Laserfiche WebLink
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:Eric Seaburg Name: <br />729,078.58$ <br />Date: <br />By: <br />Title: <br />By: <br />Title: <br />Approved by City 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); 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 />Contractor's Certification <br />Amount due this application <br />Contractor: <br />Balance to finish, including retainage (Line 3 - Line 4) <br />Date: <br />Principal Engineer <br />Signature: <br />Work Completed <br />Stored Materials <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% $ 976,352.28 <br /> $ - <br />48,817.61$ <br />-$ <br />503,720.65$ <br />423,814.02$ <br />48,817.61$ <br />927,534.67$ <br />Contractor: <br />Engineer: <br />Project: <br />23-04 <br />0N1.125376 <br />Contractor's Application for Payment <br />Application No.:3 <br />City of Little Canada <br />OMG Midwest, Inc. Minnesota Paving & Materials <br />Bolton & Menk, Inc. <br />Twin Lake Boulevard Improvements <br />Owner's Project No.: <br />Engineer's Project No.: <br />Agency's Project No.: <br />Application Period: <br />Contract: <br />Owner: <br />9/1/2023 <br />Application Date:9/5/2023 <br />1,618,064.22$ <br />87,366.64$ Net change by Change Orders <br />7/29/2023 to <br />Original Contract Price <br />976,352.28$ <br />1,705,430.86$ <br />Retainage <br />Current Contract Price (Line 1 + Line 2) <br />Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) <br />Date: <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: 09A1206E-C2EB-4A52-8371-CD35D0B267D5 <br />Luke Tulip Project Manager <br />September 7, 2023 <br />September 7, 2023 <br />Bill Dircks <br />Public Works Director <br />September 8, 2023