Agenda - Council - 07/22/2003 - Laserfiche WebLink

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APPLICATION FOR PAYMENT NO. 9 FINAL To: Ci~ of Ramsay (OWNF, R) ' From: Ma~eY Contnmtian, lnc_ 19245 Hwy 7, Excelsior, MN 55331 (CONTRACTOR) Contract: __General Con.qtnmticm Project: Minne.qc~ta Pump T-Tmme No 3 OWNER's Contract No. ENGINEER's Project No. For Work accomplished through the date of: 05/20/f)3 1 .) Original Contract Price: 2.) Net change by Change Orders/Written Amendments (+-) 3.) Current Contract Pr/ce (1 plus 2): 4.) Total completed and stored to date: 5.) Retainage (per Agreement): % of completed work $0 00 · % of stored material: $000 Total Retainage: 6.) Total completed and stored to date less retainage (4-5) 7.) Less previous Application for Payments: 8.) DUE THIS APPLICATION (6-7) $ 495.S00 Of)' $ O_Of) $ S03/g62_91 $ 17:633.93 Accompanying Documentation: CONTRACTOR'S Certification: The undersigned CONTRACTOR certifies that (1) all previous progress payments received fi:om OWNER on account of Work done under the Contract referred to above have been applied on account to discharge CONTRACTOR's legitimate obligations incurred in connection with Work covered by pr/or'Applications for Payment numbered 1 through 9_m~lusive; (2) title of all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by th.is Application for Payment will pass to OWNER at t/me of payment free and clear of all Liens, security interests and encumbrances (expect such as are covered by a Bond acceptable to OWNER indemnifying OWNER against any such Lien, security interest or encumbrance); and (3) all Work covered by this Application for Payment is in accordance with the Contract Documents and not defective. Dated 1~ ' ' . Mag-ney Construction, Inc,(Contractor) State of /'~/I/t/./,dz'/~d County of Subscribed ~nd ~¢n]d~'b,~fodF~/~/ day of flf/z~, , 5003. Notary Public ~/~.~JK~~.~v/-"-....,.~ ' fi'. My Commission expires: ,-7~ ,~-(-~ ~/ ~',~2S' Dated k/~ [/¢~ '-~t~'~ Bnltnn & Menk, Thc (engineer) -91-