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By: �7� 7- By: <br />Name: Zach Lingl P. Name: <br />Title: Project Manager Title: <br />Date: 8/6/2025 Date: <br />Contractor's Application for Payment <br />Owner: City of Ramsey Owner's Project No.: C.P. 25-04 <br />Engineer: Bolton & Menk, Inc. Engineer's Project No.: 24X.135503 <br />Contractor: Dave Perkins Contracting, Inc. Agency's Project No.: <br />Project: Dickenson's Mississippi Estates Reconstruction <br />Contract: <br />Application No.: 1 Application Date: 8/6/2025 <br />Application Period: From 7/14/2025 to 7/31/2025 <br />1. Original Contract Price $ 672,350.11 <br />2. Net change by Change Orders $ 6,844.13 <br />3. Current Contract Price (Line 1 + Line 2) $ 679,194.24 <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) $ 66,486.07 <br />5. Retainage <br />a. 5% X $ 66,486.07 Work Completed $ 3,324.30 <br />b. X $ - Stored Materials $ <br />c. Total Retainage (Line 5.a + Line 5.b) $ 3,324.30 <br />6. Amount eligible to date (Line 4 - Line 5.c) $ 63,161.77 <br />7. Less previous payments <br />8. Amount due this application $ 63,161.77 <br />9. Balance to finish, including retainage (Line 3 - Line 4) $ 612,708.17 <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 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: Dave 133,erkinssontracting, Inc. <br />Signature: <br />Name: <br />Rene Perkins <br />President <br />Date: <br />Title: <br />Recommended by Bolton & Menk, Inc. Approved by City of Ramsey <br />7 (3Yz0Zr <br />g_G-2r,Z< <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />