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Please Remit Payment to: RJM Construction, LLC <br />830 Boone Ave North <br />Golden Valley, MN 55427 <br />APPLICATION AND CERTIFICATE FOR PAYMENT <br />CONSTRUCTION <br />To City of Elk River <br />Project:19520-=3 Elk River Multi -Purpose Facility and Lion John <br />Invoice * <br />9520003318 <br />Distribution to : <br />Owner. Attn: Justin Femrite <br />ft"8019 Street NW <br />Application No.: <br />18 <br />0 Owner <br />13065 Orono Parkway <br />Elk River, MN 55330 <br />Application Date: <br />11i30/2020 <br />Architect <br />Contractor <br />Elk River, MN 55330 <br />Architect: <br />Period From: <br />11/1/2020 <br />To: 11/3012020 <br />CONTRACTOR'S APPLICATION FOR PAYMENT The unders nad Corrhaotor certifies that to the best of the Contractor's knowledge <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. 2.35% of Completed Work $620,942.80 <br />b. 0,00% of Stared 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 />$25,934,028.00 <br />$567,579.40 <br />$26,501,607.40 <br />$26,427,823.74 <br />$620,942.80 <br />$25,806,680.94 <br />$25,797,059.36 <br />$9,621.58 <br />$694,926.46 <br />CHANGE ORDER SUMMARY <br />Deductions <br />p <br />in prrievious mon! s 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 />y <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 />RJM Construction LLC <br />State of: <br />me this <br />My Commissiodexpires:l -- <br />County of, <br />day of _ a <br />In accordance with the Contract Documents, based on orrsite observatq <br />W�9 <br />comprising the above application, the Architect codifies to the Owner the r <br />Architect's knowledge, information, and belief, the Work he- p_------ <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 />ARCHITECTS CERTIFICATE FOR PAYMENT <br />AMOUNTCERTIFIED $ 9,621.58 <br />"' KING <br />Nary Publio-Minnesota <br />pcommbskn Eby Jan 31. 2022 <br />(Attach explanation Hamount certified di/(ers f m the amount appliedindmi aff figures on dWsApphcation <br />and on the Continuation Sheet that are changed to conform with the amount certified.) <br />ARCHITECT: J-V�k" 12/7/20 <br />By: 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 />