Laserfiche WebLink
Contractor's Application for Payment <br />Owner: <br />Engineer: <br />Contractor: <br />Project: <br />City ofRamsey <br />Bolton & Menl<,|nc. <br />EnebokConstruction Company <br />The coRGrading Improvements <br />Application No.,: Application Period: <br />From <br />Owner's Project No-, 23-20 <br />Engineer's Project No.:oR1.13Ooys <br />Agency's Pro'ect No.: <br />Application Date-, 9/9/2024 <br />8/1/2024 to 8/31/2024 <br />1. Original Contract Price <br />Z. Net change byChange Orders <br />S. Current Contract Price (Line 1+Line 2) <br />4. Total Work completed and materials stored to date <br />(Sum Of Column G Lump Sum Total and Column ] Unit Price Total) <br />l Keta(nage <br />a. l% X $ 4,255,236.16 Work Completed <br />b. X $ Stoned Materials <br />c.Total Reta(nage(Une5.a+UneS.b) <br />6.Amount eligible uzdate (Line 4'Line 5.d <br />7. Less previous payments <br />8.Amount due this application <br />g. Balance u,finish, including reta/nage (Line 3 Line 4) <br />� <br />� <br />411971240.34 <br />56,955.69 <br />- <br />� 4125523616 <br />42,552.36 <br />42,552.36 <br />41212)683.80 <br />4,Z0965l47 <br />3,031.33 <br />Contractor's Certification <br />The undersigned Contractor certifies, tothe best o[its knowledge, the following: <br />(z)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 />(z)Title toall Work, materials and equipment incorporated in said Work, or otherwise listed in or covered bvthis 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: EnebakConstruction Company: 1,16972Brandtjen Farm Drive, Lakeville, IVIN55044 <br />Signature: <br />Name: <br />_1 /% 1 e e, k7 C4 <br />Recommended by Engineer <br />KevnNdb <br />Principal Engineer <br />9/9/2024 <br />Approved by Owner <br />By: <br />Name: <br />Title: <br />241 <br />L�k*iq- -Nit <br />It 2.1--za. 2 <br />EJcocC-azoContractor's Application for Payment <br />WzozuNational Society mProfessional Engineers for EJcoc All rights reserved. <br />