4.3. SR 11-21-2016 - Laserfiche WebLink

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Contractor's Application For Payment No. 24 Period To: 10/31/2016 Application Date: 10/31/2016 To (Owner): City of Elk River From (Contractor): Rice Lake Construction Group IVia (Engineer): Bolton 8 Menk, Inc. Project: Wastewater Treatment Facility Improvements 2014 Contract: All Construction Owner's Contract No.: (Contractor's Project No.: 1422 Application for Payment Change Order Summary Approved Change Orders Number Additions Deductions 1 $ 259,991.59 $ 2 $ $ TOTALS $259,991.59 $0.00 NET CHANGE BY CHANGE ORDERS $259,991.59 Contractor's Certification The undersigned Contractor certifies that: (1) all previous pmgre payments received from Owner on account of Work done under t Contract have boon applied on account to discharge Contractor's legitim� obligations incurred in connection with Work covered by prior Applicatio for Payment; (2) title of all Work, materials and equipment incorporated said Work or otherwise listed in or covered by this Application for Paym( will pass to Owner at time of payment free and clear of all Liens, secur interests and encumbrances (except such as are covered by a Be acceptable to Owner indemnifying Owner against any such Liens, secur interest or encumbrances); and (3) all Work covered by this Application Payment is in accordance with the Contract Documents and is r defective. Payment of: 1. ORIGINAL CONTRACT PRICE 2. Net change by Change Orders 3. CURRENT CONTRACT PRICE (Line 1 t 2) 4. TOTAL COMPLETED AND STORED TO DATE (Column F on Progress Estimate) 5. RETAINAGE: a. 5% x $15,502,379.87 Work Completed b. 5% x $0.00 Stored Materials c. Total Retainage (Line 5a + Line 5b) 5. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5c) 7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application) B. AMOUNT DUE THIS APPLICATION 9. BALANCE TO FINISH, PLUS RETAINAGE (Column G on Progress Estimate + Line 5 above) (Line B or other - attach explanation ejx-ppllanation of other amount) is recommended by: - " " 1 Payment of: is approved by: Approved by: $16,525,200.00 $259,991.59 $16,785,191.59 $15,502,379.87 $775,118.99 $0.00 $775,118.99 $14,727,260.88 $14,393,127.77 $334,133.11 $2,070,199.30 (Engineer) (Date) (Line 8 or other - attach explanation of other amount) (Finance Director) (Date) Funding Agency (if applicable) (Date) r11CDC No. C-620 (2002 Edition) Prepared by the Engineers' Joint Contract Documents Committee and endorsed to the Associated General Contractors of America and the Construction Specifications Institute.