Agenda - Council - 06/25/2024 - Laserfiche WebLink

Home

Application for Payment (continued) Total Contract Amount Contract Change Order No. Contract Change Order No. Contract Change Order No. Less Previous Applications: AFP No. 1: 735,690.78 AFP No. 2: AFP No. 3: AFP No. 4: AFP No. 5: $ 6,671,414.00 AFP No. 6: AFP No, 7: AFP No. 8: AFP No. 9: Total Amount Earned $ 3,023,575.90 Material Suitably Stored on Site, Not Incorporated into Work Percent Complete Percent Complete Percent Complete GROSS AMOUNT DUE LESS 5 % RETAINAGE AMOUNT DUE TO DATE LESS PREVIOUS APPLICATIONS AMOUNT DUE THIS APPLICATION $ 3,023,575.90 $ 151,178.80 $ 2,872,397.11 $ 735,690.78 $ 2,136,706.33 CONTRACTOR'S AFFIDAVIT The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress payments received from the Owner on account of work performed under the Contract referred to above have been applied by the undersigned to discharge in full all obligations of the undersigned incurred in connection with work covered by prior Applications for Payment under said contract, Water Treatment Plant Trunk Water Main Improvements, City of Ramsey, MN and (2) all material and equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment and free and clear of all liens, claims, security interests and encumbrances. Date 6L/ (e/ COUNTY OF (OCiG31t\k., STATE OF NVNINCSOta. Before me on this (.o'*' day of �� hi►t� f� 112,sn* is the ---PrPh i ric.r\L (office) of the Contractor above mentioned that he executed the above Application for Payment and Affidavit on b . . e statements contained therein are true, correct and complete. , 20A/ Northdale Construction Co., Inc. (Contractor) e By ) SS (Name and Title) My Commission expires i I31 12029 o,.... , KRISTINE R CHRISTENSON �� a Notary Public 1 J k, z. Minnesota • w �� My Commission Expires A Jan 31, 2029 , 20 2.'4 , personally appeared known to be, who being duly sworn did depose and say that he (Notary Public) The undersigned has checked a on ac or s .p ca o . • .y ent shown above. A part of this Application is the Contractor's Affidavit stating that all previous payments to him under this contract have been applied by him to discharge in full all of his obligations in connecting with the work by all prior Applications for Payment. In accordance with the Contract, the undersigned recommends approval of payment to the Contractor for the Amount due. City of Ramsey, MN By �, -t-( Date (:› % /2.6 Z 4.- By Short Ilott Hern Inc. � ,�l � Dave Hutton, PE (Lic. MN, ND, WI) Date 6/6/24 Page 4 of 4