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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.: 0R1.130893 <br /> Contractor: Enebak Construction Company Agency's Project No.: <br /> Project: The COR Grading Improvements <br /> Contract: <br /> Application No.: 2 Application Date: 11/6/2023 <br /> Application Period: From 10/1/2023 to 10/31/2023 <br /> 1. Original <br /> ig a!Contract Price 4 19 7�4034 <br /> 3 <br /> 2. Net g v g <br /> change b Chan e Orders <br /> �71 s.98 <br /> 3. Current Con <br /> tract Price(Line 1+L� e 2 <br /> 4 236 95 <br /> 4. Total Work completed and materials stored to date <br /> (Sum of Column G Lump Sum Tot <br /> al and Column J Un <br /> it it Price Total) <br /> ) 831 87297 <br /> 5. Retainage <br /> a. 5 o X 2/ 5318797 Work Com <br /> pleted m leted <br /> `1 1593 5` <br /> , � p $ 4 , 6 <br /> b. X Stored Materials <br /> c. Total Ret arna e(Line 5.a+Line <br /> e 5.b) i4i <br /> 032::. <br /> 6. Amoun <br /> t eligible t o date Line 4-Line 5.c <br /> 269�2 <br /> t e <br /> 7. Less previo <br /> us payments <br /> ,59,3.63 <br /> 8 Amount due this application <br /> 181 s$8s <br /> 9. Balance to finish, including retai aeL(Line 3- <br /> Line 4 <br /> :.:............................................... <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 g <br /> 3 All the Work covered b this Application for Payment is in accordance with the Contract Documents and is not defective. <br /> { � Y pp� Y <br /> 3 <br /> Contractor: Enebak Construction Company: 16972 Brandtjen Farm Drive, Lakeville, MN 55044 <br /> Signature: Date: `l 1-1 3-2023 <br /> Name: Title: Project Manager <br /> Recommended by Engineer Approved by owner <br /> By. By. <br /> Name: Itevin Kielb Name: q <br /> Title: Principal Engineer Title. ( ,r"r <br /> Date: 11/3/2023 Date: <br /> r <br /> EJCDC C--620 Contractor's Application for Payment <br /> (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />