Agenda - Council - 11/26/2024 - Laserfiche WebLink

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Application for Payment(continued) Total Contract Amount Total AnouniEarned 7,168,618.37 Material Suitably Stored on Site, Not Contract Change Order No. 1 $130,118.38 Incorporated Into Work _________ Contract Change Order No. 2 $141.608.83 Percent Complete _ Contract Change Order No. 3 $124.785'45 Percent Contract ohange Order No, 4 $88'898'37 Percent _ - Tn1m|Con(rac\w|th Chabge Orders $7.156.003'13 Percent Complete Less Previous App||omUonm� GROSSAMOUNTDIJE -------- $ 718861037 AFPNo. 1: $7351880.78 AFP No.e� 627.558-75 LESS 5 q6 RETAINAGE $ 358 43O.S2 ApP No.2/ $31136.706.33 AFPNo.r, AMOUNT DUE TO DATE $ 8810187'45 ---------- ---------- AFP No, o/ $1.234.000.14 AFP No.8/ LESS PREVIOUS APPLICATIONS $ 8 306474 56 App No,4/ $8981347.59 AFP No.9: AMOUNT DUE THIS APPLICATION $ 50371288 ..FP AFP No. . _.-'..-98 CONTRACTOR'S AFFIDAVIT The undersigned Contractor hereby swears under penalty o/perjury that(1)all previous progress payments received from the Owner on account of work performed under the Contract referred to above have been applied by the undersigned to discharge in full all obligations of the undersigned incurred in connection with work covered by prior Applications for Payment under said contract,Water Treatment Plant Trunk Water Main Improvements, City of Ramsey, MN and(2)all material and equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment and free and clear of all liens, claims, security interests and encumbrances, Date \) 2«�4 No�hdo|mCon�m�<nnOn. Inc, ' -~_-� COUNTY ) By STATE OF >a� ' 04dm LLmoo-, (Nom�mn�lme) ' ~ Before meonthis day of . 20 personally appeared --1�i co k, Qb C) known to be,who being duly sworn did depose and say that he Is the a6r-) (office)of the Contractor above mentioned that he executed the above Application for Payment aad Affidavit on behalf of said Contractor; and that all of the statements contained therein are true,correct and ?-'- KRISTINE R CHRI 7TE'NSON Pic Notary Public Minnesota My Commission expires �a -e 12--dUt/�-)to-n Lor� My Commission Expires (Notary Public) The undersigned has checked the Contractor's Application for Payment shown above,A part of this Application is the Contractor's Affidavit stating that all previous payments to him under this contract have been applied by him to discharge in full all of his obligations)n connecting with the work by all prior Applications for Payment. In accordance with the Contract,the Undersigned recommends approval of payment to the Contractor for the Amount due. CltyoY Ramsey, K8N Short Elliott Hendrickson Inc. By By ~ � Dave Hutton, - .._, . - `_ - . ._. ...' Det e \ � Oeby 11 2024 pmuo4my4 'aoe�o/^