Agenda - Council - 11/28/2023 - 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.: 0R1.131248;0R1.129410 Contractor: Meyer Contracting, Inc. Agency's Project No.: Project: Lift Station#10 Improvements Contract: Application No.: 4 Application Date: 10/31/2023 Application Period: From 10/1/2023 to 10/31/2023 1. Original al Contract Price ............................. 4 454.93 ............... 2. Net change han e b Change Orders v g 3. Current Contract Price Line 1+ Line 2 146.14, , 54.�3 4. Total Work completed and materials stored to date Sum of Column G Lump Su m um Total and Colum n J Unit Price Tot al) 1,391,136.51 p ) 5. Retainage a. 5 a X 1 391 13 51 'W ork vrk Completed $ 69 55653 p .................... b. X :. ,-.......:.:.'Stored Materials c. R Total e g a{ + ' e 5 ta�na Line 5.a Li ne .b .83 6. Amount -- eligible to date Line Li ne one 5.c 13215. _. ,47. Lessprevious payments 1 271 8.6 8. Amou nt due this application 415 oG 9. Balance -- t❑fnsh including ret atna a Line 3 Line 4 031 7 8.42 g g { � $ , j 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 s . i (3)All the Work covered by this Application for Payment is in accordance with the Contract Documents and s not defective. Y is i s.' f s' is Contractor: Meyer Contracting, Inc. in 1 1/2/23 Signature: Date: r Name: Scott Pelletier Title: Project Manager I Recommended by Engineer Approved by Owner By: By. Name: Zach Ling 1, Name: Title: Project Manager Title: L�Put LL k lc� uk'Ir-LC h il r, Date: 10/31/2023 Date: y 1 I EJCDC C--620 Contractor's Application for Payment (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved.