Agenda - Council - 11/23/2010 - Laserfiche WebLink

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CHANGE ORDER SUMMARY Change Orders approved in previous months by Owner TOTAL ADDITIONS - 37,153.00 37,153.00 DEDUCTIONS 0.00 Approved this Application Date Approved Number TOTALS 0.00 0.00 Net change by Change Orders 37,153.00 •r 1 L I V r J I'VIII 1 V 1.-1 • 11 I' S I. - , V I\ , A■ ■, I L., • II TO: City of Ramsey (O'WHER) 7550 Sunwocd Drive MW Ramsey, MN 55303 FROM (CONTRACTOR): CB&I Inc- - -Steel Plate Structures 9550 Hickman Road Clive, IA 50325 - 5316 CONTRACT FOR 2MMG HP 1152 TOL 16600 St Francis Blvd., Unit #2 CONTRACTOR'S APPL CATION FOR PAYMENT The undersigned Contractor certifies That to the best of the Contractor's knowlettge, information and belief that the Worfi covered by this Aplication for Payment has been completed in accordance with Contract Documents, that aII amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is naul due_ CONTRACTOR: CB &I Inc. - Steel Plate Structures CUSTOMER PROJECT: Water Tower No.3 Project No_08 -21 VIA (ENGINEER): Progressive Consulting Engineers, tnc. 6120 Earle Brown Drive, Suite 629 CONTRACT DATE 07109!09 Minneapolis, MN 55430 • Date: November 1, 2010 ENGINEER'S CERTIFICATE FOR PAYMENT In accordarcewith the Contract Documents, based on on -site observations and the data comprising the above appplicarion, the Engineer certll5es to the Owner that to the best cf the Engineer's knvr Ledge, information and belief the Work has progressed as ind5caied, the quality of the Work is in aocArdance with the Contract Documents_ and the Contractor is entitled to payment of the AM6UNT CERTIFIED_ AIA DOCUMENT Gh'2 AFPL} AT1ON AND CERTIFICATE FOR PAYMENT 1.1 ISRI ESflo.'J PW g 1592 T E ?JAERIO? N INSTI TE OF ARCHRECIS 173s NEW YORK AVENUE. N.w, ?S FINGTOto, O.C. 20:6 L. I' J44ICJY 1 17.1114 APPLICATION NO: 16 CM NO. 37/47815 PERIOD TO: 10/30/10 ENC[H EER'S t=ROJECT rlo: Project No. 08015 Application is made for Payment, as shown below, in connection with The Contract. Continuation Sheet, A1A Document G703, Is attached. 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line 14!. - 2) 4. TOTAL COMPLETED & STORED TO DATE {Col G on G703) 5. RETAINAGE: a. 3% of Completed Work {Cot D +E on G703) 11_ e% of Stored Material Cot F on G703) Total Retainage (Line 5a f 5b or (Total in Col I of G703) 6. TOTAL EARNED LESS RETAINAGE (Line4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT [Line 6 from prior Certificate) 5. CURRENT PAYMENT DUE 9. BALANCE TO FINISH. PLUS RETAINAGE (Line 3 less Line 6) State of: IOWA County of: POLK Subscribed and swam to before me this 1st day of November, 2010. Notary Public Commission expires: AMOUNT CERTIFIED Dec. 03, 2010 3 94-' S X970 rAcit uirq yr 15110 PAGES $96,766.59 0.00 Distribution b: OWNER ENGrINEER CONTRACTOR OTHER $3,188,400.00 $37,153.00 $3,225,553-00 $3,225,553.00 $3,128,786.41 $3,127, 816.41 6970.00 $96,766.59 P GAY LA L. 6GNZ Commission I Iulrnber 713885 My Carnmissfon EIp December, 3 20/ (Attach explanation if amount certified differs from the amount applied for.) ENGINEER: Progressive Consulting En jeers, Inc_ By i�� -r—� Date: OWNER: City of Ramsey Sy: Date: This CerliFcate is not negotiable. The AMOUNT CERTIFIED s payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the CAvner or Contractor under Yris Contract $966,766.59 GrUZ -14`12 W U1