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ro <br />CT- <br />uSign Envelope ID: 42FFC03B-5D22-43CD-B492-F500B0I BCB8E <br />Application No,: <br />City of Ramsey Public Works <br />0 <br />0 <br />i2 <br />r-- <br />✓ <br />Application Date: <br />19520-0180 <br />0 <br />O J <br />CO <br />C \1 <br />0 <br />Contract Date: <br />195200180-033005 <br />Commitment: <br />Contract For: 195200180-033005 - Concrete <br />-0 a) s <br />.O <br />7 <br />❑ -- L) C <br />E U U : <br />C ;,� U <br />O 3 0 <br />O o a <br />`o 0 a <br />8 co <br />a • L <br />ao0 <br />• C3 <br />(13 <br />v <br />E <br />O <br />o U <br />-O <br />• 7 <br />o -oED, <br />• E <br />a) <br />Q] <br />E <br />,2 O E. <br />C <br />• 00� <br />• 4 <br />C <br />< E N -0 <br />"0 <br />E <br />• O a] . <br />• N d7 N <br />- o C [Cf <br />Q] <br />L § <br />a)• m�! <br />= 2 .9 CD <br />= 4- 4_,- <br />a)•� c <br />o a) <br />I----0UU CI <br />$1, 347, 350.00 <br />1. ORIGINAL CONTRACT AMOUNT <br />a <br />0 <br />2, NET CHANGE BY CHANGE ORDERS <br />$1,347,350.00 <br />3. CONTRACT SUM TO DATE <br />L!_ <br />0 <br />0 <br />Z <br />0 <br />0 <br />0 <br />0 <br />iri <br />Co <br />Co <br />4. TOTAL COMPLETED AND STORED TO DATE <br />O <br />C5] <br />0 <br />N <br />0 <br />0 <br />By: Kristin Berg <br />ED- <br />C <br />0 <br />0 <br />0 <br />0) <br />(0 <br />C1) <br />5, RETAINAGE <br />0 <br />0 <br />0 <br />0 <br />5.00% of Completed Work <br />0 <br />() <br />'0 <br />Subscribed and sworn to before me this <br />(Columns D + E) <br />5.00% of Stored Materials <br />Notary Public: <br />My commission expires: <br />0 <br />4) <br />C <br />E <br />a <br />0 <br />ARCHITECTS CERTIFICATE FOR PAYMENT <br />LO <br />0 <br />CO <br />CO <br />CO- <br />Total Retainage <br />(Line 5a + Line 5b OR Sum of Column I) <br />u) .2 <br />U <br />❑ ❑ <br />(I) <br />al 2 <br />Q a) <br />e) 2U <br />OM -T3 g rn m <br />m.c u) <br />a3 2 E <br />-O M O U <br />0 0 <br />Q' CD L. -0 <br />C <br />N a] <br />gut) <br />❑.0 <br />• C <br />0�❑,� <br />4) <br />O <br />.gyp U C ILI 1-0 <br />• U f C11 <br />U L U U 6 <br />p Q Cli i-� Cy <br />cI- <br />U V7 <br />Es <br />C-9--0 0< <br />U Tc3 m <br />• C - C <br />: U E <br />U MC� <br />tC5 .g a] -E oCL <br />T2E a <br />U <br />co E ❑ <br />• ❑ C 0 <br />8 <br />0 <br />CO <br />as <br />10 <br />CO <br />c <br />6. TOTAL EARNED LESS RETAINAGE <br />(Line 4 less Line 5 Total) <br />0 <br />0 <br />0 <br />0 <br />7. LESS PRIOR CERTIFICATES FOR PAYMENT <br />AMOUNT CERTIF <br />(Line 6 from prior Certificate) <br />a) <br />o <br />❑ <br />C <br />❑) <br />E <br />-a3- <br />m = <br />c o <br />D N <br />0 <br />@ U <br />ED. <br />N 5, <br />N <br />E <br />0 <br />(p <br />lC <br />$225,848.25 <br />8. CURRENT PAYMENT DUE <br />0) <br />N <br />0 <br />0) <br />0 <br />CO <br />0 <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />ARCHITECT <br />(Line 3 less Li <br />0) <br />0 <br />0 <br />DEDUCTIONS <br />0 <br />0 <br />a <br />0 <br />0 <br />0 <br />ADDITIONS <br />0 <br />0 <br />0 <br />ft <br />0 <br />0 <br />CHANGE ORDER SUMMARY <br />Total changes approved in previous months <br />0 <br />E <br />a) <br />a <br />2 <br />(5) <br />F- <br />■ <br />0 <br />0 <br />0 <br />co <br />J <br />0 <br />F^ <br />NET CHANGES by Change Orders <br />