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3� <br />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 />t — Please Remit Payment to: RJM Construction, LLC <br />830 Boone Ave North <br />Golden Valley, MN 55427 <br />APPLICATION AND CERTIFICATE FOR PAYMENT <br />ENT <br />Project:19520-0033 Elk River Multi -Purpose Facility and Liar John <br />Weicht Park <br />Architect: <br />Application is made for psymerd, as shown below, in connection with the Contract. <br />Continuation Sheet is attached. <br />1. Odginal 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. 0.00% of Completed Work $0•00 <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 />$25,934,028.00 <br />$567,579.40 <br />$26,501,607.40 <br />$26,427,623.74 <br />$0.00 <br />$26,427,623.74 <br />$25,806,680.94 <br />8. Current Payment Due ........................... $620,942.80 <br />9. Balance To Finish, Plus Retainage ................. $73,983.66 <br />Invoice 0: 9520003319 Distribution to: <br />Application No.: 19 Owner <br />Application Date: 11130/2020 Architect <br />0 Contractor <br />Period From: <br />To: 11/30/2020 <br />The undersigned Contractor certifies that to the beat 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 />RJM Construction LLC <br />Stale of. A0County of. �c <br />Subscribed a me this day of _ _ <br />Notary Pubiin. <br />My Commissioexpires: `" JUSTIN <br />r" KING <br />In accordance with the Contract Documents, based on on -site observations � � co01 Pubfic.Mfnnesot, <br />comprising the above application, the Architect certifies to the Ownerthat n to mka►on .ran 3t, 20; <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 />ARCHITECTS CERTIFICATE FOR PAYMENT <br />AMOUNT CERTIFIED $ 620,942.80 <br />(Attach e*Wndw if amount certified differs from the amount applied. inf ia/ all figures on this Applkatfon <br />and on the ConMustfon Sheet that are changed to conform with the amount certified.) <br />BRCHITECT;;q�.,. Data - <br />Y <br />This <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 />