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Contractor's Application for Payment <br /> Owner: City of Ramsey owner's Project No.: 23--20 <br /> Engineer: Bolton&Menlo Inc. Engineer's Project No.: 0111,130893 <br /> Contractor; Enebak Construction Company Agency's Project No.: <br /> Project: The COR Grading Improvements <br /> Contract: <br /> Application No.. 4 Application Date: 1 g 2024 <br /> Application Period: From 12/1/2023 to 12/31/2023 <br /> 1. Original Contract Price 3 <br /> � $ 4,�.97,2�0.34 <br /> 2. Net change by Change orders $ 61055.69 <br /> 3. Current Contract Price Line 1+Line 2 <br /> � ) $ 4,254,196.D3 <br /> 4. Total Work completed and materials stored to date <br /> {Sum of Column o Lump Sum Total and Column J Unit Price Total} $ 4,168,665.03 <br /> 5. Reta i nage <br /> a. 5% X $ 4,168,665.03...Work Completed $ 2Q8143.3.25. <br /> b. X Stored Materials <br /> c, Total Retainage(Line S.a+Line 5.b) $ q8 433:25 <br /> 6. Amount eligible to date Line 4-Line 5.c <br /> 3 $ 3,0,231.78 <br /> 7. Less previous payments $ 316861673 44 <br /> ,,� <br /> 8, Amount due this application $ 73554 <br /> 9, Balance to finish,including retainage(Line 3 Line 4) $ 85, 37., 0 <br /> Contractors Certification <br /> r <br /> The undersigned Contractor certifies,to the best of Its knowledge,the following: 5. <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 /> f <br /> V <br /> Contractor: Enebak Construction Company:16972 Brandtjen Farm Drive,Lakeville,MN 55044 <br /> 1 <br /> Signature; . Date: ✓ <br /> tl (:3z <br /> Name: <br /> j Title; • d .. <br /> gl <br /> F <br /> Recommended by Engineer Approved by Owner <br /> By. By: <br /> Name. Kevin Kielb Name: 1:5 LAAL4��(z trn,�� <br /> Title: Principal Engineer Title w <br /> Date: 1/8/2024 Date: <br /> gd <br /> EJCDC C-620 Contractor's Application for Payment <br /> (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />