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From <br />1. <br />2. <br />3. <br />4. <br />5. <br />a.X <br />b.X <br />c. <br />6. <br />7. <br />8. <br />9. <br />Name:Name: <br />48,312.28$ <br />-$ <br />429,781.80$ <br />488,151.47$ <br />48,312.28$ <br />917,933.27$ <br />to <br />Original Contract Price <br />Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) <br />6/25/2022 <br />Balance to finish, including retainage (Line 3 - Line 4) <br />7/24/2022 <br />Application Date:8/2/2022 <br />1,329,210.94$ <br />-$ <br />966,245.55$ <br />1,329,210.94$ <br />Retainage <br />Current Contract Price (Line 1 + Line 2) <br />Net change by Change Orders <br />Contractor's Application for Payment <br />Application No.:3 <br />City of Little Canada <br />OMG Midwest Inc., dba Minnesota <br />Paving & Materials <br />Bolton & Menk, Inc. <br />2022 Street Improvements <br />Owner's Project No.: <br />Engineer's Project No.: <br />Agency's Project No.: <br />Application Period: <br />Contract: <br />Owner: <br />Contractor: <br />Engineer: <br />Project: <br />22-02, 22-03, 22-04, 22-05 <br />0N1.125241 <br />Total Retainage (Line 5.a + Line 5.b) <br />Amount eligible to date (Line 4 - Line 5.c) <br />Less previous payments <br />5% $ 966,245.55 <br /> $ - <br />Work Completed <br />Stored Materials <br />Contractor's Certification <br />Date: <br />Signature: <br />Amount due this application <br />362,965.39$ <br />Approved by City of Little Canada <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); <br />and <br />(3) All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. <br />Recommended by Bolton & Menk, Inc. <br />Name: <br />OMG Midwest Inc., dba Minnesota Paving & Materials <br />Date: <br />Title: <br />Date: <br />By: <br />Title: <br />By: <br />Title: <br />EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />DocuSign Envelope ID: 6B869C52-ED0E-458A-B56D-3089AF31D6F0 <br />August 2, 2022 <br />Dan LoBello Project Manager <br />August 3, 2022 <br />Eric Seaburg <br />PM <br />August 3, 2022 <br />Bill Dircks <br />Public Works Director