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200-101-015, 200-101-014, 062-621-014 <br />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: Name: <br />Contractor's Application for Payment <br />Application No.:1 <br />City of Little Canada <br />Husky Construction, Inc. <br />Bolton & Menk, Inc. <br />2026 Little Canada Road Improvements Tree Clearing Quote Project <br />Owner's Project No.: <br />Engineer's Project No.: <br />Application Period: <br />Contract: <br />Owner: <br />Contractor: <br />Engineer: <br />Project: <br />2026-PW-67 <br />Agency's Project No.: <br />By: <br />Title: <br />Date: <br />By: <br />Title: <br />70,851.00$ <br />Date: <br />Signature: <br />Husky Construction, Inc. <br />Contractor's Certification <br />Balance to finish, including retainage (Line 3 - Line 4) <br />Approved by City of 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 />3/1/2026 3/31/2026 <br />Application Date:4/15/2026 <br />to <br />Original Contract Price <br /> $ 74,580.00 <br />16,539.00$ <br /> $ - <br />Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) <br />Retainage <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 />Amount due this application <br />3,729.00$ <br />-$ <br />70,851.00$ <br />5% <br />56,280.00$ <br />Name: <br />34,839.00$ <br />91,119.00$ <br />74,580.00$ <br />0N1.134421 <br />Current Contract Price (Line 1 + Line 2) <br />Contractor: <br />3,729.00$ <br />Net change by Change Orders <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: 5DD4663E-CDB6-492C-A57A-5D30D2CF0975 <br />April 16, 2026 <br />PresidentApril Boogren <br />April 16, 2026 <br />Principal Engineer <br />Eric Seaburg <br />Public Works Director <br />April 16, 2026 <br />Bill Dircks