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Contractor's Application for Payment Owner-, City of Ramsey Owner's Project No.: 23-20 Engineer: Bolton & Menk, Inc. Engineer's Project No.: 0111.130893 Contractor: Enebak Construction Company Agency's Project No.: Project: The,COR Grading Improvements Contract: Application No.: 3 Application Date: 12/8/2023 Application Period: From 11/1/2023 to 11/30/2023 1. on inal Contract Price 4 4 4 ...................... .................... g 2. Net chap e b Chan e orders g y g 56 95569 3. Current Contract Price Line 1 Line 2 ` 4 25�'196 63 -.. ... ....... . 4. Total Work completed and materials stored to date Sum of Column G Lump Sum Total and Column J Unit Price Total .3880.708 88 � p } $ ` 5. Retainage 0 5 Work C a. / X 3 884 70888 rk Completed 19 03 $ � p , - ``` S b. X tared Materials c. Total Retsina a Line 5.a Line 5.b 194 0 5.44 ` 3 `'' 6. Amount eligible to date Line 4- Line 5.c 3 686` 67344 7. Less previous payments `690 27903.2 996394 128■Amo Amount due this application 9. Balance to finish including retains e Line 3 - Line 4 373 487 15 Contractor's Certification The undersigned Contractor certifies, to the best of its knowledge, the following: (1) All previous progress payments received from owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for Payment; (2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by this Application for Payment, will pass to owner at time of payment free and clear of all liens, security interests, and encumbrances (except such as are covered by a bond acceptable to owner indemnifying owner against any such liens, security interest, or encumbrances); and (3) All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Contractor: Enebak Construction Company: 16972 Brandtjen Farm Drive, Lakeville, MN 55044 Signature: Date. 12--1 1-2023 Name: Thomas Hanson Title: Project Manager Recommended by Engineer Approved by owner _per Name: Itevi n Kiel b Name: xk A Title: Principal Engineer Title:NA «� ,.>� r• '. /2 1J. w Date: 12/8/2023 Date: 1 EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.