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Please Remit Payment to: RJM Construction, LLC <br />DocuSign _Envelope ID: 5A1199C1-4372-4D33-8FEF-3D71 A48A9A7A <br />W <br />>- <br />Q <br />0_ <br />Li- <br />W <br />1- <br />0 <br />w <br />0 <br />ci <br />z <br />O <br />0 <br />J <br />a. <br />CONSTRUCTION <br />Distribution to : <br />s-- <br />O <br />co <br />O <br />0 <br />Project: 19520-0180 City of Ramsey Public Works <br />A <br />(D <br />c <br />0 <br />C.) <br />0 <br />Application No. : <br />7550 Sunwood Drive NW <br />0 <br />O <br />U <br />N <br />CJ <br />CO <br />Application Date: <br />N <br />O CO <br />Period From: <br />Ramsey, MN 55303 <br />U <br />0 <br />U <br />1- <br />a) <br />5 <br />O <br />O <br />a) <br />0 <br />a) <br />a) <br />O <br />cu <br />a) <br />O <br />(a <br />U <br />a) <br />a) <br />'t3 <br />a) <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />0 <br />LO <br />c <br />U <br />a) <br />'a <br />(CS <br />a) <br />a) <br />a) <br />N <br />a) <br />0 <br />((3 <br />O <br />a) <br />.c <br />5 <br />a) <br />('3 <br />-c <br />O <br />U <br />U <br />(o <br />O <br />U <br />a) <br />5 <br />0 <br />U <br />a) <br />5 <br />O <br />T.) <br />0 <br />a) <br />5 <br />>, <br />(0 <br />4- <br />a) <br />(3 <br />O <br />ca <br />a) <br />co <br />(o <br />a) <br />O <br />O <br />U <br />RJM Construction LLC <br />CONTRACTOR: <br />d) <br />r✓ <br />co <br />0 <br />0 O O 0) <br />O O O d' <br />O co <br />N (f3 N O <br />C0 C0 N <br />O <br />C0 C0 a <br />CO CO O <br />C0 C0 <br />1.Original Contract Sum <br />2. Net Change By Change Order <br />a) <br />• CV/ <br />• O 0 CO <br />3. Contract Sum To Date <br />O a) <br />U) ° a) <br />.0 O <br />U U) <br />0) <br />0) <br />0 <br />a) <br />O <br />a) <br />0 <br />a <br />a▪ ) <br />(0 <br />.L] <br />a) <br />0 <br />(LU <br />0 <br />a) <br />5 <br />a) <br />(Q <br />Z3 <br />a) <br />cn <br />a) <br />Q <br />cn <br />0 <br />4- <br />a) <br />.� <br />(0 <br />O <br />a <br />a) <br />a) <br />0 <br />Y <br />U) <br />a) <br />U <br />0 <br />a) <br />`(7 <br />(a <br />ram-+ <br />a) <br />a <br />0 <br />((0 <br />C <br />0 <br />a) <br />5 <br />a) <br />0 <br />O <br />0 <br />a) <br />N f` N <br />•,t' O d <br />Total Retainage <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />C0 <br />LO <br />10 <br />t!' <br />64 <br />AMOUNT CERTIFIED <br />C0 <br />M <br />1f) <br />LO <br />10 <br />8. Current Payment Due <br />9. Balance To Finish, Plus Retainage <br />a <br />c <br />c0 <br />4) <br />0 <br />• <br />Q <br />C <br />a, <br />v <br />a <br />Q)o <br />ro <br />(�D a) <br />0 <br />-r <br />U <br />123 <br />a <br />a3 a, <br />n if amount certified <br />ion Sheet that are c <br />11/08/2021 <br />ITS <br />0 <br />1 3 <br />0 <br />< CO <br />Deductions <br />O <br />O <br />0 <br />O <br />O <br />O <br />0 <br />0 <br />0 <br />(1) <br />(J) <br />CJ) <br />O <br />C) <br />O <br />O <br />Q <br />1? <br />O <br />O <br />Ca <br />U") <br />(/) <br />d9 <br />C <br />0 <br />-13 <br />Q <br />CHANGE ORDER SUMMARY <br />Total changes approved <br />in previous months by Owner <br />Total Approved this Month <br />TOTALS <br />Net Changes By Change Order <br />