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APPLICATION AND CERTIFICATE FOR PAYMENT Invoice k: 230033-1 <br />Toowner. Housing & Redevelopment Authority for the Proiect 230033 Former Elk River Meat Market Application No.: 1 Oisldbulion to: <br />City of Elk River Demo ® owner <br />13065 Orono Pkwy Elk River, MN 55330 0 Architect <br />Period To: 3f31/2023 n Contractor <br />From contractor. Veit&Company, Inc. Via Architect <br />14000 Veit Place Project Nos: <br />Rogers, MN 55374 <br />contract For. Contract Oats: <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Application is made for payment, as shown below, in connection with the Contract. <br />continuation Shell 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 em% of Completed Work <br />b. o o% of Stored Material <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 />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 <br />paid by the Contractor for Work for which previous Certificates for Payment were <br />issued and payments received from the Owner, and that current payment shown <br />herein is now due. <br />$64,500.00 <br />CONTRACTOR: Veit &Company, Inc. <br />$5,088.00 <br />$69.588.00 <br />$69,588.00 By: L Date: 3/21/2023 <br />Todd Gertzen, Piroject M ger/Estimator <br />State of: Minnesota <br />$0.00 Subscribed and sworn to before Mathis 21sit <br />$0.00 Notary Public: <br />My Commission expires""1/3172028 <br />$0.00 <br />$69,588.00 <br />$0.00 <br />$69,588.00 <br />$0.00 <br />CHANGE ORDER SUMMARY <br />Additions <br />Deductions <br />Total changes approved <br />In previous months by Omer <br />$0.00 <br />$0.00 <br />Total Approved this Month <br />$5,088.00 <br />$0.00 <br />TOTALS <br />$5,088.00 <br />$0.00 <br />Net Changes By Change Order <br />$5,088.00 <br />County of: Hennepin <br />day of qr»q <br />NadLlo i.. KGnri <br />NOTF,F,Y PS1NLIC, <br />M1NN8SVi'A <br />ARCHITECT'S CERTIFICATE FOR PAYMENT ell�w <br />In accordance with the Contract Documents, based on on -site observations and the data <br />comprising the above application, the Architect certifies to the Owner that to the best of the <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 />AMOUNT CERTIF ED $69,588M <br />(Attach explanation if amount certified dffteis ham the amount applied, Inifial aft figures on this Application and on the <br />Continuation Sheet thal are changed to conform with Me am0wnt cedlfied.) <br />ARCHITECT: <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 />