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Contractor's Application for Payment <br />Owner: City of Ramsey <br />Engineer: Bolton & Menk, Inc. <br />Contractor: Douglas -Kerr Underground <br />Project: The COR Intrastructure Improvements <br />Contract: <br />Owner's Project No.: 23-19 <br />Engineer's Project No.: OR1.130893 & OR1.134180 <br />Agency's Project No.: <br />Application No.: 6 Application Date: 10/16/2024 <br />Application Period: From 9/1/2024 to 9/30/2024 <br />1. Original Contract Price $ 2,973,047.22 <br />2. Net change by Change Orders $ (6,447.46) <br />3. Current Contract Price (Line 1 + Line 2) $ 2,966,599.76 <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column I Unit Price Total) $ 2,896,827.43 <br />5. Retainage <br />a. 5% X $ 2,896,827.43 Work Completed $ 144,841.37 <br />b. X $ - Stored Materials $ <br />c. Total Retainage (Line 5.a + Line 5.b) $ 144,841.37 <br />6. Amount eligible to date (Line 4 -Line 5.c) $ 2,751,986.06 <br />7. Less previous payments $ 2,721,813.82 <br />8. Amount due this application $ 30,172.24 <br />1 9. Balance to finish, including retainage (Line 3 - Line 4) $ 69,772.33 <br />Contractor'5 Certification <br />The undersigned Contractor certifies, to the best of its knowledge, the foliowing: <br />(1) All previous progress payments received from Owner an account of Work done under the Contract have been applied on <br />account to discharge Coritractors 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 Iiens, 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 />Signature: <br />Name: <br />TICC-ani <br />Recommended by Engineer <br />By: <br />Name: <br />Title: <br />Date: <br />Zach Lingl,1'E <br />Project Manager <br />10/16/2024 <br />1.11.11M <br />fi <br />Approved by Owner <br />By: <br />Name: <br />Title: <br />Date: <br />Date: IoJt,1joTitle: Iti)h}yb11e‘ <br />ELE=Lb...C.A. 6, (.4 <br />1, It, <br />kiz)(t‘ <br />(-z4- <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 Nations! Society of Professional Engineers for EJCDC. All rights reserved. <br />1 <br />6 <br />