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Contractor's Application for Final 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.: 3 - Final Application Date: 8/6/2025 <br />Application Period: From 12/1/2024 to 7/31/2025 <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) $ 928,253.30 <br />5. Retainage <br />a. X $ 928,253.30 Work Completed $ <br />b. X $ - Stored Materials $ <br />c. Total Retainage (Line 5.a + Line 5.b) $ <br />6. Amount eligible to date (Line 4 - Line 5.c) $ 928,253.30 <br />7. Less previous payments $ 899,647.60 <br />8. Amount due this application 5 28,605.70 <br />9. Balance to finish, including retainage (Line 3 - Line 4) NA <br />Contractor's Certification for Final Payment <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 account <br />to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for 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 are <br />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; and <br />(4) The provisions of M. S. 290.92 have been complied with and that all claims against me by reason of the Contract have been paid <br />or satisfactorily secured. <br />Contractor: <br />Signature: <br />Name: <br />Douglas -Kerr Underground, LLC <br />Recommended by Engineer Approved by Owner <br />By: <br />Name: Zach Lingl, P <br />Title: Project Manager <br />Date: 8/6/2025 <br />By: <br />Name: <br />Title: <br />Date: <br />Date: 8/802025 <br />Title: <br />Manager <br />13.6.4 <br />�s-Ltc� iJJ ,stb j <br />uJor i4s di'rc-c er- <br />WI4` 261..4' <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />