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APPLICATION FOR PAYMENT <br />To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion <br />Application No.: <br />7 <br />830 Boone Avenue North John Weicht Park <br />Period To: <br />08/31/20 <br />Golden Valley, MN 55427 <br />From: Kendall Doors & Hardware, Inc. <br />Application Date: <br />08/20/20 <br />1312 Northland Drive <br />Project No.: <br />19520-0033 <br />Suite 100 <br />Contract Date: <br />11/13/19 <br />Mendota Heights, MN 55120 <br />Commitment: <br />195200033-081105 <br />Contract For: 195200033-081105 - Hollow Metal Doors & <br />Frames <br />1. ORIGINAL CONTRACT AMOUNT <br />2. NET CHANGE BY CHANGE ORDERS <br />3. CONTRACT SUM TO DATE <br />4. TOTAL COMPLETED AND STORED TO DATE <br />(Column G) <br />5. RETAINAGE <br />5.00% of Completed Work <br />(Columns D + E) <br />5.00% of Stored Materials <br />(Columns F) <br />Total Retainage <br />(Line 5a + Line 5b OR Sum of Column 1) <br />6. TOTAL EARNED LESS RETAINAGE <br />(Line 4 less Line 5 Total) <br />7. LESS PRIOR CERTIFICATES FOR PAYMENT <br />(Line 6 from prior Certificate) <br />8. CURRENT PAYMENT DUE <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) <br />$92, 614.00 <br />$198,271.84 <br />$290,885.84 <br />$289,006.34 <br />$10,140.42 <br />$10,140.42 <br />$278,865.92 <br />$251,113.77 <br />$27,752.15 <br />$12,019.92 <br />CHANGE ORDER SUMMARY <br />ADDITIONS <br />DEDUCTIONS <br />Total changes approved in previous months <br />$190,455.72 <br />$0.00 <br />Total approved this month <br />$9,138.62 <br />$1,322.50 <br />TOTALS <br />$199,594.34 <br />$1,322.50 <br />NET CHANGES by Change Orders <br />$198,271.84 <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and <br />belief the Work covered by the Application for Payment has been completed in accordance with the <br />Contract Documents, that all amounts have been paid by the Contractor for Work for which previous <br />Certificates for Payment were issued and payments received from the Owner, and that current <br />payment shown herein is now due. <br />CONTRACTOR: <br />By: Jason Self Date: 08/21/20 <br />State Of. <br />County Of: <br />Subscribed and sworn to before me this <br />Notary Public: <br />My commission expires: <br />ARCHITECTS CERTIFICATE FOR PAYMENT <br />day of <br />In accordance with the Contract Documents, based on the on -site observations and the data <br />compromising this application, the Architect certifies to the owner that to the best of the Architects <br />knowledge, information and belief the Work under the Architecfs Contract has progressed as <br />indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is <br />entitled to payment of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED $27,752.15 <br />(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the <br />Application for Payment and on the Continuation sheet that are changes to conform to the amount <br />certified.) <br />ARCHITECT: <br />By: Date: <br />The Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named <br />herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the <br />Owner or Contractor under this Contract. <br />Page 1 of 1 <br />