4.4. SR 01-21-2020 - Laserfiche WebLink

Home Browse Search

EXHIBIT E APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 3 SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena & John Weicht Park Facilities APPLICATION NO: 4 830 Boone Avenue North 1000 School Street NW APPLICATION DATE: 12/18/2019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 12/01 /2019 SUBMITTED FROM: Design Electric, Inc. ARCHITECT: 292 Design Group PERIOD TO: 12/31 /2019 4807 Heatherwood Road 3533 East Lake Street PROJECT NO: St. Cloud, MN 56301 Minneapolis, MN 55406 CONTRACT DATE: 7/10/2019 CONTRACT FOR: 26 00 00 Electrical CONTRACT NO.: COMMITMENT: 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 labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,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) 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 complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. ORIGINAL CONTRACT SUM................................................................... 1,786,914,00 NET CHANGE BY CHANGE ORDERS TO.................................................-32,807.14 CONTRACT SUM TO DATE.. ...................................... .......... I .............. TOTAL COMPLETED AND STORED TO DATE .................... 5 % OF COMPLETED WORK 12,199.60 % OF STORED MATERIAL 1, 754,106.86 243 992.07 TOTALRETAINAGE.............................................................................. 12,199.60 TOTAL EARNED LESS RETAINAGE........................................................ 231 ,792.47 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ......................... PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICATES FOR PAYMENT.— ................ ........ ....... 185,329.87 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE..................................................................... 46,462.60 for any of the materials andlor labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE......................................... 1,522,314.39_ _ State of: MN .I r.rueger LIC The person signing below does hereby cerify that he/she is fully authorized and empowered to Y t'4J4TA execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: BentonTA instrument. Subscribed and sworn to before me this 18 day of December 20 19 NOTARY PUBLIC: SIGNED: Signed: 155111 PRINTED, TITLE es Schoon, VP My Commission Expires: 1 /31 /2020