2008-111 Council Resolution - Laserfiche WebLink

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• • Original Contract Amount Material Suitably Stored on Site, Change Order No. 1 Change Order No. 2 Change Order No. 3 Change Order No. 4 APPLY ' 'ION FOR PAYMENT NO. 10 (FINAL) $2,231,503.85 Not Incorporated into Work $385,410.00 $8,470.00 $6,300.00 $10,600.98 Total Amount Earned: CO Percent Complete: 100% CO Percent Complete. 100% CO Percent Complete: 100% CO Percent Complete: 100% Gross Amount Due: Less Retainage: Amount Due to Date: Less Previous Applications: Amount Due This Application: $2,151,563.43 $385,410.00 $8,470.00 $6,300.00 $10,600.98 $2,562,344.41 $2,562,344.41 ($2,416,751.27) $145,593.14 CONTRACTOR'S AFFIDAVIT The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress payments received from the Owneron account of work performed under the Contract referred heretofore have been applied by the undersigned to discharge in full all obligations of the undersigned incurred in connection with work covered by prior Applications for Payment under said contract (indicated below), and (2) all material and equipment incorporated in said Project or otherwise iist&1 in or covered by this Application for Payment and free and clear of all liens, claims, security interests and encumbrances. Contract for: Legacy at Woods Edge - Phase 1 Lino Lakes, Minnesota lean Rehbein Companies (Contr:eit /or /het (b1gnature) COUNTY O ) /�, ) SS STATE OF � ii�L.2r —) 8' - 18-08 (Date) ©AOL6 C _ HGEN iJ Pfickt M+u6R (Name and Title) Dena J Sche. en_erger Notary PutA: Minnesota My Commission ides January 31, 2013 Before me on this day of , 20 f personally appeared o , known to be, y did • . e and say that he/she is the rp qna ,,,o .:i. sworn q �v - of the Contractor above mentioned that he/she executed the above Application for aylient and Affidavit on behalf of said. Contractor and that all of the statements contained therein are true, correct, and complete. My commission expires: j The undersigned has checked the Contractor's Application for Payment shown above. A part of this Application is the Contractor's Affidavit stating that all previous payments to him/her under this contract have been applied by him/her to discharge in full all of his/her obligations in connection with the work by all prior Applications for Payment Short Hendrickson Inc Approved by City of Lino Lakes SEH (Signature) 3535 Vadnais Center Drive By Date By Date 45A-4 Ai m ) p� �►� a (Name and ide (Name and Title) St. Paul, Minnesota 55110 Summary Page