Laserfiche WebLink
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.: 3 Application Date: 8/11/2026 <br />Application Period: From 7/1/2026 to 7/31/2026 <br />1. Original Contract Price $ 1,066,382.87 <br />2. Net change by Change Orders $ - <br />3. Current Contract Price (Line 1 + Line 2) $ 1,066,382.87 <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) $ 1,051,213.22 <br />5. Retainage <br />a. 1% X $ 1,051,213.22 Work Completed $ 10,512.13 <br />b. X $ - Stored Materials $ - <br />c. Total Retainage (Line 5.a + Line 5.b) $ 10,512.13 <br />6. Amount eligible to date (Line 4 - Line 5.c) $ 1,040,701.09 <br />7. Less previous payments $ 1,003,554.92 <br />8. Amount due this application $ 37,146.17 <br />9. Balance to finish, including retainage (Line 3 - Line 4) $ 15,169.65 <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, In . <br />Signature: Date: IV / -4/ 6 <br />t <br />Name: j °Al 1 /tA, (, 5V if Title: loofflum , - A$V <br />f j 1 • <br />Recommended by Engineer Approved by/Owner <br />� �/ <br />By: ��� By: 41tzf "`^ <br />/6 <br />Name: Zach Lin I G' Name: ��L <br />g +I-��dh <br />Title: Principal Title: e,4-y Ef7 ?€2r <br />Date: 8/11/2026 Date: CV (14 /292 j <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />