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Application for Payment(continued) <br /> Total Contract Amount $ ea71 s414.00 Total AmouotEarned 774 <br /> ,411.35 <br /> Material Suitably Stored on Site, Not <br /> Incorporated into Work <br /> Contract Change Order No. Percent Complete <br /> Contract Change order No. Percent Complete <br /> Contract Change Order No. percent Complete <br /> Less Previous Applications: GRDG8AMDUNToUE $ 774,411.35 <br /> AFp No. 1: ��P No.m� LESS a 96 RETA|NAGE $ 38,720.57 <br /> ----------- -------- --------- <br /> ApP wo.o: ��pwo.7� AMOUNT DUE To DATE $ 735680 7a <br /> xFP No.o: x�p No.a� LESS PREVIOUS APPLICATIONS $xFP No.4: xF�No.a� AMOUNT DUE THIS APPLICATION $ 7351690.78 <br /> AFP No.s: <br /> CONTRACTOR'S AFFIDAVIT <br /> The undersigned Contractor hereby swears under penalty of perjury that(1)all previous progress payments received from the <br /> Owner on account of work performed under the Contract referred to above have been applied by the undersigned to discharge in <br /> full all obligations of the undersigned incurred in connection with work covered by prior Applications for <br /> Payment under said contract,Water Treatment Plant Trunk Water Main Improvements, City of Ramsey, MN and (2)all material and <br /> equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment and hao and clear of all <br /> liens, claims, security interests and encumbrances. <br /> Ooto 12024 Nodhdo|a Construction Co., Inc. <br /> COUNTY ) By T—re, AUJ& <br /> STATE OF )SS ' (Name and 111e) <br /> Before this personally appeared <br /> known to be,who being duly sworn did depose and say that <br /> xe|mthe C111f mii (office)of the Contractor above mentioned that he executed the above Application <br /> for Payment and Affidavit on behalf of said Contractor;and that all of the statements contained therein are true, correct and <br /> complete. <br /> Notary Public <br /> My Commission axp|nsoMinnesota <br /> My Commission Expires (Notary Public) <br /> The undersigned has checked the ContracWs Apj51ic7ti6`n rrayl ment shown above.A part of this Application is the Contractor's <br /> Affidavit stating that all previous payments to him under this contract have been applied by him to discharge in full all of his <br /> obligations in connecting with the work by all prior Applications for Payment. <br /> In accordance with the Con(nact, the undersigned recommends approval of payment to the Contractor for the Amount due. <br /> City of Ramsey, MN Short Elli <br /> By ~ By <br /> - Dave Hutton, PE —.~ .'_. '-.' <br /> Data Date May 20 2024 <br /> Page of <br />