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Contractor's Application for Payment <br />Owner: City of Ramsey Owner's Project No.: 25-01 <br />Engineer: Bolton & Menk, Inc. Engineer's Project No.: 24X.136138 <br />Contractor: Douglas -Kerr Underground, LLC Agency's Project No.: <br />Project: Rivers Bend Regional Stormwater Improvements <br />Contract: <br />Application No.: 2 Application Date: 12/10/2024 <br />Application Period: From 11/1/2024 to 11/30/2024 <br />1. Original Contract Price 899,653.31 <br />2. Net change by Change Orders <br />3. Current Contract Price (Line 1 + Line 2) 899,653.31 <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) 908,734.95 <br />5. Retainage <br />a. 1% X $ 908,734.95 Work Completed 9,087.35 <br />b. X $ - Stored Materials <br />c. Total Retainage (Line 5.a + Line 5.b) 9,087.35 <br />6. Amount eligible to date (Line 4 - Line 5.c) 899,647.60 <br />7. Less previous payments 229,480.21 <br />8. Amount due this application 670,167.39 <br />9. Balance to finish, including retainage (Line 3 - Line 4) (9,081.64) <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 Hens, 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: Dou9las-Kerr Underground, LLC <br />Signature: <br />Name: L Rvan Kerr <br />Recommended by Engineer <br />By: <br />Name: Zach Ling!, <br />Title: <br />Date: <br />Project ManagV <br />12/10/2024 <br />Date: 12/10/24 <br />Title: Manager <br />Approved by Owner <br />By: <br />Name: t; (,)1342-, 'S`*b <br />Title: C„ ii=i Gvtitsvpsce-dPui.titc,.(Ali-J4,6 <br />Date: -0 A tit 4 t--zr..)-2—s <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />