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EJCDC C-620 Contractor's Application for Payment <br />(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. <br />Contractor's Application for Payment <br />Owner:City of Little Canada Owner's Project No.:24-PW42 <br />Engineer:Bolton & Menk, Inc.Engineer's Project No.:0N1.125375 <br />Contractor:Miller Excavating, Inc.Agency's Project No.:200-101-012 <br />Project:2024 Street Improvements <br />Contract: <br />Application No.:1 Application Date:6/3/2024 <br />Application Period:From 5/1/2024 to 5/31/2024 <br />1.Original Contract Price $1,081,937.60 <br />2.Net change by Change Orders $141,942.79 <br />3.Current Contract Price (Line 1 + Line 2)$1,223,880.39 <br />4.Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total)$118,941.17 <br />5.Retainage <br />a.5%X $118,941.17 Work Completed $5,947.06 <br />b.X $-Stored Materials $- <br />c.Total Retainage (Line 5.a + Line 5.b)$5,947.06 <br />6.Amount eligible to date (Line 4 - Line 5.c)$112,994.11 <br />7.Less previous payments <br />8.Amount due this application $112,994.11 <br />9.Balance to finish, including retainage (Line 3 - Line 4)$1,104,939.22 <br />Contractor's Certification <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 />Contractor:Miller Excavating, Inc. <br />Signature:Date: <br />Name:Title: <br />Recommended by Bolton & Menk, Inc.Approved by City of Little Canada <br />By:By: <br />Name:Name: <br />Title:Title: <br />Date:Date: <br />DocuSign Envelope ID: D4F0E498-3363-4DA9-9CFD-AF26210A7479 <br />Mindy Hackett Controller <br />June 3, 2024 <br />Principal Engineer <br />June 3, 2024 <br />Eric Seaburg Bill Dircks <br />Public Works Director <br />June 3, 2024