K-4 - Pay Estimate 4 - Rathje - Original Town Phase Two

REQUEST FOR PAYMENT PROJECT NAME: Original Town Urbanization Project: Phase Two DATE: 7/31/2021 OWNER: City of Tiffin CONTRACT FOR: RATHJE CONSTRUCTION CO. PROJECT # 7187 REQUEST NUMBER: 4 PERIOD FROM: 7/1/2021 TO: 7/31/2021 ORIGINAL CONTRACT AMOUNT $1,824,618.96 CHANGE ORDER AMOUNT $3.00 ADJUSTED CONTRACT AMOUNT $1,824,621.96 TOTAL COMPLETED TO DATE $496,389.56 PREVIOUS REQUESTS FOR PAYMENT $302,099.00 TOTAL EARNED THIS REQUEST $194,290.56 LESS 5% RETAINAGE $9,714.53 CURRENT PAYMENT DUE $184,576.03 SUBCONTRACTOR: Rathje Construction Co. SIGNED: [signature] TITLE: Secretary