Agenda - Council - 10/24/2023 - Laserfiche WebLink

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Contractor's Application for Payment Owner: City of Ramsey owner's Project No.: 23-12 Engineer: Bolton&Menk,Inc. Engineer's Project No.: 0111.126299 Contractor: Douglas-Kerr Underground,LLC Agency's Project No.: Project: HY-10 Ramsey Improvements Contract: r Application No.: 3 Application Date: 10/9/2023 Application Period: From 9/1/2023 to 9/30/2023 .1,398,953.30 1. Original Contract Price $ .M 2. Net change b Change orders $ y 3. Current Contract Price(Line 1+Line 2) $ 1,398,953.30 4. Total Work completed and materials stored to date (Sum of Column G Lump Sum Total and Column J Unit Price Total) $ 11263,442.23 5. Retainage a. 5/ X $ 1,263,442.23 work Completed $ 63,172.11 b. x $ Stored Materials $ .. C. Total Retainage{Line 5.a+Line 5.b} $ 63, .72.11 6. Amount eligible to date(Line 4-Line 5.c) $ 112.001270.12 928,913,30 7. Less previous payments $ 8. Amount due this application $ 271� 56-82 . etaina a Line 3�-Line 4 $ 135 511.07 9. Balance to finish, including r g ( � x 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 liens,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 i the Work covered b Application for Payment is in accordance with the Contract Documents and is not defective. { �Al y this PP . I�. l Contractor:: s �� ,� ��..4 W% 14.104.-x A-4. L L na#ure: Date: Si g .► r Name: Title: �, �• � s Recommended by Engineer Approved by owner By: � $y: } Name: Zach Lin 6 Name: I a i Title: Project Manager Title `` 23 : 3 20 Date Date. 10/1 / i. i'. 1' EJCDC C-620 Contractor's Application for Payment (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved.