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EXHIBIT E <br />APPLICATION AND CERTIFICATE FOR PAYMENT <br />Page 1 of 2 <br />SUBMITTED TO: RJM Consiructlon„ LLC PROJECT: Elk River Multi Purpose Facility & <br />APPLICATION NO: 1 <br />B30 Boone Avenue N6rih <br />Dion John Weicht Park <br />APPLICATION DATE: 11-27-19 <br />Golden Valley, MN 55427 <br />PERIOD FROM! 11-1-19 <br />SUBMITTED FROM: ARCHITECT: <br />292 Design Group <br />PERIOD TO: 11-30-19 <br />Seating And Athletic Facility Enterprises <br />3533 East Lake Street: <br />PROJECT NO: 19005.00 <br />79554 325th Street <br />Minneapolis, YIN 55406 <br />CONTRACT DATE: 7-11-19 <br />Ellendale, MN 5602€ <br />CONTRACT Fpp CONTRACT NO,. <br />19520-0033 <br />COMMITMENT: <br />13' 3417 Leg Truss Bleacher S stem <br />—Section <br />hereby certify that the work performed and the material supplied to data, as shown here, <br />ORIGINAL CONTRACT SUM.................................................................,. <br />125, 797. 00 <br />represent the actual value of accomplishment under the terms of the contract (and all authorized <br />changes hereto) between the undersigned and RJM Constructlon relating to the above -referenced <br />NET CHANGE BY CHANGE GIRDERS TO ...............„............................... <br />0 , 00 <br />project. I further certify that no labor or materials have been supplied under condrads, <br />agreements, verbal or written, or any other arrangement of any type whalsoever,other than the <br />CONTRACT SUM TO DATE ........ ..... <br />125 797' 00 <br />conlract duly authorized and executed change orders, and the undersigned does hereby releases <br />RJ{%l Construction from any claim or riability therefor for the period covered by this applicallun. l <br />TOTAL COMPLETED AND STARED TO iJl'tiTt=........................................... <br />26,358.00 <br />also cerlIfy that payments, less applicable retention, have been made through the period covered <br />by previous payments received from the contractor to 1) all my subcontractors (sub- <br />subcontracturs) and 2) for all rnaterlal and labor used In or in connection with the performance of <br />°+4 OF COMPLETED WORK <br />this contract. 1 further certify that I have complied with Federal. Slate, and bral tax laws, including <br />Social Security laws, Unemployment Compensation Laws and WorkmaWs Compensation laws <br />% OF STORED MATERIAL <br />insofar as applicable to the performance this contract. <br />TOTALRETAIf+PAGE.................. ............................................................ <br />1,317.90 <br />TOTAL EARNED LESS RETAINAGE................ ......................................... <br />LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER <br />........................ <br />PARTIAL WAIVER OF LIEN <br />Now therefore, upon receipt of the payment of the current payment due on this applicalion the <br />LESS PREVIOUS CERTIFICATES FOR PAYMENT ..................................... <br />undersigned does hereby irrevocably release and waive any and all mechanic`s liens or rights to <br />25,040.10 <br />clalm any and all mechanic's liens or other Itens against the above real estate or any part Ihereof <br />CURRENT PAYMENT DUE ... ..................... --........ --- .............. ............ <br />for any of the materials andfor labopr therefore furnished or performed In connection with Ihis <br />BALANCE TO FINISH INCLUDING RE7AINAGE.........................................100,756.90 <br />proj.ecl, reserving. however, air rren rights for labor and/or materials furnished after said date. <br />- <br />Slate of. Minnesota <br />The person signing below does hereby cerify that he/she is fully authorized and empowered to <br />execute this instrument and to bind the undersigned hereto, and does In fact so execute this <br />County of. Freeborn <br />instrument. <br />Subscribed and Sworn to before me this <br />SIGNED <br />27th dayof November <br />NOTARY PUBLIC: <br />Signed: <br />PRINTED, TITLE President My Commission Expires: <br />20 19 <br />T !C Churct►lil <br />Nkmry Putbllic <br />minnesma <br />11, 294 <br />