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Please. Remit Payment to: RJM Construction, LLC <br />DocuSign Envelope ID: 94465321-7934-4DD1-A69E-2A65D20CB706 <br />APPLICATION AND CERTIFICATE FOR PAYMENT <br />CO STRUCTI0N. <br />O r c <br />8 N C7 N <br />cu <br />0 <br />Application No. <br />a) <br />0 <br />Ramsey, MN 55303 <br />i <br />L (a <br />a _C <br />C <br />.0 d 2 <br />a) Q (1) <br />C <br />a0.a c.) <br />-a a)) 0 <br />2-o },4- <br />0C,C N <br />-. -+-' 00.'if) <br />co) cp <br />0 E ' a- <br />U cu <br />Ll. a) a,v - >5 <br />a)0 0 <br />0 .V a C <br />Ca <br />0 a) <br />XI CO U) <br />-«�_C, au <br />0 : h-- a) <br />CA N <br />115 . N = C - <br />a) <br />Q 0 (0 C <br />.,.©0._cn <br />a 0 •-• <br />4 C <br />Q o'� <br />0 22 <br />to •F ' C ((0 <br />C U <br />Q • --- a)O <br />m i° o E <br />Y/ ,0 c 0 5 <br />�. C1: <br />-0 C---• <br />�� C <br />1--. C co 0 <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />0 <br />0 <br />ti) <br />8 <br />0 <br />U <br />C <br />N <br />0 <br />RJM Construction LLC <br />CONTRACTOR: <br />(Ni <br />0 <br />Tao <br />• .0 <br />ID v E c? <br />� C <br />0 •0) ElCO <br />CDi-' c <br />co 0 0 <br />co <br />.i" c co .0 <br />c © c 0 <br />:,. .ED <br />v 0 z <br />•0-0 . ni <br />< 0 <br />J <br />$16,361,624.00 <br />3. Contract Sum To Date <br />C <br />C0 <br />o <br />t1) <br />E <br />N <br />0 <br />a) <br />1 Q <br />N <br />- c <br />o <br />ca•U •0) <br />�_ <br />032.0 <br />cut m0 <br />Ci3 >. <br />(0 (O Z 2 <br />a) <br />CO Q <br />rci 0 U <br />Cll Cr, call <br />0 . co 0 <br />N t� <br />=�a_a <br />0 <br />O as -in <br />ID co <br />c.a)0 2 C <br />cn N 0 <br />0w c) 0- 0 <br />..00 <br />CI <br />0 .= <br />a15 <br />0 C. C <br />0 cv 0 O <br />U ..,_. <br />0 CD <br />1 2 0 <br />E Q <br />0 CO <br />0 ._,-0,:, <br />Qc. to' <br />c — o <br />00 .Q c .0, <br />Ca <br />C CI)1) <br />0L �4- <br />c"_'.5c a <br />O •CU <br />'Q) <br />0 0- Cr <br />co E L 0 <br />0 Q <br />CO <br />C) <br />(NI <br />69. <br />• <br />() <br />CO <br />0 <br />- <br />I— Ii5 <br />NC <br />.D ' <br />ds <br />405 <br />Ca Q a a) <br />co <br />111 0 0 . <br />co o o <br />Zo- <br />C C] CD 0 <br />4 ca .16 <br />$11,632,196.13 <br />6. Total Earned Less Retainage <br />$10,541,642.00 <br />7. Less Previous Certificates For Payments . . <br />co <br />0 <br />(i <br />0 <br />a) <br />• a) <br />C � <br />0 0 <br />(13 <br />(73 <br />D <br />rosz <br />1- <br />o <br />0 0 <br />0 <br />0 0 <br />E <br />D v <br />LL 0 <br />0 -(0 <br />L? li .Q o <br />C ) <br />10 <br />Lo <br />0) <br />0) <br />r <br />Ef} <br />8. Current Payment Due <br />1- <br />CO <br />C) <br />EP} <br />9. Balance To Finish, Plus Retainage <br />H <br />2 <br />ce <br />08/ 11 /2021 <br />cts <br />0 <br />m <br />C C <br />0 0 <br />0 E <br />a 0 0 <br />c <br />W_ c " _ 0 Q] <br />UCC <br />'a <br />W <br />U 1 0 <br />(0 <br />03 <br />I <br />0 C. o <br />ai <br />u) <br />a � <br />a) •C 0 <br />CCD <br />to <br />o•a <br />mCa <br />m c <br />v <br />a <br />U 0 <br />co <br />to <br />N <br />I--0 0- <br />Qi <br />C <br />a <br />0 <br />• <br />C 3 <br />4=1 <br />V3 <br />0 <br />Vj <br />CD <br />CR <br />d <br />E& <br />0 <br />C7 <br />CD <br />C7 <br />Ef} <br />C] <br />C7 <br />CD <br />Eft <br />C 3 <br />CD <br />C <br />} <br />CHANGE ORDER SUMMARY <br />Total changes approved <br />in previous months by Owner <br />Total Approved this Month <br />1_ TOTALS <br />Net Changes By Change Order <br />