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Contractor's Application for PaymentOwner's Project No.:Engineer's Project No.:Agency's Project No.:4 From09/01/23to 09/21/23A C D E F F1 F2 G H I J K LItem Quantity UnitsUnit Price($)Value of Bid Item(C X E)($)Quantity Previous EstimateValue Previous EstimateEstimated Quantity Incorporated in the WorkValue of Work Completed to Date(E X G)($)Progress Estimate - Unit Price WorkCity of Little CanadaBolton & Menk, Inc.OMG Midwest, Inc. Minnesota Paving & MaterialsTwin Lake Boulevard ImprovementsOwner:0N1.12537623-04Engineer:Contractor:Project:Contract:09/21/23B% of Value of Item (J / F)(%)Balance to Finish (F - J)($)DescriptionWork CompletedMaterials Currently Stored (not in G)($)Work Completed and Materials Stored to Date (H + I)($)Contract InformationBid Item No.Application Date:Application Period:Application No.:Previous Estimate1,664,371.72$ 935,293.14$ 1,150,980.39$ -$ 1,150,980.39$ 69% 513,391.33$ 122 56.00 LF 214.50 12,012.00 56.00 12,012.00 56.00 12,012.00 12,012.00 100% - 123 1.00 LS 4,646.40 4,646.40 1.00 4,646.40 1.00 4,646.40 4,646.40 100% - 124 1.00 EACH 8,237.00 8,237.00 1.00 8,237.00 1.00 8,237.00 8,237.00 100% - 125 60.00 LF 105.60 6,336.00 60.00 6,336.00 60.00 6,336.00 6,336.00 100% - 126 3.00 EACH 2,100.00 6,300.00 3.00 6,300.00 3.00 6,300.00 6,300.00 100% - 127 914.00 LF 3.17 2,897.38 914.00 2,897.38 914.00 2,897.38 2,897.38 100% - 128 309.00 LF 2.04 630.36 309.00 630.36 309.00 630.36 630.36 100% - 41,059.14$ 41,059.14$ 41,059.14$ -$ 41,059.14$ 100% -$ 1,705,430.86$ 976,352.28$ 1,192,039.53$ -$ 1,192,039.53$ 70% 513,391.33$ PROJECT TOTALBASE BID + ALTERNATE 1 + CHANGE ORDER 1 + CHANGE ORDER 2PROJECT TOTALFLUSHING HYDRANTSEDIMENT CONTROL LOG WOOD FIBERCHANGE ORDER 2REMOVE AND REPLACE 29" SPAN RC PIPE-ARCHRECONSTRUCT SANITARY MANHOLE36” STORM JETTING AND TELEVISINGCONSTRUCTION ENTRANCESILT FENCECHANGE ORDER 2 TOTALUnit PriceEJCDC C-620 Contractor's Application for Payment(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.4 of 4DocuSign Envelope ID: 5DD39E2D-55DC-46B1-8BE6-8680F879E5CB
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