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c <br />E <br />La <br />0 <br />w <br />a <br />FT <br />0 <br />ca <br />12 <br />Application and Certification for Payment <br />APPLICATION NO: 5 <br />PROJECT: <br />PERIOD TO:7/3112026 <br />VIA CONSTRUCTION MANAGER: H+U CONSTRUCTION <br />CONTRACT DATE: 2/11/2026 <br />CONTRACT FOR: Ramsey Waterfront Waterplay Park Impr <br />•❑ L y <br />C — 3 <br />fO Y .2 <br />0 3 v <br />a <br />c <br />C ❑ <br />.8 o f. <br />aCO <br />�-a <br />... a"3 . <br />ti o <br />u <br />`° ❑ C E La <br />m <br />❑ o <br />❑ as U w 6 <br />y v+s N (0 C3 <br />1n �, a Li-)tc s. <br />Z <br />D Q. 'ES a`7 2 <br />v1 E lfl tog 7. 4.2. 7 <br />y t io E 0 U <br />oa1ac <br />°.- <br />(0 <br />in u -- -0 <br />N a. n a7 G <br />.. . ❑ 0 v_i <br />in co w e <br />8 L ea e <br />T — 3 a1 <br />_ L <br />C w ... C <br />C <br />o to E L <br />U } C A it <br />41 U E D <br />°�i ov-E <br />y Oaya� <br />C L [] V • <br />a <br />C <br />. - 0 W <br />rri0U Li <br />Z <br />LU <br />U <br />a_ t <br />§ <br />Oc <br />o <br />LL <br />q1 <br />Zc <br />c <br />aD <br />U <br />C7 <br />Ir- <br />3 -5 <br />9 U <br />Jo 76 <br />J3 <br />t <br />q ilQ <br />Em <br />©Q <br />d <br />va <br />N C <br />o <br />Z <br />".1 c <br />f 0.0 <br />Q <br />0 <br />0 <br />O <br />as <br />u'7 <br />2 <br />Q <br />U <br />Lel <br />v <br />co <br />ep <br />(NI <br />6,9 a9 ill .0 <br />1. ORIGINAL CONTRACT SUM <br />2. Net Change by Change Orders <br />3. CONTRACT SUM TO DATE (Line 1 + 2) <br />4. TOTAL COMPLETED AND STORED TO DATE <br />a. <br />L.) <br />5. RETAINAGE: <br />State of: MN <br />D7 <br />CO- <br />5.00 % of Completed Work <br />la <br />County of Steams <br />0 <br />Q <br />0.00 % of Stored Material <br />co <br />co <br />tal retainage (Line 5a + 5 <br />6. TOTAL EARNED LESS RETAINAGE <br />(Line 4 less Line 5 Total) <br />-6 <br />V! ❑ go <br />y <br />Ea{-.G. <br />0 <br />(a 0 - .Gr <br />0 E <br />C (6 T <br />- a <br />B <br />o d c <br />0 © t <br />r6 vi - a: <br />zw.�_ <br />_o ° <br />❑U-dt <br />wiy °� m <br />Cr V7 C <br />D <br />n 2 F, <br />0 <br />iC L72 <br />ro <br />1) rn 4 <br />rtS <br />n=i t E <br />r C •_ 7 <br />7 - d O <br />p 97 <br />0 2 <br />i] <br />c0 `q <br />n ❑ m c <br />U C <br />o d7.(?0 <br />Y w 61 <br />a � w <br />U C a F <br />ccu q; m W <br />Cma:DO <br />a ❑ vz <br />PoxmM. <br />u = <br />C r E.. N Q <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br />Q <br />0 <br />N <br />19 <br />Ln <br />Op <br />ti <br />co <br />- <br />co <br />in eft <br />(Line 6 from prior Certificate) <br />8, CURRENT PAYMENT DUE <br />w <br />0 <br />w <br />U <br />z <br />J <br />0 <br />z <br />2 <br />1% <br />FQ <br />0 <br />2 <br />a <br />d <br />a <br />(fl <br />I <br />CO <br />ti <br />Cr) <br />Cr) <br />a9 <br />AMOUNT CERTIFIED <br />ell <br />(Line 3 less Line 6) <br />ARCHITECT <br />1 <br />CO <br />DEDUCTIONS 1 <br />0 <br />0 <br />d <br />0 <br />27 <br />O <br />0 <br />6 <br />C? <br />(1) <br />2 <br />0 <br />h <br />0 <br />Q <br />9,352.00 <br />cri <br />L <br />cc- <br />N <br />n <br />m <br />CHANGE ORDER SUMMARY <br />Total changes approved in <br />previous months by Owner <br />Total approved this Month <br />TOTALS <br />NET CHANGES by Change Order <br />