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Contractor's Application for Payment No. <br />4 <br />To (Owner): City of Elk River <br />Application 6/4/2022 to 6/27/2022 <br />Application Date: <br />June 27, 2022 <br />Period: <br />Project: Natures Edge Business Center <br />From (Contractor): <br />Via (Engineer): <br />Hakanson Anderson <br />Third Addition <br />Northwest Asphalt <br />Application For Payment <br />Change Order Summary <br />Approved Change Orders <br />Number <br />Additions <br />Deductions <br />TOTALS <br />NET CHANGE BY <br />CHANGE ORDERS <br />$0.00 <br />$0.00 <br />$0.00 <br />1. ORIGINAL CONTRACT PRICE.................................................................... <br />2. Net change by Change Orders........................................................................... <br />3. Current Contract Price (Line 1 f 2)................................................................. <br />4. TOTAL COMPLETED AND STORED TO DATE <br />5. RETAINAGE: <br />a. 5% X Work Completed ............................................. <br />b. 0% X Stored Material .............................................. <br />c. Total Retainage (Line 5.a+ Line 5.b)................................................... <br />6. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5.c)..................................... <br />7. MATERIAL ON HAND NOT INSTALLED (75% of Cost) .......................... <br />8. LESS PREVIOUS PAYMENTS....................................................................... <br />9. AMOUNT DUE THIS APPLICATION........................................................... <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, will pass to Owner at time of payment free and clear of all Liens, security interests, and <br />encumbrances (except such as are covered by a bond acceptable to Owner indemnifying Owner against any such <br />Liens, security, interest, or encumbrances); and <br />(3) All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not <br />defective <br />Contractor S'nature .r ✓-' <br />By: �' _ Date: <br />r` <br />$ $1,967,329.71 <br />$ $0.00 <br />$ $1,967,329.71 <br />$ $1,716,725.31 <br />$ <br />$ $85,836.27 <br />$ $0.00 <br />$ $85,836.27 <br />$ S1,630,889.04 <br />$ $1,389,959.07 <br />$ $240,929.97 <br />ENGINEER: HAKANSON ANDERSON <br />9 Certifi lion: We recommend pay ent for work and quantites shown. <br />�`-`- 7/0/22 <br />(Engineer) Date <br />OWNER: CITY OF ELK RIVER <br />rt, . —�L 7/8/2022 <br />(Owner) Date <br />Code: 245-4-6210-4530 <br />