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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.: OR1.127005
<br />Contractor: Douglas -Kerr Underground, L.L.0 Agency's Project No.: SAP. 199-115-004
<br />Project: 2022 Riverdale Drive Trunk Utility Improvements
<br />Contract:
<br />Application No.: 6 Application Date: 11/9/2022
<br />Application Period: From 10/1/2022 to 10/31/2022
<br />1. Original Contract Price
<br />$ 2,163,890.22
<br />2. Net change by Change Orders
<br />$ (29,352.50)
<br />3. Current Contract Price (Line 1 + Line 2)
<br />$ 2,134,537.72
<br />4. Total Work completed and materials stored to date
<br />(Sum of Column G Lump Sum Total and Column .1 Unit Price Total)
<br />$ 2,085,866.54
<br />5. Retainage
<br />a. 5% X $ 2,085,866.54 Work Completed
<br />$ 104,293.33
<br />b. X $ - Stored Materials
<br />$
<br />c. Total Retainage (Line 5.a + Line 5.b)
<br />$ 104,293.33
<br />6. Amount eligible to date (Line 4- Line 5.c)
<br />$ 1,981,573.21
<br />7. Less previous payments
<br />$ 1,941,949.57
<br />8. Amount due this application
<br />$ 39,623.64
<br />9. Balance to finish, including retainage (Line 3 - Line 4)
<br />$ 48,671.18
<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 Iiens, security interests, and encumbrances (except such as
<br />are covered by a bond acceptable to Owner indemnifying Owner against any such Iiens, 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: 1)4,i,„ /,‘ . k,.....,... Li,,,j,„/,/,,,,,„,„i. Liic
<br />Signature: 1—Date: iii — / Le--1-
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<br />Name: bf fi ...I , S. A ife. iq Title: Al iti ••-,i er t., e,_,
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<br />Recommended by Engineer Approved by Owner
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<br />By: By: L•c----)
<br />Name: Kevin P. Kielb Name: c---cQ. LA--.)‘ tLj
<br />Title: Project Engineer Title: C..., i tj ep,ie,,
<br />Date: 11/9/2022 Date: 1 k tit 4-120 2.. 7—
<br />EICDC C-620 Contractor's Application far Payment
<br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.
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