10-25-2023 Council Packet - Laserfiche WebLink

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From 1. 2. 3. 4. 5. a.X b.X c. 6. 7. 8. 9. Name:Name: Date: Title: 709,424.00$ 1,222,796.50$ Retainage Current Contract Price (Line 1 + Line 2) Total Work completed and materials stored to date (Sum of Column G Lump Sum Total and Column J Unit Price Total) 10/18/2023 Application Date:10/18/2023 1,010,402.50$ 212,394.00$ Net change by Change Orders 9/1/2023 to Original Contract Price Contractor's Application for Payment Application No.:5 City of Little Canada Albrecht Company Bolton & Menk, Inc. Pioneer Park Improvements Owner's Project No.: Engineer's Project No.: Agency's Project No.: Application Period: Contract: Owner: Contractor: Engineer: Project: 0T6.124526 35,471.20$ -$ 387,804.25$ 286,148.55$ 35,471.20$ 673,952.80$ Work Completed Stored Materials Total Retainage (Line 5.a + Line 5.b) Amount eligible to date (Line 4 - Line 5.c) Less previous payments 5% $ 709,424.00 $ - Date: Signature: Albrecht Company Contractor's Certification Amount due this application Contractor: Balance to finish, including retainage (Line 3 - Line 4)513,372.50$ Date: By: Title: By: Title: Approved by Little Canada 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. Recommended by Bolton & Menk, Inc. Name: EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. DocuSign Envelope ID: C547D3FD-3A00-4B07-A465-43055258AFD6 General Manager October 19, 2023 Matt Johnson Principal Engineer October 19, 2023 Eric Seaburg Bryce Shearan Parks & Recreation Director October 19, 2023