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Z1-t- ((c, <br />Contractor's Application for Payment <br />Owner: City of Ramsey Owner's Project No.: 23-19 <br />Engineer: Bolton & Menk, Inc. Engineer's Project No.: 0R1.130893 & OR1.134180 <br />Contractor: Douglas -Kerr Underground Agency's Project No.: <br />Project: The COR Intrastructure Improvements <br />Contract: <br />Application No.: 2 Application Date: 6/7/2024 <br />Application Period: From 5/1/2024 to 5/31/2024 <br />1. Original Contract Price $ 2,973,047.22 <br />2. Net change by Change Orders $ 31,052.54 <br />3. Current Contract Price (Line 1 + Line 2) $ 3,004,099.76 <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column 1 Unit Price Total) $ 1,318,668.14 <br />5. Retalnage <br />a. 5% X $ 1,318,668.14 Work Completed $ 65,933.41 <br />b. X $ - Stored Materials $ - <br />c. Total Retalnage (Line 5.a + Line 5.b) $ 65,933.41 <br />6. Amount eligible to date (Line 4 - Line 5.c) $ 1,252,734.73 <br />7. Less previous payments $ 579,085.11 <br />8. Amount due this application $ 673,649.62 <br />9. Balance to finish, including retainage (Line 3 - Line 4) $ 1,685,431.62 <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 <br />(3) All the Work covered by this Application for Payment Is in accordance with the Contract Documents and is not defective. <br />Contractor: Douglas -Kerr Underground, LLC <br />C� 6/7/Z <br />Signature: Date: y <br />Name: iQy„a,..._ 1E- {err- Title: 2/ �i yip. <br />'�i✓( <br />Recommended by Engineer Approved by Owner <br />By: /,706 By: <br />Name: Zach Ling!, PE Name: Sr—C�u¢_ <br />Title: Project Manager Title: (v�etsll�u il11e(J�o�c4 ,��r, <br />Date: 6/7/2024 Date: C ( '2� F <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />