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Contractor's Application For Payment No, 4 <br />Application Pedod To: 2127/2015 Appllcat3on Date: 31212015 <br />To (Owner): City of Elk River I From (Contractor): Rice Lake Construction Group Via (Engineer): Balton & Menk, Inc. <br />aciilty Improvements 2014 <br />Appllcatlon for Payment <br />Change Order Sum <br />Approved Change <br />Number <br />1. ORIGINAL CONTRACT PRICE <br />2. Not change by Change Orders <br />3. CURRENT CONTRACT PRICE (Line t t 2) <br />4. TOTAL COMPLETED AND STORED TO DATE <br />(Column F on Progress Estimate) <br />S. RETAINAGE: <br />a. 8% X $2,878,601.87 Work Completed <br />b. 8% X $0100 Stored Materials <br />c. Total Retalnaga (Line 6a + Line Sb) <br />8. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 6c) <br />7. LESS PREVIOUS PAYMENTS (Line 9 tom prior Application) <br />$16,525,200.00 <br />$0.00 <br />$16,525,200.010 <br />$2,878,601.87 <br />$143,930.09 <br />$0.00 <br />$143,930.09 <br />$2,734,671.78 <br />$2,429,186.00 <br />TOTALS <br />$0.00 <br />$0.00 8. AMOUNT DUE THIS APPLICATION <br />$306,606.78 <br />9. BALANCE TO FINISH, PLUS RETAINAGE <br />NET CHANGE BY <br />(Column G on Progress Estf mate + Llne 8 above) <br />$13,790,528.22 <br />CHANGE ORDERS <br />$tl.00 <br />Contractor's CerUflcatlon <br />$305,505.78 <br />The undersigned Conuador oeroea that: (1) all previous progress <br />Payment of <br />payments received from Owner on account of Work done under the <br />(Line 8 or other - act explanation of other amount) <br />Coract have been applied on account to discharge Cantractor'e <br />m <br />Iegiimats obligallons Incurred in connection with Work covered by prior <br />Applitatlons for Payment, (2) title of ell WorK materials and eyulpment <br />Is racommanded by: <br />Mar. 5 2015 <br />Inmrporemd In said VVorx or otherwise Ilatetl In or covered try this <br />, <br />Application for Paymerd will pass to Owner of lima of payment free and <br />(Engineer) <br />(Date) <br />clear of all `,fens, security Interests and enaanbrenom (except such as are <br />covered by a Bond acceptable to Owner indemnifying Owner against any <br />Q+ <br />$305,505.78 <br />such Liens, security Intsreat or encumbrances); and (3) all Work covered <br />Payment of: <br />by this Application for Payment Is in accordance with the Contract <br />(Line 8 or other - attach explanation of outer amourd) <br />Documents and Is not defective. <br />is approved by. <br />(Finance Director) <br />(Date) <br />13y: Date: <br />Approved by. <br />'w <br />.3/.z l5 <br />Funding Agency (If applicable) <br />(Date) <br />rJCDC No. C420 (2M BdW..) <br />7rrpa.. try IM Irnahrern' Joie! Cwlract Det.menv Cemralaee aid todened tfy Ore Metraled C.+.r.l Coeeetran Of Artrrtem mad UK C—h mr j "Sp-I t.eani T..t&&, <br />