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To <br />City of Elk River <br />3065 Orono Parkway <br />Elk River, MN 55330 <br />From <br />Apex Facility Solutions, SBC <br />403 Jackson St <br />Suite 308 <br />Anoka MN 55303 <br />612-581-0219 <br />CONTRACTORS APPLICATION FOR PAYMENT <br />Application <br />is made for payment, as shown below, in connection <br />with the contract <br />signed 10/19/2020 <br />1. <br />ORIGINAL CONTRACT SUM <br />$ <br />2,070,067.00 <br />2. <br />NET CHANGE BY CHANGE ORDERS <br />$ <br />3. <br />CONTRACT SUM TO DATE (1+2) <br />$ <br />2,070,067.00 <br />4. <br />TOTAL COMPLETE TO DATE (D) <br />$ <br />1,335,835.57 <br />5. <br />RETAINAGE <br />5% <br />$ <br />13,223.80 <br />6. <br />TOTAL EARNED LESS RETAINAGE <br />$ <br />1,322,611.77 <br />7. <br />LESS PREVIOUS PAYMENTS <br />$ <br />1,301,668.71 <br />8. <br />CURRENT PAYMENT DUE <br />$ 20,943.06 <br />9. <br />BALANCE TO FINISH, INCLUDING RETAINAGE <br />$ <br />747,455.23 <br />CHANGE ORDER SUMMARY <br />ADDITIONS <br />I DEDUCTIONS <br />Prior months approved change orders <br />Total approved CO's this month <br />Total <br />$ - <br />$ <br />NET CHANGES by Change Order <br />$ <br />Project <br />Guaranteed Energy Savings Agreement <br />Remit payment to <br />Apex Facility Solutions, SBC <br />403 Jackson St <br />Suite 308 <br />Anoka MN 55303 <br />APPLICATION FOR PAYMENT <br />Invoice No: <br />2 <br />Invoice date: <br />2/8/2021 <br />Billed through: <br />2/28/2021 <br />Apex Project number: <br />30320046 <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 <br />completed in accordance with the Contract Documents, that all amounts have been paid by <br />the Contractor for Work for which previous Certificates for Payment were issued and <br />payments received from the Owner, and that current payment shown herin is now due. <br />Contractor: Apex Facility Solutions, SBC <br />f <br />By: <br />017 ,A..L-&1z <br />