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Contractor's Application for Payment <br />Owner: <br />Engineer: <br />City of Ramsey <br />Bolton & Menk, Inc. <br />contractor: Reshetar Systems, Inc. <br />Project: The COR Tree Clearing <br />Contract: <br />4plication No.: 1 <br />Application Period: From <br />Owner's Project No.: 23-17 <br />Engineer's Project No.: OR1.130893; OR1.131247 <br />Agency's Project No.: <br />Application Date: 7/14/2023 <br />6/14/2023 to 7/13/2023 <br />1. Original Contract Price <br />2. Net change by Change Orders <br />3. Current Contract Price (Line 1 + Line 2) <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 />5. Retainage <br />a. 5% X $ 57,841.50 Work Completed <br />b. X $ - Stored Materials <br />c. Total Retainage (Line 5.a + Line 5.b) <br />6. Amount eligible to date (Line 4 Line 5.c) <br />7. Less previous payments <br />8. Amount due this application <br />9. Balance to finish, including retainage (Line 3 - Line 4) <br />287,000.00 <br />287,000.00 <br />57,841.50 <br />2,892.08 <br />2,892.08 <br />54,949.42 <br />54,949.42 <br />229,158.50 <br />OntracLors Certification <br />Th'e 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 />PaVment; <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: <br />Signature: <br />Name: <br />1-) <br />(7) es #017 ebt.7 /IF/7Qs I 1.7 <br />IWO/ /t? 4f e,,z40-- <br />Date: <br />Title: <br />I/0743 <br />vp, <br />Recommended by Engineer <br />By <br />Name: Kevin Kielb <br />Title: Principal Engineer <br />Date: 7/14/2023 <br />Approved by Owner <br />By: <br />Name: <br />Title: <br />Date: <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />