 pror„ 10/87To11/87 Name of Minneaota govemmental unk tor which work was performed Total amount of contract AmouM still due Dept. of Public Works $4529.y0 0.00 Address oi Minnesota govemmental unit City,town or post oitice Z�p code 900 City Hall Annex St. Paul , MN 55102 Did you pay or supervise the payment of persons em loy d on this contract? � Yes ❑ No If yes,did you withhold Minnesota income tax from t e ages of each employee as required by Minnesota Statute 0. 2? � Yes ❑ No Have you filed all required withholding returns and d os ed Minnesota tax withheld with the Department of Revenue as required by Minnesot St utes 290.92 and 290.97? � Yes ❑ No Do you authorize the Department to info�m the prime co ractor _ upon it's request whether your form IC-134 has bee ce ified? � Yes ❑ No If you are a subcontractor, list your prime contractor' bu iness name and address. Name: Schreiber-Mullaney Const . C . nc. 2365 So. Century Ave. Woodbury, MN If you are a contractor or subcontractor,skip the nex se tion of this form and sign below. 55125 If you are a prime contractor, fill in the names and a dr sses of all your subcontractors. If you need more space to list your subcontractors,attach a separate sheet.Also you m st ttach certified affidavits of your subcontractors and sign below. Name and address Name and address �=a - Name and address Name and address Name and address Name and address � I dedare under the penalties of criminal liabiliry for willfully 'ng false statement, that the above statemerns are true and coRect to the best of my knowledge and beliei. Sign �• a /N _ _ 6- �� r nature rtle Date Certificate of Compllan th Minnesota Statutes 290.92 and 290.97 Based on the facts stated in the above affidavit and the acts in the�les and records of the Department of Revenue, the above contractoNsubcontractor has prope�ly complied with all f the provisions of Minnesota Statute 290.92 relating to the withholding of income tax on wages paid to employees and in esota Statute 290.97 relating to contract services with the State of Mi ota or any of ifs governmental or political su ivi ions. fEe 1 3 ��$� �•�//�'d�l'.�:1�+� Si�lue d autl�a�iaed Depar4nent of Fievenie�ep�nativ�e De�e (,� !C-t 3a � Minnes ta partment of Revenue ��`�� (Rev.71851� . Affidavit for Obtaining Fin I S ttlement of Contract with the State of ' Minnesota and any of its ol ical or Governmental Subdivisions Name of contractor Minnesota identification number Standard. Electric CO. Ir1C. (if none,read instructions) Business address `7�/90 J �� Zfi72 Maplewood Drive Areacodeandtelephonenumber City,town w post office State Zip code Maplewood Mi sota 55109 (612 ) 484-8044 Check the box which describes your involvement in thi pr ect(read definitions on other side) ❑ Prime contractor ❑ Contractor 0 Subcontractor Project location Project or contract number Period of contract(Month/Year) Public Works Garaye 8538 From ��87 To 9�87 Name of Minnesota govemmental unit for which work was performed Total amount oi contract Amount still due Dept. of Public Works $4838.00 $2600.00 Address of Minnesota govemmental unit City,town or post office Zip code 900 City Hall Annex St. Paul, I�T 55102 Did you pay or supervise the payment of persons em oy on this contract? � Yes ❑ No If yes,did you withhold Minnesota income tax from t e ges " of each employee as required by Minnesota Statute 2 0. 2? � Yes ❑ No Have you filed all required withholding retu�ns and de osi ed Minnesota tax withheld with the Department of Revenue as required by Minnesot Sta ut�s 290.92 and 290.97? � Yes ❑ No Do you authorize the Department to inform the prime on ractor upon it's request whether your form IC-134 has been cer ified? � Yes ❑ No If you are a subcontractor, list your prime contractor' bu iness name and address. Name: Schreiber-Mullaney Const. Co I c. 2365 So. Century Ave. Woodbury, [rIId If you are a contractor or subcontractor,skip the nex se ion of this form and sign below. 55125 If you are a prime contractor, fill in the names and a dr ses of all your subcontractors. If you need more space to list your subcontractors, attach a separate sheet.Also you m st ttach certified affidavits of your subcontractors and sign below. Name and address Name and address Name and address Name and address Name and address Name and address - I declare under the penalties of criminal liability for willfully ma ing false statement, that the above statements are true and correct to the best of my knowledge and belief. Sign � o� ` -� Here Your signature Title Date � Certificate of Complian e th Minnesota Statutes 290.92 and 290.97 Based on the facts stated in the above affidavit and he acts in the files and records of the Department of Revenue, the above contractor/subcontractor has properly complied with all f the provisions of Minnesota Statute 290.92 relating to the withholding of income tax on wages paid to employees and in esota Statute 290.97 relating to contract services with the State of Minnesot�,�y of its govgrnmental or political su ivi ions. �� rA • FEg 13 Signature of auUwraed De�tmec�t of Revenue repnesentative Date , . . ��=�°.� Whia —Fin�nc�.Aeet�p• CITV 0I iAllR IAUL Gn�ry—Contrectof DEPART E OF Piihl i r Wnrkc Plnk —Ofiice CoDY Q.Rod—�u�druplicate DI SI OF ' N�. C NTR.ACT ESTIMATE FOR PAYMENT O on5truction CONTRACT NA1V�■ O► eoNTI1�OT �' • DATE March 23 1988. � CAPITAL PROJECTS LEDGER F N FUND-ACTIVITY-OBJECTJOB PERMANENT IMPROVEMENT R V LVING FUND II 250-12204-0532 D65CqIPT10N OF GONTRAGT PROJECT NO. CON7RAGT N7, Public Works Storage Garage Re ai s ' 8538 2728 OATE OF PURCH.ORO.CONT. SPECIFIE DA E CONTRACT EXTENDED TO AUTMORITY FOR EXTENSION— p_ OF GOMP ETI N ADM�N.OROER July 14 �0 87 October 0 �0 87 �0 8 LETTER �y ESTIMATE NO. 2 F R P RIOD FROM fY TO �A __ NAMEOF CONTRACTOR ADDRESS OF CONTRAGTOR Schreiber—Nlullaney Constructi n o. I 2365 Century Ave. So. , Woodbury, MN 551"L5 Value of Work Previously Complete 31, 158.00 Valqe of Work Completed this period �D9554) 450.�� Additions or Deductions: see Adm. O der Total Vslue of Work Completed to D te 32,320.00 Lesa: Previous Payments 29,602.00 Lesa: Previous Retentions 1,556.00 Leas: Preaent Retention (Reduce) (556.00) 30,602.00 Total $ 1,718.00 Amount of this Estimate AMOUNT OF CONTRAGT 31 H7 OO TOTAL AMOUNT OF CONTRACT 32 3ZO OO [XTRAS AUTHORI2ED D9554 I 45 0� PREVIOUS ESTIIdATES 2.9 6�2 00 ,.._ TOTAL I 32 32 OO TH16 ESTIMATE 1 71H OO I I CREDIT6 AUTHORIIED I O TOTA ESTIMATES 31 32O OO , 3Z 3Z OO BALANGE DUE ON GONTRACT 1 OOO I OO NET TOTAL CONTRAGT I I I HEREBY CERTIFY THAT THE ABOVE ppp VE : ' '�• PA55[D FOR PAYMENT: WORK MAS BEEN GOMPI.ETEO IN AC- j CORDANGE WITH CONTRACT. PLANS 1 ANO 6PECIFICATIONS. � BY � '� r-� ,� CITV ARCHITECT F�NAI AUDIT � ` �'- . � J�f . � � , UNSTRUCT N EN N � IV.HEAD ANO/OR DEPT.DIRECTOR BY � .� l FINANC pIV. I � ' VOUCMER NUMBER � STATE OF MINNESOTA� i AFFIDAVIT F C NTRACTOR iCOUN OF RAMSEY��X '_ � '�� 6einy duly aworn, depoaea axd aaya he ia the v.�d �'"��-� � � o/ � , Coxtraetor, and as aueh ia duly aufhorixed to make the � jolfowing aJjidavit: That all elai»ta Jor I! k and labor perJormed upon the a ove numbered tontraet from the com- � mencement oJ the work thereon until ihe � day oJ �Y� 18�.., ho,ve been Ju�ly i paid, and that there is xothinp due o� t be me due hereajter to any psrsan Jar any work o+labor perJornud or materjal i Jurniahed upon said eantraet prior to s id te. � �'j� • /' , �-^�A�A^ V. .� ' S BC IBED ND S RN EMFC ME T IS i . �tY �•�=;v.. V ,nrr�� ..J t � � #�;� 2:�. !\�,1�!.:� .i • - � � :,°^'`s „�PUi;I_IC—^'��•i"�,�TA ,,..: I, • :c',.i'�,..,� (�(�i�=;�� . 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