4.3 SR 06-20-2023 - Laserfiche WebLink

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Contractor's Application for Payment Owner: City of Elk River Owner's Project No.: Engineer: Bolton & Menk, Inc. Engineer's Project No.: OR1.128082 Contractor: North Valley Inc. Agency's Project No.: Project: 2023 Street Improvements Project Contract: Application No.: 1 Application Date: 6/1/2023 Application Period: From 5/1i2023 to 5/31/2023 1. Original Contract Price $ 5,433,358J1 2. Net change by Change Orders $ - 3. Current Contract Price (Line 1+ Line 2j $ 5,433,358J1 4. Total Work completed and materials stored to date {Sum of Column G Lump Sum Total and Column J Unit Price Total) $ 1,71Q297.53 5. Retainage a. 5% X$ 1,71Q297,53 Work Completed $ 85,514.88 b. X $ - Stored Materials $ - c. Total Retainage (Line 5.a + Line 5.b) $ $5,514.88 6. Amount eligible to date (line 4- Line 5.c) $ 1,624,782.65 7. Less previous payments 8. Amount due this application $ 1,624,782.65 9. Balance to finish, including retainage (Line 3- Line 4) $ 3,723,061.18 Contractor's Certification The undersigned Contractor certifies, to the best of its knowledge, the following: (1) All previous progress payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for Payment; (2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by this Application for Payment, will pass to Owner at time of payment free and clear of all liens, security interests, and encumbrances (except such as are covered by a bond acceptable to Owner indemnifying Owner against any such liens, security interest, or encumbrances); and (3) All the Work covered by this Applitation for Payment is in accordance with the Contract Dotuments and is not defective. Contractor: North Valley inc. Signature: Date: June 6, 2023 Name: Timothy P. Erickson Tisie: Secretary/Treasurer Recommended by Engineer Approved by Owner By: °A°""'jt�� By: �l�%J'LLG� Name: Jason W. Cook, PE Name: Justin Femrite Title: Project Manager Title: Chlef Date: 6/1/2023 Date: 6-6-23 Code: 401-4-8080-4530 EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professionai Engineers for EJCDC. All rights reserved.