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DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC C� / _ SZU
<br />Please Remit Payment to: RJM Construction, LLC
<br />830 Boone Ave North
<br />�7Jf�1.t Golden Valley, MN 55427
<br />rV iPP1 ICATI AND CERTIFICATE FOR PAVM NT
<br />CONSTRUCTION
<br />To Owner City of Elk River
<br />Project:19520-0033 Elk River Multi -Purpose Facility and Lion John
<br />Invoice #:
<br />9520003310
<br />Distribution to:
<br />Attn: Justin Femdte
<br />WMAls Street NW
<br />Application No.:
<br />10
<br />= Owner
<br />13065 Orono Parkway
<br />Elk River, MN 55330
<br />® Architect
<br />Elk River, MN 55330
<br />Application Date:
<br />pp
<br />4/3012020
<br />0 Contractor
<br />Architect:
<br />Period From:
<br />4/112020
<br />To:
<br />4/30/2020
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Application is made for payment, as shown below, in connection with the Contract.
<br />Continuation Sheet is attached.
<br />1.Original Contract Sum ... $25,772,257.00
<br />2. Net Change By Change Order .................... $398,559.40
<br />3. Contract Sum To Date $26,170,816.40
<br />4. Total Completed and Stored To Date ..... $19,673,766.53
<br />5. Retainage:
<br />a. 4.68% of Completed Work $920,129.36
<br />b. 0.00% of Stored Material $0.00
<br />Total Retainage ....... $920,129.36
<br />6. Total Earned Less Retainage ...................... $18,753,637.17
<br />7. Less Previous Certificates For Payments ............ $16,855,092.89
<br />8. Current Payment Due ............... $1,898,544.28
<br />9. Balance To Finish, Plus Retainage . $7,417,179.23
<br />CHANGE ORDER SUMMARY
<br />Additions
<br />Deductions
<br />Total vlousgmon isrr y wrier
<br />$601,520.46
<br />$202,961.06
<br />Total Approved this Month
<br />$24,032.27
<br />$24,032.27
<br />TOTALS
<br />$625,552.73
<br />$226,993.33
<br />Net Changes By Change Order
<br />$398,559.40
<br />The undersigned Contractor certifies that to the best of the Contractor's knowledge,
<br />information, and belief, the work covered by this Application for Payment has been completed in
<br />accordance with the Contract Documents. That all amounts have been paid by the Contractor for Work for
<br />which previous Certificates for Payment were issued and payments received from the Owner, and that
<br />current payment shown herein is now due.
<br />CONTRACTOR:
<br />-4*
<br />B • T:-. +eye.,
<br />RJM Construction LLC
<br />State of:
<br />Subscribed and sworn to before me this
<br />Notary Public:
<br />My Commission expires:
<br />5/4/2020
<br />Date:
<br />County of:
<br />day of
<br />In accordance with the Contract Documents, based on on -site observations and the data
<br />comprising the above application, the Architect certifies to the Owner that to the best of the
<br />Architect's knowledge, information, and belief, the Work has progressed as indicated,
<br />the quality of the Work is in accordance with the Contract Documents, and the Contractor
<br />is entitled to payment of the AMOUNT CERTIFIED.
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />AMOUNT CERTIFIED $ 1,898,544.28
<br />(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and
<br />on the Continuation Sheet that are changed to conform with the amount certified.)
<br />ARCHITECT:
<br />°awa 5/6/20
<br />Michelle Maier&-Atak ` "" "Q'°'°"°° �°
<br />By �" il « A;.� M .� , Date:
<br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
<br />Contractor named herein. Issuance, payment, and acceptance of payment are without
<br />prejudice to any rights of the Owner or Contractor under this Contract.
<br />
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