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200-101-015, 200-101-014, 062-621-014 From 1. 2. 3. 4. 5. a. X b. X c. 6. 7. 8. 9. Name: Name: Contractor's Application for Payment Application No.: City of Little Canada Husky Construction, Inc. Bolton & Menk, Inc. 2026 Little Canada Road Improvements Tree Clearing Quote Project Owner's Project No.: Engineer's Project No.: Application Period: Contract: Owner: Contractor: Engineer: Project: 2026-PW-67 Agency's Project No.: to 0N1.134421 2 & FINAL Signature: Husky Construction, Inc. Contractor's Certification Balance to finish, including retainage (Line 3 - Line 4) Approved by City of 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. (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. Recommended by Bolton & Menk, Inc. Name: Title: Contractor: Date: N/A By: Title: Date: By: Title: Date: 4/1/2026 5/31/2026 Application Date:7/7/2026 56,280.00$ 34,839.00$ 91,119.00$ 91,629.50$ Current Contract Price (Line 1 + Line 2) -$ Net change by Change Orders Original Contract Price $ 91,629.50 $ - Total Work completed and materials stored to date (Sum of Column G Lump Sum Total and Column J Unit Price Total) Retainage Work Completed Stored Materials Total Retainage (Line 5.a + Line 5.b) Amount eligible to date (Line 4 - Line 5.c) Less previous payments Amount due this application -$ -$ 20,778.50$ 70,851.00$ 91,629.50$ EJCDC C-620 Contractor's Application for Payment (c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved. Docusign Envelope ID: 0E7E4E6F-7587-866C-8247-375F53395ACF July 7, 2026 April Boogren President July 8, 2026 Eric Seaburg Principal Engineer Public Works Director Bill Dircks July 8, 2026