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CONSTRUCTION
<br />TO City of Elk River
<br />Owner: Attn: Justin 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 />%V961s 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 $1,241,173.96
<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 />9520003315
<br />Distribution to
<br />Application No.:
<br />15
<br />0 Owner
<br />ArchitectContractor
<br />Application Date:
<br />9/30/2020
<br />Period From:
<br />9/1/2020
<br />TO:
<br />9/30/2020
<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 />$25,934,028.00
<br />CONTRACT RJM Construction LLC
<br />$567,579.40
<br />$26,501,607.40
<br />By, Dat
<br />$26,404,451.10
<br />State of:
<br />Subscribed a sm to, fore me this
<br />Notary Public:
<br />My Commission expires: 1311
<br />$1,241,173.96
<br />$25,163,277.14
<br />$25,087,524.12
<br />$75,753.021
<br />$1,338,330.26
<br />CHANGE ORDER SUMMARY
<br />Additions
<br />Deductions
<br />Total changes agrgved
<br />in previous months y Owner
<br />$956,343.73
<br />$388,764.33
<br />Total Approved this Month
<br />$0.00
<br />$0.00
<br />TOTALS
<br />$956,343.73
<br />$388,764.33
<br />Net Changes By Change Order
<br />$567,579.40
<br />10/7/2020
<br />County of: D-N--4*—
<br />day of . "-AD
<br />JUSTIN M. KING
<br />In accordance with the Contract Documents, based on on -site observationsa`*_ l�u JC-Minnesota
<br />comprising the above application, the Architect certifies to the Owner that to My C_ftss. dos Jan 31. 2o22
<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 $75,753.02
<br />(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application
<br />and on the Continuation Sheet that are changed to conform with the amount certified.)
<br />ARCHffUI-_ 10/8/20
<br />By: plL-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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