K-3 - Pay Estimate 4 - Final - Soccer Field Parking Lot Expansion - LL Pelling

PARTIAL PAYMENT ESTIMATE NUMBER 4 FINAL CONTRACTOR: LL Pelling Co. ADDRESS: PO Box 230 CITY, STATE, ZIP North Liberty, IA 52317 OWNER: City of Tiffin PROJECT: Soccer Fields Parking Lot Expansion Project HFC#18218.227 <table> <tr> <th>Date of Completion:</th> <th>Amount of Contract:</th> <th>Date of Estimate:</th> </tr> <tr> <td>Original: 8/15/2019</td> <td>Original: $302,908.39</td> <td>From: 30-Nov-19</td> </tr> <tr> <td>Revised:</td> <td>Revised:</td> <td>To: 8-Mar-21</td> </tr> </table> <table> <tr> <th></th> <th>THIS PERIOD</th> <th>TOTAL TO DATE</th> </tr> <tr> <td>Amount Earned</td> <td>$0.00</td> <td>$302,672.39</td> </tr> <tr> <td>Add Material Stored On-Site</td> <td>$ -</td> <td>$ -</td> </tr> <tr> <td>Subtract Materials Installed On-Site</td> <td>$ -</td> <td>$ -</td> </tr> <tr> <td>Subtotal</td> <td>$ -</td> <td>$302,672.39</td> </tr> <tr> <td>Retainage (5%)</td> <td>$ (15,133.62)</td> <td>$ -</td> </tr> <tr> <td>Previous Payments</td> <td></td> <td>$ 287,538.77</td> </tr> <tr> <td>Amount Due</td> <td>$ 15,133.62</td> <td>$ 15,133.62</td> </tr> </table> Estimated % of Job Complete Based on Amount Earned/Contract Amount only 100% This does not constitute work completed to date Is Contractor's Construction Progress on Schedule? YES NO N/A I hereby certify that I have carefully inspected the work and as a result of my inspection and to the best of my knowledge and belief, the quantities shown in this estimate are correct and have not been shown in previous estimates and the work has been performed in accordance with the contract documents. HART-FREDERICK CONSULTANTS P.C. By: [signature] Title: Benjamin A. Carhoff, Project Engineer Date: March 8, 2021 Approved by Owner's Representative: By: ____________________________ Title: ____________________________ (Additional signatures -- if required) By: ____________________________ Title: ____________________________