Laserfiche WebLink
Application for Payment(coninued <br /> Total Contract Amount $ n07141400 Total Amount Earned 718063651 <br /> Material Suitably Stored on Site, Not <br /> Contract Change Order No. 1 $130'116'38 Incorporated into Work <br /> Contract Change Order No. 2 $1411608.93 Percent Complete <br /> Contract Change Order No. 3 $1241765.45Percent <br /> Contract Change Order No. 4 $88)998,37Percent Complete Total Contract with ChabOeOrders $7.156.903.13 Percent Complete <br /> Less Previous Applications: GROSS AMOUNT DUE <br /> ---------' $ 718053651 <br /> AFP No. 1: $73e0690.78 �ppNo.a�_ a27�58J5 LESS o 96 RETA|NAGE $ <br /> __ <br /> AFP No.2: AFP No.7: 503,712.89 AMOUNT DUE ToDATE $ 7,180,536.51 <br /> xppwo.3: _ $1�34,000.14 AFP No.o. 286,201.34 LESS PREVIOUS APPLICATIONS $ 711061448.80 <br /> App No.4: $696.347.59 ���wo.e� AMOUNT DUE THIS APPLICATION $ 7408771 <br /> AppNo <br /> .e: �m76,170.98 <br /> CONTRACTOR'S AFFIDAVIT <br /> The undersigned Contractor hereby swears under penalty of perjury that(1)all previous progress payments received from the <br /> Owneronaocounto[wmrkperformedundortheContraotna[erredhoabovohowsbeenappHedbyUhaunderoignadbodiaohangein <br /> full all obligations of the undersigned incurred in connection with work covered by prior Applications for <br /> Payment under said contract,Water Treatment Plant Trunk Water Main |mpnmemanhy.City of Ramsey. MN and (2)all material <br /> and equipment incorporated in said Project or otherwise listed in or covered by this Application for Payment and free and clear of <br /> all liens, claims, security interests and encumbrances. <br /> Dobm 1 .202,5 Northdale Construction Co., Inc. <br /> COUNTY OF By k <br /> STATE OF >88 -- ~ (Name and Title) <br /> Before me on this I day of �)(-L)a rL-� 20 2.S personally appeared <br /> known to be,who being duly sworn did depose and say that <br /> he /uthe (orMoe)oY the Contractor above mentioned that he executed the above AppUcaUon <br /> for Payment and Affidavit on behalf of said Contractor;and that all of the statements contained therein are true, correct and <br /> complete. <br /> k- Notary Public <br /> My Commission expires <br /> JION <br /> Ir <br /> (Notary Public) <br /> MY Commission Expires <br /> Minnesota <br /> The undersigned has cheo�������b ont shown above.A part of this Application|u the Contractor's <br /> Affidavit stating that all previous payments to him under this contract have been applied by him to discharge in full all of his <br /> obligations in connecting with the work by all prior Applications for Payment. <br /> In accordance with the Contract,the undersigned recommends approval of payment to the Contractor for the Amount due, <br /> City nf Ramsey, MN Short Elliott Hendrickson Inc. <br /> By By <br /> Date Date 1/7/2025 <br /> Page 4or4 <br />