K-4 - Pay Estimate 3 - Shawver Well Company - Well 5 Improvements

SUMMARY <table> <tr> <th></th> <th>Total Approved</th> <th>Total Completed</th> </tr> <tr> <td>Contract Price</td> <td>$296,015.00</td> <td>$290,407.00</td> </tr> <tr> <td rowspan="2">Approved Change Order (list each)</td> <td>Change Order No. 1</td> <td>$2,720.00</td> <td>$1,292.00</td> </tr> <tr> <td>Change Order No. 2</td> <td>$37,000.00</td> <td>$37,000.00</td> </tr> <tr> <td colspan="2">Revised Contract Price</td> <td>$335,735.00</td> <td>$328,699.00</td> </tr> </table> Stored Total Earned $328,699.00 Retainage (5%) $16,434.95 Total Earned Less Retainage $312,264.05 <table> <tr> <th>Total Previously Approved (list each)</th> <th>Pay Estimate No. 1</th> <th>$131,062.95</th> </tr> <tr> <td></td> <td>Pay Estimate No. 2</td> <td>$178,683.60</td> </tr> </table> Percent Complete 98% Total Previously Approved $309,746.55 Amount Due This Request $2,517.50 The amount $2,517.50 is recommended for approval for payment in accordance with the terms of the contract. Prepared By: Shawver Well Company, Inc. Signature: [signature] Name: Ryan Bucke Title: President Date: 10/5/22 Recommended By: Veenstra & Kimm, Inc. Signature: [signature] Name: Dave Schechinger Title: Engineer Date: October 4, 2022 Approved By: Tiffin, Iowa Signature: [signature] Name: ______________________ Title: ______________________ Date: ______________________