4.5 SR 12-21-2020 - Laserfiche WebLink

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code: 4207-8540-4520 signature: ' Please Remit Payment to: RJM Construction, LLC 830 Boone Ave North Golden Valley, MN 55427 APPLICATION AND CERTIFICATE FOR PAYMENT To City of Elk River Project:19520-0033 Elk River Multi -Purpose Facility and Lion John Invoice #: 9520003317 Distribution to ; Owner: Attn: Justine Femrite VANIs Street NW Application No.: 17 Owner 13065 Orono Parkway Elk River, MN 55330 Architect Elk River, MN 55330 Application Date: 10/3112020 Contractor Architect: Period From: 10/1/2020 To: 10131 /2020 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge, information, and belief, the work covered by this Application for Payment has been completed in Application is made for payment, as shown below, in connection with the Contract. accordance with the Contract Documents. That all amounts have been paid by the Contractor for Work for Continuation Sheet is attached. which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1.Original Contract Sum ............... . .......... $25,934,028.00 2. Net Change By Change Order .............. . ..... . $567,579.40 3. Contract Sum To Date ............. . . ...... . . ... $26,501,607.40 4. Total Completed and Stored To Date ........ < .... , . $26,417,658.23 5. Retainage: a. 2.35% of Completed Work $620,598.87 b. 0.00% of Stored Material $0.00 Total Retainage ................... $620,598.87 6. Total Earned Less Retainage ......... , .. . _ ... $25,797,059.36 7. Less Previous Certificates For Payments . a . $25,783,864.12 8. Current Payment Due ................ 9. Balance To Finish, Plus Retainage ................. $704,548.04 CHANGE ORDER SUMMARY Ad iti n Deductions Total changes approved to previous rnonths b Owner $956,343.73 $388,764.33 Total Approved this Month $0.00 $0.00 TOTALS $956,343.73 $388,764.33 Net Changes By Change Order $567,579.40 RJM Construction LLC State of: /P1 *n Subscribed and fore me this Notary Public: My Commission a p County of: - /06 day of —. , ZO O In accordance with the Contract Documents, based on on -site observati r comprising the above application, the Architect certifies to the Owner that to o Architect's knowledge, information, and belief, the Work has progressed as indicate ,��' the quality of the Work is in accordance with the Contract Documents, and the Contractor c7 is entitled to payment of the AMOUNT CERTIFIED.04 ARCHITECT'S CERTIFICATE FOR PAYMENT' AMOUNT CERTIFIED $ 13,195.24 (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: 11/11/20 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.