Agenda - Council - 08/19/2002 - Laserfiche WebLink

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EX~'tzNI_) DI~I. PLIC TION FOR NO, To: Ci~ of Ram~ey (O~R) IWIEWED BY From: Mn~ey Cnnmmfion: Me. 19245 H~ 7, Excelsior, ~' 55331 (CONT~CTOR) Contract: ~General Con,rotation ., r APPROVAL Project: Minne~nt~ Pump ~nu~e ~ 3 0~R's Contract No. ENG~ER's Project No. For Work accomplished t~ou~ the date of: ~ 1.) Original Contract Price: 2.) Net change by Change Orders/Written Amendments (+-) 3.) Current Contract Price (1 plus 2): 4.) Total completed and stored to date: 5.) Retainage (per Agreement): ~ of completed work $25;111.96 5% of stored material: $ 0_00 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;500 O0 $ 46g:300 71 Accompanying Documentation: CONTRACTOR'S Certification: The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of Work done under the Contract referred to above have been applied on account to discharge CONTRACTOR's legitimate obligations/ncurred in connection w/th Work covered by pr/or Apphcafions for Payment numbered 1 through 8 inclusive; (2) rifle of all Work, materials and equipment incorporated in said Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time 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. .~: ........... - ...............:~ ,vxal~ney constmclaon, lnc (Conic'actor) / Subscribed and sworn ~o b~f4~ ~e thi~/]_.,~ d~ of /qT~-"'- , 2002. Payment of the above AMOUNT DUE THIS APPLICATION is recommended. Dated lqnltnn & Menk: Inc. (en~neer) By. -31-