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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. Engineer's Project No.: 0R1.131245;0111.129410 <br /> Contractor: Meyer Contracting, Inc, Agency's Project No.: <br /> Project: Lift Station#10 Improvements <br /> Contract: <br /> Application No.: 3 Application Date: 10/6/2023 <br /> Application Period: From 9/2/2023 to 10/5/2023 <br /> 1. Original Con <br /> tract Price l 61`4 93 <br /> l.. <br /> 2. Ne <br /> t change Y g r b Change Orders <br /> 3. Current +rr Contract Price(Line <br /> n 1 Line 2 <br /> 4' <br /> $ 1, . 1,454.�3 <br /> 4. Total Work completed and materials stored to date <br /> Sum of Column G Lump Su <br /> m um Total and Col <br /> umn J Unit Price Tot <br /> al) 1 <br /> � p ) $ ,1.86,756.44 <br /> 5. Retainage <br /> a. 5 <br /> fl <br /> l X 1 18 75 Ullo 44 .Work Completed <br /> ► p � 55 3375 <br /> 3 <br /> I <br /> b. <br /> X ❑ e I St r d Materials <br /> c. Total Ret <br /> g a� +Line e 5 a�na Line 5.a n .b <br /> 3 .7 S2 <br /> 6. mount eligible -- <br /> A � ible to date Line 4 Li <br /> ne 5.c <br /> ;1 sz 1 7 4 s,62 <br /> .................... <br /> g <br /> { <br /> .... .........:.......................... . <br /> ......... ... <br /> 1 0 977. Less previous payments S. Amount due th <br /> is s �application <br /> 2Z <br /> pp <br /> 9. Balance o -- <br /> t finish, including et 'r aina e Line 3 Line 4 <br /> 2 <br /> g g � } $ 74,C98.49 <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 an such liens security interest or encumbrances •and <br /> v � g v � v � �� - <br /> (3)All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. <br /> i. <br /> Contractor: Meyer Contracting, Inc. <br /> - 10/10/23 <br /> Signature: Date. <br /> Name: Scott Pelletier Title: Project Manager <br /> Recommended by Engineer Approved by owner <br /> f <br /> } <br /> By: By <br /> Name: Zach Ling, PE Name: - <br /> Title: Project Manager Ti <br /> g <br /> Date: 10/6/2023 Date: <br /> f <br /> :x <br /> is <br /> EJCDC C-620 Contractor's Application for Payment <br /> (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br /> �x <br />