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Contractor's Application for Payment <br /> Owner: City of Ramsey Owner's Project No.: 23--20 <br /> Engineer: Bolton&Menk, Inc. Engineer's Project No.: 0131.130893 <br /> Contractor: Enebak Construction Company Agency's Project No.: <br /> Project: The COR Grading Improvements <br /> Contract: <br /> Application No.: 1 Application Date: 10/5/2023 <br /> Application Period: From 9/1/2023 to 9/30/2023 <br /> 1. Original Co <br /> ntract Price <br /> �97 24 <br /> 0 34 <br /> , <br /> 2 etc - <br /> . N t han e b Chan e Orde s <br /> � v � <br /> r <br /> 3 + �Current Contract Price(Line 1 n Line 2 <br /> 4 7 240.34. <br /> 4. Total Work completed and materials stored to date <br /> 535 3 <br /> Sum of Column G Lu 5 u m Tota I a d Co n lumn J Unit Price To tal ` 17 <br /> m � , <br /> :.:.. .... ....... .... ................ .. <br /> 5. Retainage <br /> 0 <br /> a. 5/ X <br /> 3 3 1 2 ark Completed <br /> d $ �5 7f 80 <br /> p 9 <br /> b. <br /> X .. <br /> ......Stored Materials <br /> c Total <br /> Retarna a{Line 5.a Li <br /> ne 5.b <br /> } <br /> 5. Amount e - <br /> m eligible to date Line 4 Li <br /> ne 5.c <br /> 5�Dg 593 6 <br /> g <br /> { <br /> . 3. <br /> 7. Less previous payments <br /> ; <br /> $ Amount <br /> due this 5 application <br /> 9. Balance to finish including ret aina a Line 3 Line 4 <br /> 3 7$62 : <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 /> I�= <br /> Contractor: Enebak Construction Company: 10972 Brandtjen Farm Drive, Lakeville, MN 5504401 <br /> Signature: Date: 10--10.2023 �= <br /> Name: Title: Project Manager <br /> s; <br /> Recommended by Engineer Approved by Owner <br /> By. By. F,. Ole <br /> Name: Kevin Kielb Name: <br /> Title: Principal Engineer Title: <br /> l�. <br /> x , <br /> Date: 10/5/2023 Date: <br /> EJCDC C-620 Contractor's Application for Payment <br /> (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />