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Application for Payment(conUnue0 <br /> Total Contract Amount $ 66711414.00 Total Amount Earned 4322,523.42 <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: GROSS AMOUNT DUE $ 432252342 <br /> xpp No. 1, 735169078 AFP No.e, LESS 5 96RETA|NAQE $ 218126.17 <br /> ApPNo o: 21138708.33 AFp No.7: AMOUNT DUE TODATE $ 410689725 <br /> AFP No.o: AFP No. e: LESS PREVIOUS APPLICATIONS $ 287239711 <br /> App No.4: xFPwu.e� AMOUNT DUE THIS APPLICATION $ 123400014 <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 <br /> in 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 VVabsr Mein Improvements, O\Ly of Ramoey. MN and (2)all <br /> material and equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment and free <br /> and clear of all liens, claims, security interests and encumbrances. <br /> �J <br /> Date - . 20 Northde|e Construction Co. Inc. <br /> (Contractor) <br /> COUNTY OF By <br /> LJ <br /> STATE OF )SG ~ (Name ATitle) ' <br /> Before this_ (51�N day of personally appeared <br /> known tobe. who being duly sworn did depose and say <br /> that ho |ethe (omoo) of the Contractor above mentioned that ha executed the above <br /> Application for Payment and Affidavit on behalf of said Contractor; and that all of the statements contained therein are tme, <br /> correct and complete. <br /> Till <br /> My Commission <br /> F " <br /> Minnesota <br /> MY Commission Expires (Notary Public) <br /> Jan <br /> 2029 <br /> The undersigned has cheo��8l e' Rp <br /> Payment shown above. A part of this Application |othe <br /> Contractor's Affidavit stating that all previous payments to him under this contract have been applied by him to discharge in full <br /> all of his obligations in connecting with the work by all prior Applications for Payment, <br /> In accordance with the Contract, the undersigned re commends approval of payment to the Contractor for the Amount due. <br /> City of Ramsey, KUN Short Elliott Hendrickson <br /> /I <br /> By By S i 1//4 — <br /> Oaio Date 7/15/24 <br /> Page 4o/4 <br />