4.3 SR 10-19-2020 - Laserfiche WebLink

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Ti &L CONSTRUCTION TO City of Elk River Owner: Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 55330 CONTRACTOR'S APPLICATION FOR PAYMENT Please Remit Payment to: RJM Construction, LLC 830 Boone Ave North Golden Valley, MN 55427 APPLICATION AND CERTIFICATE FOR PAYMENT Project: 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Architect: Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet is attached. 1. Original Contract Sum ............. 2. Net Change By Change Order ................... 3. Contract Sum To Date ............... 4, Total Completed and Stored To Date ... 5. Retainage: a. 2.35% of Completed Work $620,586.98 b. 0.00% of Stored Material $0.00 Total Retainage ............... ......... 6. Total Earned Less Retainage ... ........ 7. Less Previous Certificates For Payments .... 8. Current Payment Due ................. ......... 9. Balance To Finish, Plus Retainage ..... $25,772,257.00 $729,350.40 $26,501,607.40 $26,404,451.10 $620,586.98 $25,783,864.12 $25,163,277.14 $717,743.28 CHANGE ORDER SUMMARY Additions Deductions Total changes agngved in previous moms y Owner $956,343.73 $226,993.33 Total Approved this Month $0.00 $0.00 TOTALS $956,343.73 $226,993.33 Net Changes By Change Order $729,350.40 Invoice #: 9520003316 Distribution to Application No.: 16 0 Owner Application Date: 9/30/2020 ArchitectO Contractor Period From: To: The undersigned Contractor certifies that to the best of the Contractor's knowledge, information, and belief, the work covered by this Application for Payment has been completed in accordance with the Contract Documents. That all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. RJM Construction LLC State of: My Ccmmissid7t expires:% [.*, I,-,_ 101712020 County of: day of Q-4-4-- , %— In accordance with the Contract Documents, based on on -site observatio, KING comprising the above application, the Architect certifies to the Owner that NOtarY Public-MinneWa a Architect's knowledge, information, and belief, the Work has progressed 2 COM Expires eS Jan 31, 2o the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED $ 620,586.98 (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) ARCHITECT- 10/8/20 By:— � —Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment, and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.