Agenda - Council - 09/27/2022 - Laserfiche WebLink

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Contractor's Application for Payment Owner: City of Ramsey Owner's Project No.: 20-05 Engineer: Bolton & Menk, Inc. Engineer's Project No.: OR1.125908, OR1.128236 Contractor: Douglas -Kerr Underground, LLC Agency's Project No.: SP 020-121, SAP 119-115-005 Project: 2022 Riverdale Drive Extension Contract: Application No.: 1 Application Date: 9/13/2022 Application Period: From 8/1/2022 to 9/9/2022 1. Original Contract Price 2. Net change by Change Orders 3. Current Contract Price (Line 1 + Line 2) 4. Total Work completed and materials stored to date (Sum of Column H Unit Price Total and Column M Stored Materials) 5. Retainage a. 5% X $ 52,621,00 Work Completed b. X $ - Stored Materials c. Total Retainage (Line 5.a + Line 5.b) 6. Amount eligible to date (Line 4 - Line 5.c) 7. Less previous payments 8. Amount due this application 9. Balance to finish, including retainage (Line 3 - Line 4) S 5 2,342,102.66 5 S 2,342,102.66 52,621.00 2,631.05 5 S 5 2,631.05 49,989.95 49,989.95 2,289,481.66 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 ❑bligations incurred in connection with the Work covered by prior Applications for Payment; (2) Title to all Work, materials and equipment 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. Contractor: Signature: Name: 0 1/4, et' "" 1"". j7. Date: Title: Recommended by Engineer By: Name: Kevin P. Kielb Title: Project Engineer Date: 9/13/2022 Approved by Owner By: Name: Title: Date: EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professional Engineers for E.JCDC. All rights reserved.