Laserfiche WebLink
Contractor's Application for Payment No. 3 <br />To (Owner): City of Elk River <br />Application 5/1/2022 to 6/3/2022 Application Date: <br />I June 6, 2022 <br />Period: <br />Project: Natures Edge Business Center <br />From (Contractor): Via (Engineer): <br />Hakanson Anderson <br />Third Addition <br />Northwest Asphalt <br />Application For Payment <br />Change Order Summary <br />Approved Change Orders <br />1. ORIGINAL CONTRACT PRICE.................................................................... <br />$ <br />$1,967,329.71 <br />Number Additions <br />Deductions <br />14. <br />2. Net change by Change Orders.......................................................................... <br />$ <br />$0.00 <br />3. Current Contract Price (Line 1 t 2)................................................................. <br />$ <br />$1,967,329.71 <br />TOTAL COMPLETED AND STORED TO DATE <br />$ <br />$1,463,114.81 <br />5. RETAINAGE: <br />a. 5% X Work Completed ............................................. <br />$ <br />S73,155.74 <br />b. 0% X Stored Material .............................................. <br />$ <br />$0.00 <br />I` <br />c. Total Retainage (Line 5.a + Line 5.b)................................................... <br />$ <br />$73,155.74 <br />6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5.c)..................................... <br />$ <br />S1,389,959.07 <br />7. MATERIAL ON HAND NOT INSTALLED (75% of Cost) .......................... <br />18. <br />$ <br />TOTALS1 <br />$0.00 <br />$0.00 <br />LESS PREVIOUS PAYMENTS....................................................................... <br />$ <br />$804,680.23 <br />NET CHANGE BY <br />9. AMOUNT DUE THIS APPLICATION........................................................... <br />$ <br />$585,278.84 <br />$0.00 <br />I <br />CHANGE ORDERS <br />Contractor's Certification <br />The undersigned Contractor certifies, to the best of its knowledge, the following: <br />(1) All previous progress payments received from Owner on account of Work done under the Contract have been <br />applied on account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by <br />prior Applications for Payment; <br />(2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by this <br />Application for Payment, wil ss to Owner at time of payment free and clear of all Liens, security interests, and <br />encumbrances (except such as are covered" y a d acceptable to Owner indemnifying Owner against any such <br />Liens, security intere , or encurn races); and <br />(3) All the Work c ered by thi plication for P yment is in accordance with the Contract Documents and is not <br />defective. <br />Contractor S' ture <br />By: // Date: <br />ENGINEER: HAKANSON ANDERSON <br />Certification: We recommend payme or work and quantites shown. <br />Z----- 6-10-22 <br />L/ (Engineer) Date <br />OWNER: CITY OF ELK RIVER <br />6.10.2022 <br />(Owner) Date <br />245-4-6210-4530 <br />