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Contractor's Application for Payment No. <br />FINAL <br />To (Owner): City of Elk River <br />Application 6101120'3 to 12/312023 <br />Application Date: <br />Jamnuary 24, 2024 <br />Period: <br />Project: Natures Edge Business Center <br />From (Contractor): <br />Via (Engineer): <br />Hakanson Anderson <br />Third Addition <br />Northwest As halt <br />Application For Payment <br />ORIGINAL CONTRACT PRICE ......... ............. _._.............................. <br />Net change by Change Orders ... ............. ....... ...... ............ ... ....... <br />_..........._. <br />Current Contract Price(Line It2)...... .......................... _................._..... <br />TOTAL COMPLETED AND STORED TO DATE <br />RETAINAGE: <br />a.0% X Work Completed ...................... _...._....._... <br />h. 0% X Stared Material .......... ._.......................... <br />c. Total Retaloage (Line 5.a+ Line S.b)._._......______....._...._............. <br />AMOUNTELIGIBLE TO DATE (Line 4- Line S.c)....._................. __.... <br />MATERIAL ON HAND NOT INSTALLED (75 % of <br />LESS PREVIOUS PAYMENTS .......... ... ....... .......................... <br />�...__.._.... <br />AMOUNT DUE THIS APPLICATION .................. .......... .._..................... <br />Contractor's Certification <br />The undersigned Contractor eenifres. to the best of its knowledge, the follo%%ins: <br />(1) All previous progress payments received from Osmer on account of Work done under the Contract have been <br />applied on account to discharge Contractors legitimate obligations incurred in connection with The Work covered <br />by prior Applications for lrm menu: <br />(2) Title to all Work, materials and equipment incorporated in said Wor6 or otherwise listed in or covered by this <br />Application for payment, win pass to Owner at time or payment frcc and clear of all Liens, security interests, and <br />encumbrances (except such as are covered by a bond acceptable to Owner indemnifying Owner against am, such <br />Liens. security interest, or encumbrances): and <br />(3) All the Rork covered by this Application for Payment is in accordance m1h the Contract Documents and is not <br />defective. <br />Contractq"iguatore <br />S S1,967,329.71 <br />$ 50.00 <br />S SI,967,329.71 <br />S S1,912,656.36 <br />S <br />S S0.00 <br />S S0.00 <br />S S9.00 <br />S S1,912,656.86 <br />S <br />S $1,874,403.72 <br />S SM.253.14 <br />ENGINEER: HAKANSON ANDERSON <br />Certification: We recommend pay:hent for work and quantites shown <br />1-24-2024 <br />(% (Engineer) Date <br />OWNER: CITY OF ELK RIVER <br />L� Zgt72y <br />(Owner) Date <br />Z <br />Page 62 of 201 <br />