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EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. Contractor's Application for Payment Owner:City of Little Canada Owner's Project No.:23-01, 23-02, 23-03, 23-05 Engineer:Bolton & Menk, Inc.Engineer's Project No.:0N1.127995 Contractor:OMG Midwest, Inc. dba. Minnesota Paving & MaterialsAgency's Project No.: Project:2023 Street Improvements Contract: Application No.:2 Application Date:6/30/2023 Application Period:From 6/1/2023 to 6/30/2023 1.Original Contract Price $833,102.17 2.Net change by Change Orders $- 3.Current Contract Price (Line 1 + Line 2)$833,102.17 4.Total Work completed and materials stored to date (Sum of Column G Lump Sum Total and Column J Unit Price Total)$464,272.49 5.Retainage a.5%X $464,272.49 Work Completed $23,213.62 b.X $-Stored Materials $- c.Total Retainage (Line 5.a + Line 5.b)$23,213.62 6.Amount eligible to date (Line 4 - Line 5.c)$441,058.87 7.Less previous payments $182,596.62 8.Amount due this application $258,462.25 9.Balance to finish, including retainage (Line 3 - Line 4)$368,829.68 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 Application for Payment is in accordance with the Contract Documents and is not defective. Contractor:OMG Midwest, Inc. dba. Minnesota Paving & Materials Signature:Date: Name:Title: Recommended by Bolton & Menk, Inc.Approved by City of Little Canada Signature:Signature: Name:Name: Title:Title: Date:Date: DocuSign Envelope ID: 2FC4639E-B904-43BF-A7ED-3EF6A6291650 July 5, 2023 Luke Tulip Project Manager PM July 5, 2023 Eric Seaburg Bill Dircks July 5, 2023 Public Works Director