4.3. SR 09-16-2019 - Laserfiche WebLink

Home Browse Search

APPLICATION AND CERTIFICATE FOR PAYMENT Page of SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena & Lion John Weicht Park APPLICATION NO: #1 830 Boone Avenue North APPLICATION DATE: 711 612 01 9 Golden Valley, MN 55427 PERIOD FROM: 7/1/2019 SUBMITTED FROM: Twin City Acoustics, Inc. ARCHITECT: 9449 Science Center Drive New Hope, MN 55428 CONTRACT FOR: Acoustical Treatment CONTRACT NO.: I hereby certify that the work performed and the material supplied to date, as shown here. represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above - referenced project I further certify that no Tabor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatscever,other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. I also certify that payments, less applicable retention, have been made through the period covered by previous payments received from the contractor to 1 j all my subcontractors {sub -subcontractors} and 2) for all material and labor used in or in connection with the performance of this contract. I further certify that I have compiled with Federal, State, and local tax laws, including Social Security IaWS. Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanics liens or other liens against the above reale estate or any part thereof for any of the materials andlor labopr therefore furnished or performed in connection with this project, reserving, however, all Iien rights for labor andler materials furnished after Bald date. The person signing below does hereby cerlfy that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does In fact so execute this instrument. Twin City Acoustics, Inc. 9449 Science Center Drive •~" �' New Hope, MN 55428 r SIGNED: PRINTED, TITLE Dave Brinker, President PERIOD TO: 7131/2017 PROJECT NO: #19005.00 CONTRACT DATE: 7111 /2019 COMMITMENT: YES/NO ORIGINAL CONTRACT SUM. .................... 1-1 ... I..". ............................... $ 149,410.00 NET CHANGE BY CHANGE ORDERS TO .......... ......................... I............ CONTRACT SUM TO DATE ....................... .......................... I ......... I....... $ 149,410.00 TOTAL COMPLETED AND STORED TO DATE ......................................... $ 2,250.00 5 % OF COMPLETED WORK 5 % OF STORED MATERIAL 5 112.50 TOTALRETAINAGE ............................. .................. —..... --l- ...... ...... $ TOTAL EARNED LESS RETAINAGE....................................................... $ LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ $ LESS PREVIOUS CERTIFICATES FOR PAYMENT .................................... $ 112.5n 9 137 5n CURRENT PAYMENT DUE.................................................................... $ 2.137.50 BALANCE TO FINISH INCLUDING RETAINAGE ........................................ $ 147,272.50 State of: Minnesota County of: Anoka Subscribed and swom to before me this 16th day of July NOTARY PUBLIC: Signed: Mycommiss Expires: 1/31/2022 JULIE LYNN HAUPERT Notary Public tl Minnesota It My Commission Expires Jan 31. 2022