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DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D
<br />CONTINUATION SHEET Page 3of3
<br />Application and Certification for Payment, containing Application No.: 13
<br />Contractor's signed certification is attached. Application Date: 07131120
<br />In tabulations below, amounts are stated to the nearest dollar. To: 07131120
<br />Use Column I on Contracts where variable retainage for line items may apply.
<br />Architect's Project No.:
<br />Invoice # : 9520003313 Contract: 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park
<br />A B C D E F G H I
<br />Item Description of Work Scheduled
<br />No. Value
<br />31 B
<br />Lions Earthwork
<br />32A
<br />Asphalt Paving
<br />32B
<br />Concrete/Sidewalk/Curb/Gutter
<br />32C
<br />Multipurpose Landscaping
<br />32D
<br />Lions Landscaping
<br />32E
<br />Chain Link Fence
<br />33A
<br />Utilities
<br />3B.1
<br />Precast Concrete
<br />313.2
<br />Precast Concrete
<br />313.3
<br />Precast Raker/Plank/Stadia
<br />01-00
<br />General Conditions/Requirements
<br />90-50
<br />General Liability Insurance
<br />90-60
<br />Construction Contingency
<br />90-80
<br />Builders Risk Insurance
<br />99-99
<br />Contractors Fee
<br />293,489.00
<br />381,555.19
<br />27,000.00
<br />94,480.00
<br />150, 325.79
<br />635,496.55
<br />1,182,922.00
<br />930,000.00
<br />1,048; 025.00
<br />1,253,432.94
<br />268,451.52
<br />103, 037.52
<br />65,184.58
<br />489,303.96
<br />From Previous
<br />Application
<br />(D+E)
<br />510,815.67
<br />231,859.00
<br />375,129.02
<br />0.00
<br />0.00
<br />147,901.39
<br />635,496.55
<br />1,182, 922.00
<br />922,537.00
<br />1, 048, 025.00
<br />1, 086, 337.20
<br />268,282.03
<br />0.00
<br />65,131.94
<br />449,849.58
<br />This Period
<br />In Place
<br />0.00
<br />61,630.00
<br />6,426.17
<br />27, 000.00
<br />94,480.00
<br />2,424.40
<br />0.00
<br />0.00
<br />7,463.00
<br />0.00
<br />72,080.28
<br />169.49
<br />0.00
<br />52.64
<br />14,989.18
<br />Materials
<br />Total % Balance Retainage
<br />Presently
<br />Completed (G I C) To Finish
<br />Stored
<br />and Stored (C-G)
<br />To Date
<br />lot in D or Ei
<br />fD+E+FI
<br />0.00
<br />293,489.00
<br />100.00%
<br />0.001
<br />14,674.45
<br />0.00
<br />381,555.19
<br />100.00%
<br />0.00 •
<br />19,077.76
<br />0.00
<br />27,000.00
<br />100.00%
<br />0.00
<br />1,350.00
<br />0.00
<br />94,480.00
<br />100.00%
<br />0.00
<br />4,724.00
<br />0.00
<br />150,325.79
<br />100.00%
<br />0.00
<br />7,516.30
<br />0.00
<br />635,496.55
<br />100.00%
<br />0.00
<br />31,774.83
<br />0.00
<br />1,182, 922.00
<br />100.00%
<br />0.00 i
<br />59,146.10
<br />0.00
<br />930,000.00
<br />100.00% '
<br />0.00
<br />46,500.00
<br />0.00
<br />1,048,025.00
<br />100.00% '
<br />0.00
<br />52,401.25
<br />0.00
<br />1,158,417.48'
<br />92.42% .
<br />95,015.46
<br />0.00
<br />0.001
<br />268,451.52
<br />100.00%
<br />0.00
<br />0.00
<br />0.00
<br />0.00
<br />0.00%
<br />103,037.52
<br />0.00
<br />0.00
<br />65,184.58
<br />100.00%
<br />0.00
<br />0.00
<br />0.00
<br />464,838.76
<br />95.00%
<br />24,465.20
<br />23,241.92
<br />Grand Totals 26,501,607.40 24,361,784.42 1,452,649.60 0.00 25,814,434.02 97.41% 687,173.38 1,216,119.09
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