4.3 SR 05-15-2023Request for Action
To
Item Number
Mayor and Ci T Council
4.3
Agenda Section
Meeting Date
Prepared by
Consent
May 15, 2023
Ryan Sandhoefner, Engineer 1
Item Description
Reviewed by
Pay Estimates
Justin Femrite P.E., Public Works Director
Reviewed by
Cal Portner, City Administrator
Action Requested
Approve, by motion, the pay estimates detailed below.
Background/Discussion
The following pay estimates have been reviewed and found to be accurate and in accordance with approved contracts.
Financial Impact
PROJECT
Pay Est. #
Contractor
Amount
City Hall Reroof
1 —
Partial
Palmer West Construction
$354,466.85
YAC
11
— Partial
Ebert Construction
$27,612.93
Public Safety Reroof
1 —
Partial
Granite City Roofing
$7,125.00
Northbound Liquor Reroof
1 —
Partial
Palmer West Construction
$143,450.00
Northbound Liquor Reroof
2 —
Final
Palmer West Construction
$7,550.00
Mission/Policy/Goal
Opportunity to live, work, and play.
Attachments
■ Pay Estimate 1 — Palmer West Construction
■ Pay Estimate 11 —Ebert Construction
■ Pay Estimate 1 — Granite City Roofing
■ Pay Estimate 1 — Palmer West Construction
■ Pay Estimate 2 — Palmer West Construction
The Elk River Vision P 0 W E e E 0 0 V
A welcoming community rvitb revolutionary and spirzted resourcefulness, exceptional NATURE
service, and community engagement that encourages and inspires prosperz[ Updated. August 2020
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Form W-9
(Rev. October 2018)
DePartmerd of the Treasury
Internal Revenue SeMra
1 Name (as shown on
Granite
12 Busine
Request for Taxpayer
Identification Number -and Certification
► Go to www.lrs gov1FormM for instructions and the latest information.
e tax return). Name is required on this line; do not leave this One blank
Inc.
d entity name, If different from above
Give Form to the
requester. Do not
send to the IRS.
3 Check appropriate box for federal tax classification of the person whose name is.entered on line 1. Check only one of the 4 Exemptions (codes apply only to
following seven boxes. certain entities, not Individuals; see
Instructions on page 3):
❑ Individual/sole proprietor or Z C Corporation ❑ S Corporation ❑ Partnership ❑ Trusi/estate
single -member LLC
❑ Umited liability company. Enter the tax classification (C=C corporation, S=S corporation, P--Partnership)►
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
LLC If the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-membeir LLC the
Is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑ Other (see Instructions) ►
5 Address (number, street, and ap[ or suite no.) See instructions. Requester's name
PO Box_1482
6 City, state, am
St. Cloud, MN 66302
7 List account numbers) here (optioneQ
r Taxpayer Identification Number (TIN)
Enter your TIN In the appropriate box. The TIN provided must match the name
backup withholding. For individuals, this is generally your social security nurn
resident alien, sole proprietor, or disregarded entity, see the instructions for Pa
entities, it is your employer Identification number (EIN). If you do not have a nu
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. AI
Number To Glve the Requester for guidelines on whose number to enter.
Exempt payee code (if arry)
Exemption from FATCA reporting
code (if any)
(gopB•t ro•ccaunh mehm'nedaroWe tlN U 8J
given on line 1 to avoid
bar
tuber,
Social security number
(SSN). However, for. a
rt I, later. For other
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see Now to get a
or
so see What Name and
Employer Identification number
M41
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1
1 2
1 6
6
1 9
4
1 0
--4[1 Certification _ --
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2.1 am not subject to backup withholding because: (a) I am exerhpt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service ORS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am.
no longer subject to backup withholding; and
3.1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form Of any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage interest paid,
acquisition or abandonmentcf secured property, cancellation of debt, contributions to an individual retirement arrangement ORA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. Sea the instructions for Part 11, later.
Sign signature of
Here U.S. person ► Date► y o1 a 3
General Instruc ions
Section references are to the internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to wwwJr:s.gov1FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
Identification number (TIN) which may be your social security number
(SSN), individual taxpayer Identification number OTIN), adoption
taxpayer identification number (ATIN); or employer Identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of Information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
Cat. No. 10231X
• Form 1099-DN (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers) -
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest),1098-E (student loan interest),
1098-T (tultion)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TiN, you might
be subject to backup withholding. See What is backup withholding,
later.
- — — Form W-9 (Rev.10-2018)
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