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Docusign Envelope ID: 1A3BO5B2-AA99-401B-A2C3-A85C46417A62 <br /> Contractor's Application for Payment <br /> Owner: City of Ramsey Owner's Project No.: 9002899 <br /> Engineer: Bolton&Menk,,Inc. Engineer's Project No.: 24X.135093 <br /> Contractor: Kurilla Contracting Agency's Project No.: <br /> Project: The Waterfront Trail Improvements <br /> Contract: <br /> Application No.: I Application Date: 9/16/2024 <br /> Application Period: From 7/22/2024 to 8/31/2024 <br /> 1. Original Contract Price $ 191?415.00 <br /> 2. Net change by Change Orders $ 11750.00 <br /> 3. Current Contract Price(Line I+Line 2) $ 1930165.00 <br /> 4. Total Work completed and materials stored to date <br /> (Sum of Column G Lump Sum Total and Column J Unit Price Total) $ 1537370.40 <br /> 5. Retainage <br /> a. 5% X 153,370.40 Work Completed $ 71668.52 <br /> b. X - Stored Materials $ - <br /> c. Total Retainage(Line 5.a+Line 5.b) $ 71668.52 <br /> 6. Amount eligible to date(Line 4-Line 5.c) $ 145,701.88 <br /> 7. Less previous payments <br /> 8. Amount due this application $ 145,701.88 <br /> 9. Balance to finish,including retainage(Line 3-Line 4) 39,794.60 <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); <br /> 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: Kurilla contracting Co. <br /> r-- 19ned by; <br /> Signature: 44� Date: 9/16/2024 <br /> '­43C339662_C0_E40D... <br /> Name: Austin Reid lwrilla Title: Owner <br /> Recommended by Engineer Approved by Owner <br /> By: By: <br /> Name: Zach Lingl, P�z Name: 2- <br /> Title: Project Manager Title: <br /> ;D2-r <br /> Date: 9/16/2024 Date: 7 (' SP 0 Cr <br /> EJCDC C-620 Contractor's Application for Payment <br /> (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />