|
TP
<br />CONSTRUCTION
<br />To Owner City of Elk River
<br />Attn: Justine Femrite
<br />13065 Orono Parkway
<br />Elk River, MN 55330
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Please Remit Payment to: RJM Construction, LLC
<br />830 Boone Ave North
<br />Golden Valley, MN 55427
<br />APPLICATION AND CERTIFICATE FOR PAYMENT
<br />Project:19520-0033 Elk River Multi -Purpose Facility and Lion John
<br />EItIs Street NW
<br />Elk River, MN 55330
<br />Architect:
<br />Application is made for payment, as shown below, in connection with the Contract.
<br />Continuation Sheet is attached.
<br />1.Original Contract Sum ..........................
<br />2. Net Change By Change Order .................... .
<br />3. Contract Sum To Date ......................... .
<br />4. Total Completed and Stored To Date ...: .
<br />5. Retainage:
<br />a. 4.70% of Completed Work $1,238,190.72
<br />b. 0.00% of Stored Material $0.00
<br />Total Retainage ......... .........
<br />6. Total Earned Less Retainage ......... ..........
<br />7. Less Previous Certificates For Payments ........... .
<br />8. Current Payment Due ............... ...........
<br />9. Balance To Finish, Plus Retainage ..... ..........
<br />Invoice*
<br />9520003314
<br />Distribution to:
<br />Application No.:
<br />14
<br />Owner
<br />Archdeot
<br />Application Date.,
<br />8131/2020
<br />EN Contractor
<br />Period From:
<br />81112020
<br />To:
<br />8131 /2020
<br />The undersigned Contractor certifies that to the best of the Contractors 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 />$25,772,257.00 CONTR,
<br />$729,350.40
<br />$26,501,607.40 By'--�
<br />$26,325,714.84 State of:
<br />RJM Construction LLC
<br />Notary Public: My Commission xpi
<br />Date: 0, - 9 - 2A
<br />County of: J , 10 ,,
<br />day of 4 ,_,Ism Z�+-v
<br />$1,238,190.72
<br />In accordance with the Contract Documents, based on on -site observations a I
<br />comprising the above application, the Architect certifies to the Owner that to
<br />$25,087,524.12
<br />Architect's knowledge, information, and belief, the Work has progressed as l0d'rcated',
<br />$24,598,314.93
<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 />$489,209.191
<br />ARCHITECTS CERTIFICATE FOR PAYMENT
<br />$1,414,083.28
<br />AMOUNT CERTIFIED $ 489,209.19
<br />CHANGE ORDER SUMMARY
<br />Addit'c �s
<br />Deductions
<br />Total prrous" onffi"caner
<br />$956,343.73
<br />$226,993.33
<br />Total Approved this Month
<br />$0.00
<br />$0.00
<br />TOTALS
<br />$956,343.73
<br />$226,993.33
<br />Net Changes By Change Order
<br />$729,350.40
<br />""AS GARDNER
<br />PUblic-Mfnnesata
<br />Jan 31. 202q 2
<br />(Aftach explanation it amount certified ditha from the amount applied. Inifiai all figures on this Application and
<br />on the Continuation Sheet that are changed to conform with the amount certified.)
<br />ARCHITECT:
<br />By: I u MAZ4,5- Date: 9/10/20
<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 />
|