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Contractor's Application for Final Payment Owner: Engineer: Contractor: Project: Contract: Application Application City of Ramsey Bolton & Menk, Inc. Dave Perkins Contracting, Inc. Dickenson's Mississippi Estates Reconstruction No.: Period: Owner's Project No.: C.P. 25-04 Engineer's Project No.: 24X.135503 Agency's Project No.: 5-FINAL Application Date: 7/8/2027 From 5/29/2026 to 6/30/2026 1. Original Contract Price 2. Net change by Change Orders 3. Current Contract Price (Line 1 + Line 2) 4. Total Work completed and materials stored to date (Sum of Column G Lump Sum Total and Column J Unit Price Total) 5. Retainage a. X $ 690,646.49 Work Completed b. X $ - Stored Materials c. Total Retainage (Line 5.a + Line 5.b) 6. Amount eligible to date (Line 4 - Line 5.c) 7. Less previous payments 8. Amount due this application - Final 9. Balance to finish, including retainage (Line 3 - Line 4) 672,350.11 6,844.13 679,194.24 690, 646.49 690, 646.49 663,672.73 26,973.76 na Contractor's Certification for Final Payment 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; and (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 or satisfactorily secured. Contractor: Dave Perkins Contracting, Inc. Signature: Name: DD we g Ic�rK �ws Recommended by Bolton & Menk, Inc. By: �� Name: Zach Linger:E. Title: Project Manager Date: 7/8/2027 Date: Title: Approved by City of Ramsey By: Name: Title: Date: 7 -Id - 2a2 clikx/c/4141' HaFFdh Ie-i G 4-1A- 1 vuO 2P,r —f / >I 1 / 20 2P, EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.