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Contractor's Application for Payment <br />Owner: City of Ramsey Owner's Project No.: 23-11 <br />Engineer: Bolton & Menk, Inc. <br />Contractor: Meyer Contracting, Inc. <br />Engineer's Project No.: OR1.131248; OR1.129410 <br />Agency's Project No.: <br />Project: Lift Station #10 Improvements <br />Contract: <br />Application No.: 1 Application Date: 8/2/2023 <br />Application Period: From 7/24/2023 to 8/1/2023 <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 J Unit Price Total) <br />5. Retainage <br />a. 5% X 68,51.5.55`` 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 />1,46 11454.93 <br />68,515.55 <br />3,425 78 <br />65,089.77 <br />65,089.77 <br />,392,939.38 <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: Meyer Contracting, Inc. <br />Signature: <br />Name: Scott Pelletier <br />Date: 81n/23 <br />Title: <br />Project Manager <br />Recommended by Engineer Approved by Owner <br />By: r"f By: <br />Name: Zach Lingl, PE Name: <br />Title: Project Manager Title: <br />Date: 8/2/2023 Date: <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved, <br />