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Contractor's Application for Payment <br />Owner: City of Elk River Owner's Project No.: <br />Engineer: 8olton & Menk, Inc. Engineer's Project No.: OR1.128082 <br />Contractor: North Valley Inc. Contrector's Project No.: <br />Project: 2023 Street Improvements Project Agency's Project No.: <br />Contract: <br />Application No.: 6 Application From 10/02/23 to 11/03/23 Application Date: 11/06/23 <br />A B C D E F Fl F2 G H I 1 K <br />Contract Information Previous Estimate Work Completed <br />Bid Item <br />No. Description <br />CO-1 WATSON CIRCLE PATCH <br />CO-2.1 REMOVE 12" STORM PIPE <br />CO-2.2 18" RCP STORM PIPE <br />CO-23 CONNECT TO EX MH <br />CO-2.4 81TUMINOUS STREET PATCH <br />CO-2.5 REMOVE & REPLACE CURB & 6 <br />CO-2.6 M081LIZATION <br />CO-2J TRAFFIC CONTROL <br />CO-2.8 6RATED CASTIN6 LID <br />CO-2.9 CLEAR & 6RU8 TREE <br />CO-2.10 R3501-TBCASTIN6ASSEMBLY <br />Item Quantity � Units <br />1.00 LUMP SUM <br />271.00 LIN FT <br />271.00 LIN FT <br />2.00 EACH <br />400.00 SQ YD <br />20.00 LIN FT <br />1.00 LUMPSUM <br />1.00 LUMPSUM <br />1.00 EACH <br />4.00 EACH <br />2.00 EACH <br />Unit Price <br />23.00 <br />96.00 <br />025.00 <br />3133 <br />35.13 <br />125.00 <br />450.00 <br />397.35 <br />675.00 <br />512.00 <br />WorkCompleted %of <br />Estimated Value of Work and Materials Value of <br />Value of Bid Item Quantity Completed to Date Materials Currently Stored Stored to Date Item <br />(C X E) Quantity Previous Value Previous Incorporated in (E X G) (not in G) (H + I) (1 / F) <br />($) estimate estimate the work ($) ($) ($) (%) <br />Change Orders <br />8,483.45 1.00 8,483.45 1.00 8,483.45 8,483.45 100% <br />6,233.00 271.00 6,233.00 271.00 6,233.00 6,233.00 100% <br />26,016.00 271.00 26,016.00 271.00 26,016.00 26,016.00 100% <br />8,050.00 2.00 8,050.00 2.00 8,050.00 8,050.00 100% <br />12,532.00 400.00 12,532.00 400.00 12,532.00 12,532.00 100% <br />702.60 <br />9,125.00 1.00 9,125.00 1.00 9,125.00 9,125.00 100% <br />450.00 1.00 450.00 1.00 450.00 450.00 100% <br />397.35 1.00 397.35 1.00 397.35 39735 100% <br />2,700.00 4.00 2,700.00 4.00 2,700.00 2,700.00 100% <br />1,024.00 2.00 1,024.00 2.00 1,024.00 1,024.00 100% <br />$ 75,713.40 $ 75,010.80 $ 75,010.80 $ - $ 75,010.80 99% <br />Original Contract and Change Orders <br />.11 S 4.258.839.99 S 4.993.579.12 S - S 4.993.579.12 <br />E1CDC C-620 Contractor's Application for Payment <br />Unit Price (c) 2018 National Society of Professional Engineers for E1CDC. All rights reserved. 4 of 4 <br />