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I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />APPLICATION FOR PAYMENT NO. 5 <br /> <br />To: City of Ramsey (OWNER) <br />From: Marcy Cantrn,ction: Thc_ 19245 Hwy 7, Excelsior, MN 55331 (CONTRACTOR) <br />Contract: General Canstnmtion <br />Project: Minnesota Pump Ho~ise Nc~ 3 <br />OWNER's Contract No. ENGINEER's Project No. <br />For Work accomplished through the date of: ~ <br /> <br />i.) Original Contract Price: <br />2.) Net change by Change Orders/Written Amendments (+-) <br />3.) Current Contract Price (1 plus 2): <br />4.) Total completed and stored to date: <br />5.) Retainage (per Ageement): <br /> 5% o~'completed work $1.7,147 10 <br /> 5% of stored material: $ 0 00 <br /> Total Retainage: <br />6.) Total completed and stored to date less retainage (4-5) <br />7.) Less previous Application for Payments: <br />8.) DUE THIS APPLICATION (6-7) <br /> <br />495,500 00 <br /> 0 oo <br />495,.500.00 <br />q49,942.00 <br /> <br />17,147_1-0 <br />86,660.45 <br /> <br />Accompanying Documentation: <br /> <br />CONTRACTOR'S Certification: <br /> <br />The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER <br />on account of Work done under the Contract referred to above have been applied on account to discharge <br />CONTRACTOR's legitimate obligations incurred in connection with Work covered by pr/or Applications <br />for Payment numbered 1 through 5._inclusive; (2) title of all Work, mater/als and equipment incorporated in <br />said Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of <br />payment Ii'ce and clear of all Liens, security interests and encumbrances (expect such as are covered by a <br />Bond acceptable to OWNER indemnifying OWNER against any such Lien, security interest or <br />encumbrance); and (3) all Work covered by this Application for Payment is in accordance with the Contract <br />Documents and not defective. <br />Dated March 1, 200~ Magney Construction, Inc (Contractor) <br /> <br /> ~"..7~.~...? ,~aaa. a,.2~os ][ Mark Magney, President~ <br /> <br />Subscribed and sworn/to're/fae t~/s~ay of /r~,;~r/Z._~ 2002. <br /> <br />My Commission expires: -~O/t/5 it,/ 2"'~03'~-(~d <br /> <br />Payment of the abuve AMOUNT DUE THIS APPLICATION is recommended. <br /> <br />Dated ~/'7/d) ~--- Bnltnn & Menk~ lac. (e~gineer) <br /> By <br /> <br />-67- <br /> <br /> <br />