Agenda - Council - 09/26/2023 - Laserfiche WebLink

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Contractor's Application for Payment Owner: City of Ramsey Owner's Project No.: 23--11 Engineer: Bolton & Menk, Inc. Engineer's Project No.: OR1.131248, OR1,129410 Contractor: Meyer Contracting, Inc. Agency's Project No.: Project: Lift Station #10 Improvements Contract: Application No.: 2 Application Date: 9/11/2023 Application Period: From 8/1/2023 to 9/1/2023 1. Original Contract Price 146�.'45493 2. Net change by Change Orders 3. Current Contract +i Price Line 1 Line 2 4. Total Work completed and materials stored to date ........... .. . . Su o m f Column G Lump Sum Total and Column J Unit nit Price Total 5. Retainage a a 5Q X 5 . . 14 4 944,82 . Work Com pleted leted 5 2 747.24 . p ........... .....:....... b. X Store d Materials c. Total Retsina e L + one 5.a Line 5.b 52'7 g �7 24 6. Amount eligible to date Line 4 Line 5.c 1002. 7. Less previous payments 5 089 7 7. 8. Amount due this application ......:93-7 10 . �. .................. . ............ .......... ... ............... 9. Balance to f - n�sh including retai a e (L ine ine 3 Line 4 g g { ) 11 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 obligations 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 Iiens, 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: Meyer Contracting Signature: Date• 91121Z3 Name: Scott Pelletier Title: Project Manager Recommended by Engineer Approved by Owner By: V //By • - O�_Ik Name: Zach Lingl, Name: L Title: Project Manager Title: 64. Date: 9/11/2023 Date: EJCDC C-620 Contractor's Application for Payment {c} 2018 National Society of Professional Engineers for EJCDC. All rights reserved.