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Lontractor's Application for Payment <br />Owner-, City of Ramsey Owner's Project No.: 20-05 <br />Engineer: Bolton & Menk, Inc. Engineer's Project No.: 0R1.125908, 0131.128236 <br />Contractor: Douglas -Kerr Underground, LLC Agency's Project No.: SP 020-121,, SAP 119-115-005 <br />Project: 2022 Riverdale Drive Extension <br />Contracts, <br />Application No.: 5 Application Date: 6/6/2023 <br />Application Period: From 12/1/2022 to 5/31/2023 <br />1. Original Contract Price $ 2,342,102.66 <br />2. Net change by Change Orders $ <br />3. Current Contract Price (Line I + Line 2) $ 2,342,102.66 <br />4. Total Work completed and materials stored to date <br />(Sum of Column H Unit Price Total and Column M Stored Materials) 2,*237,929.09 <br />5. Retainage <br />a. 5% X $ 2..237,929.09 Work Completed $ 111,896-45 <br />b. X $ Stored Materials $ W <br />c. Total Retainage (Line 5.a + Line 5.b) $ 111,896.45 <br />6. Amount eligible to date (Line 4 - Line 5.c) $ 2J261032.64 <br />7. Less previous payments $ 1,900,734.44 <br />8. Amount due this application $ 225,.298.20 <br />9. Balance to finish, including retainage (Line 3 - Line 4) $ 104,173.57 <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 account to <br />discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for 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 are <br />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: ( DI <br />Signature: <br />Date: NJU <br />Name.- Title: <br />Recommended by Engineer Approved by Owner <br />By: <br />By: <br />Name: Kevin P. Kielb Name: <br />J <br />Title: -Project Engineer Title: Q.0 <br />Date: 6/6/2023 Date: Z Z— <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Envineers. for EJCDC. All riphtq rP,;PrvPrI <br />