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Signature: <br />Name: <br />Contractor's Application for Payment <br />Owner: City of Ramsey Owner's Project No.: 26-01 <br />Engineer: Bolton & Menk, Inc. Engineer's Project No.: 25X.138779,26X.142868 <br />Contractor: North Valley, Inc. Agency's Project No.: SAP 199-121-003 <br />Project: 2026 Bunker Lake Boulevard Reconstruction <br />Contract: <br />Application No.: 2 Application Date: 7/10/2026 <br />Application Period: From 6/1/2026 to 6/30/2026 <br />1. Original Contract Price <br />2. Net change by Change Orders <br />3. Current Contract Price (Line 1 + Line 2) <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) <br />5. Retainage <br />a. 1% X $ 1,013,691.84 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) <br />7. Less previous payments <br />8. Amount due this application <br />9. Balance to finish, including retainage (Line 3 - Line 4) <br />1,066,382.87 <br />1,066,382.87 <br />$ 1,013,691.84 <br />10,136.92 <br />10,136.92 <br />1,003,554.92 <br />704,515.53 <br />299,039.39 <br />52,691.03 <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: North Valley, I <br />/y%i9Tr �cEfvGS <br />Recommended by Engineer <br />By: <br />Name: Zach Lin <br />Title: Principal <br />Date: 7/10/2026 <br />Approved by Owner <br />By: <br />Name: <br />Title: <br />Date: <br />Date: <br />p7/i9/ <br />Title: if2/ . <br />card #6,e, <br />f faFe,d h PUJ( <br />Cc/j FAic; h e,P. r <br />1/ 12) /2/02 6, <br />t <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />