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Contractor's Application for Payment <br /> Owner: City of Ramsey Owner's Project No.: 22-05 <br /> Engineer; Bolton &Menk, Inc. Engineer's Project No.; 0R1.127005 <br /> Contractor; Douglas-Kerr Underground, L,L.0 Agency's Project No.. S.A.P. 199--115-004 <br /> Project: 2022 Riverdale Drive Trunk Utility improvements <br /> Contract; <br /> Application No.. 3 Application Gate: 7/11/2022 <br /> Application period, From 6/1/2022 to 6 f 30/2022 <br /> 1. original Contract Price $ . 2,16 ,89022 <br /> 2, Net change by Change orders $ _ 5J52,5%. <br /> ................. <br /> 3. Current Contract Price{Line 1+Line 2} $ �1124j737.,72. <br /> 4. Total Work completed and materials stored to date <br /> (Sum of Column G Lump Sum Total and Column J Unit Price Total) $ )804,535189 <br /> 5. Retainage <br /> a. 5/o X $ .804 53.5.s9 Work Completed ;$ 0,22C,79 <br /> b: X � - ,Stored Materials -„ ...�.-- <br /> C. Total Retainage (Line 5.a+Line 5.b) 9022679. <br /> 6. Amount eligible to date{Line 4-Line 5.c} $ - 1,714,309.10 <br /> r <br /> . 7. Less previous payments <br /> .,014,306.9 <br /> R. Amount due this application $ 7.oD,002 20 <br /> 9. Balance to finish, including retainage(Line 3-Line 4) $ 320,201.83 <br /> Contractor's Certification <br /> The undersigned Contractor certifies,to the best of its knowledge,the following; <br /> (1)All previous progress payments received from owner on account of work done under the Contract have been applied on <br /> account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for <br /> Payment; <br /> (2)Title to all work,materials and equipment incorporated in said work,or otherwise listed in or covered by this Application for <br /> PayMent,will pass to owner at time of payment free and clear of all liens,security interests,and encumbrances(except such as <br /> are covered by a bond acceptable to owner Indemnifying owner against any such liens,security interest,or encumbrances);and <br /> (3)All the Work covered by this Application for Payment is in accordance with the Contract documents and is not defective. <br /> Contractor: b4;A s L4 VVdp t 9 r'C.� _ L L4' <br /> Signature; .y d.f Date; <br /> Name: �:3.� �� A . Title; 00, <br /> Recommended by Engineer Approved by Owner <br /> I - s <br /> 11 <br /> By, ,r. By. x <br /> Name; Kevin P.Kielb blame. :� y <br /> Title: Project Engineer Title: <br /> Date; 7/11/2022 Date, <br /> EJCDC C-620 Contractor's Application for Payment <br /> (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved, <br />