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- ` <br /> Contractor's Application for Payment <br /> Owner: City of Ramsey Owner's Project No.: 23-11 <br /> Engineer: Bolton&Menk, Inc. Engineer's Project No.: 0R1.131248;0R1.129414 <br /> Contractor: Meyer Contracting, Inc. Agency's Project No.: <br /> Project: Lift Station#10 Improvements <br /> Contract: <br /> r <br /> Application No.: 5 Application Date: 11/30/2023 <br /> Application Period: From 11/1/2023 to 11/30/2023 <br /> 1. Original Contract Price $ 1,46i A4.53 <br /> 2. Net v <br /> change b Change Orders <br /> g 3. Current Contract Price Line 1 L 2 Line <br /> 14 93A <br /> ........................:.... . . <br /> 01 54. <br /> ... ....... ........:............:........ <br /> .... ............ <br /> 4. Total Work completed and materials stared to date <br /> Sum of Column G Lump Su <br /> m um Total and Column J%Unit Price Total) �.395 40.851 <br /> p } <br /> 5. Retainage <br /> 0 <br /> a. 1/ X 1395 Work Completed <br /> $ 1395409 <br /> b. X :Stored Materials t als <br /> .................... <br /> c. Total 4 Retain age(Line one 5.a Line 5.b <br /> g <br /> .:...:....:........:.............:................:...............:.......:......:............... <br /> 6. Amount eligible to date Line 4 Line 5.c <br /> ❑ r 1`38 45.... 4.. <br /> 7. Less previous payments ments <br /> 79. <br /> 44. <br /> 8. this <br /> Amount due <br /> u u t application <br /> 5' S74 14 <br /> ............................... <br /> .i. <br /> 9. Balance to finish, ncludn retaina aLine 3 -Line <br /> in 4 <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 /> s <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 /> 5^ <br /> Contractor: Meyer Contracting, Inc. <br /> . � l <br /> S nature: —�- 11/3g/23 <br /> g ,Date. <br /> Name: Scott Pelletier Title: Project Manager <br /> Recommended by Engineer Approved b Owner <br /> pp Y <br /> By: <br /> , P By: . <br /> Name: Zach Lingi Name: <br /> _J <br /> Title: Project Manager Title: ,R <br /> i� <br /> V717 <br /> ,,7d <br /> �- <br /> Date: 11/30/2023 Date: k <br /> EJCDC C-620 Contractor's Application for Payment <br /> (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br /> 1' <br /> "i <br />