Agenda - Council - 05/24/2022 - Laserfiche WebLink

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Contractor's Application'for Payment Owner: City of Ramsey Owner's Project No.: 22-05 Engineer; Balton&Nlenk,Inc. Engineer's Project No.. nR1.127005 Contractor: DouglaS-Kerr Underground, L.L,C. Agency's Project.No.: S.A,P.199-115-00.4 Project: 2022 Riverdale Drive Trunk Utility Improvement Contract: Application No.. 1 Application Bate: 5/3/2022 Application Period: From 4/1/2022 to 4/30/2022 1. Original Contract Price $_ 2J631890.22 _ . . ....:... . .. . .......... 2. Net change by Change Orders 3�, 52.5Q ........ .. ... 3. Current Contract Price Line .-r-Line 2 $ 2,124,73.7 72_. 4. Total Work completed and materials stored to date (Sum of Column G Lump SLrm Total and Column J Unit Price Totals $ 465359,77. 5, Retainage a. 5 0 x 65,359, '7 Work Completed 23 267,99.. .....:......:........: . ... _ - -- b. }� .Store Materia s .................. ............... ........... ... c> TotalRetainage Line 5.a+Line 5,b) ...... ......................................... ............ 23267.99 .....:::.... 6. Amount eligible to date(Line 4-Line 5.c .... ...............JM2,D9 1.�7 Q ......... 7. Less previos payments . . . .-.................. 8. Amount due this application - �42,09� 78 .. . .................. - 9. Balance to finish,includin g retaina e 1,b5 ,37. ; �',95 ' g Line 3-Line 4 j _- Contractor's Certification The undersigned Contractor certifies,to the best of its knowledge,the following: (1)All previous progress payments received from owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with the Mork cohered by prior Applications for Payment; _ (2)Title to all Work,materials and eq�ripment incorporated in said Work,or otherwise listed in or covered by this Application for Payment,will pass to Owner at time of payment free and clear of all liens,security interests,and encumbrances(except such as are covered by a bond acceptable to Owner indemnifying Owner against any such liens,security interest,or encumbrances);and (3)All the Work covered by this application for Payment is in accordance with the Contract Documents and is not defective. Contract❑ J! '� i Signature: Date,,. �� � Name, Ais Title: Recommended by Engineer Approved by Owner M � l3 .- � ' ' y• Name: Kevin P. Kielb Name: Title: Project Engineer Title. Date: 5/3/2822 Date: i 3. EJCDC C-620 Contractor's Application for Payment (0 2018 National Society of Professional Engineers for EJCDC. All rights reserved.