11-13-2024 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: 311,373.60$ 310,505.13$ 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) 8/13/2024 to Original Contract Price 3 & Final 0C1.133275 Contractor's Application for Payment City of Little Canada Insituform Technologies USA, LLC Bolton & Menk, Inc. 2024 Sanitary Sewer Rehab Owner's Project No.: Engineer's Project No.: Agency's Project No.: Contract: Owner: Contractor: Engineer: Project: Application No.: Application Period:10/15/2024 Application Date:10/15/2024 310,505.13$ -$ Net change by Change Orders Amount due this application Contractor: Balance to finish, including retainage (Line 3 - Line 4) -$ Date: Signature: Approved by City of Little CanadaRecommended by Bolton & Menk, Inc. Name: Date: Title: -$ -$ 31,545.12$ 279,828.48$ -$ 311,373.60$ Work Completed Stored Materials Total Retainage (Line 5.a + Line 5.b) Amount eligible to date (Line 4 - Line 5.c) Less previous payments $ 311,373.60 $ - Insituform Technologies USA, LLC Date: Contractor's Certification By: Title: By: Title: 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; and (4) The provisions of M. S. 290.92 have been complied with and that all claims against me by reason of the Contract have been paid or satisfactorily secured. EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. Docusign Envelope ID: 1005EF36-0BB1-4541-9B30-749B49600E91 October 23, 2024 Bruce White Field Engineer Project Manager October 23, 2024 Mitch Hoeft Public Works Director October 24, 2024 Bill Dircks