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Contractor's Application for Pavment <br />Owner: City of Elk River Owner's Project No.: <br />Engineer: Bolton & Menk, Inc. Engineer's Project No.: 0131.128082 <br />Contractor: North Valley Inc. Agency's Project No.: <br />Project: 2023 Street Improvements Project <br />Contract: <br />Application No.: 10 Application Date: 12/5/2024 <br />Application Period: From 8/12/2024 to 12/5/2024 <br />1. Original Contract Price $ 5,433,358.71 <br />2. Net change by Change Orders $ 386,653.88 <br />3. Current Contract Price (Line 1 + Line 2) $ 5,820,012.59 <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Emit Price Total) $ 5,784,866.17 <br />5. Retainage <br />a. 1% X $ 5,784,866.17 Work Completed $ 57,848.66 <br />b. X $ Stored Materials $ - <br />c. Total Retainage (Line 5.a + Line 51) $ 57,848.66 <br />6. Amount eligible to date (Line 4 - Line 5.c) $ 5,727,017.51 <br />7. Less previous payments $ 5,599,599.46 <br />8. Amount due this application $ 127,418.05 <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 applied on <br />account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for <br />Payment; <br />(2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by this Application for <br />Payment, will pass to Owner at time of payment free and clear of all liens, security interests, and encumbrances (except such as <br />are covered by a bond acceptable to Owner indemnifying Owner against any such 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 defective. <br />Contractor: North Valley Inc. <br />Signature: P Date: %-6 <br />Name: - -- Title: P/11� <br />Recommended by Engineer Approved by Owner <br />By: W By, <br />Name: Jason W. Cook, PE Name: Justin Femrite <br />Title: Project Manager Title: Chief <br />Date: 12/5/2024 Date: 12-11-24 <br />Code: 401-4-8080-4530 <br />EICDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for E1CDC. All rights reserved. <br />Page 181 of 273 <br />