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#07 - City Center Public Works Pay Request 5
STAFF REPORT DATE: July 5, 2022 CONSENT AGENDA ITEM: City Center-Public Works Addition Pay Request #5 SUBMITTED BY: Kristina Handt, City Administrator BACKGROUND: At the November 3rd meeting, Council awarded bids for the new city center and public works addition. Also established at that time was Guaranteed Maximum Price (GMP) with H+U for construction costs. The GMP was $13,402,788. ISSUE BEFORE COUNCIL: Should Council approve Pay Request #5 for the City Center and Public Works Addition project? PROPOSAL: Pay request #5 is for $783,990.99. A copy is included in your packet. FISCAL IMPACT: With this pay request, the project remains within budget. OPTION: 1) Approve pay request #5 2) Don’t approve pay request #5 RECOMMENDATION: “Motion to approve Pay Request #5 for the New City Center and Public Works Addition.” ATTACHMENTS: • Pay Request #5 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 5Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:5/31/2022Lake Elmo, MN 55042ARCHITECT FROM (CM): OVERALLCONST. MANAGERHOFFMANN + UHLHORN CONSTRUCTION, INC.5555 W 78TH ST, SUITE AXFILEMINNEAPOLIS, MN 55439CONTRACT DATE:APPLICATION FOR PAYMENTApplication is made for Payment, as shown below,CHANGE ORDER SUMMARYContinuation Sheet, AIA Document G703, is attached.Change Orders Approved inADDITIONSDEDUCTIONS1. COMMITTED COST$13,402,788.00previous months by Owner2. Net Change by Change Orders$0.00TOTAL$0.00$0.003. SUM TO DATE (Line 1+2)$13,402,788.00Approved this Month4. TOTAL COMPLETED & STORED TO DATE $1,727,087.33NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$86,354.35 (Column D+E on G703) b. ___ % of Stored Material$0.00 (Column F on G703)Total Retainage (Line 5a + 5b or Total in Column I of G703)$86,354.35TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$1,640,732.98Net change by Change Orders$0.00 (Line 4 less Line 5 Total)The undersigned Construction Manager certifies that to the best of his 7. LESS PREVIOUS CERTIFICATES FORknowledge, information and belief the Work covered by this Application for PAYMENT (Line 6 from prior Certificate)$856,741.99Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$783,990.99and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $11,762,055.02 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 6/2/2022Notary Public:By:Date:6/2/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$In Accordance with the Contract Documents, based on on-site observations and the(Attach explaination if amount certified differs from the amount applied for).data comprising the above application, the Architect certifies to the Owner that to theARCHITECT:best of the Architect's knowledge, information and belief the Work has progressed asindicated, the quality of the Work is in accordance with the Contract Documents, andBy:Date:the Contractors are entitled to payment of the Amounts Certified.WASHINGTON COUNTY SHERRIFF SUBSTATIONLEO A DALY2022-06-21 CITY OF LAKE ELMO - OVERALLAPPLIC. FOR PAYMENT NO.#5H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 5/31/2022 AIA Document G723,APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification is attached.In tabulations below, amounts are stated to the nearest dollar. ABCDEF GHITEMDESCRIPTION OF WORKSCHEDULEDCHANGEREVISED WORK COMPLETEDTOTAL%BALANCERETAINAGENO.VALUEORDERSSCHEDULEFROMTHIS PERIODCOMPLETED(F/C)TO FINISHVALUEPREV. APPL.AND STORED(C-F)(A+B) TO DATE (D+E)InsuranceBuilders Risk Insurance25,000.000.0025,000.000.000.000.000%25,000.000.000Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.0016,459.606,021.0922,480.699%220,599.311,124.03ReimburseConstruction Management Reimbursables488,555.000.00488,555.0092,191.2541,672.50133,863.7527%354,691.256,693.19FeeConstruction Management Fee82,595.000.0082,595.005,824.075,329.5111,153.5814%71,441.42557.68TrailerTemporary City Office Trailer53,170.000.0053,170.0021,099.212,458.8923,558.1044%29,611.901,177.91ContingencyConstruction Contingency588,330.00(10,782.34)577,547.660.000.000.000%577,547.660.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete668,316.000.00668,316.000.00110,000.00110,000.0016%558,316.005,500.00#0341Strutctural Precast1,755,999.000.001,755,999.0082,373.207,706.8090,080.005%1,665,919.004,504.00#0510Steel Erection93,400.000.0093,400.000.000.000.000%93,400.000.00#0512Steel Supply485,000.009,215.00494,215.000.00251,409.18251,409.1851%242,805.8212,570.46#0610Carpentry & GC1,027,000.000.001,027,000.00137,874.2948,600.00186,474.2918%840,525.719,323.71#0750Roofing & Metal Panels1,113,300.000.001,113,300.000.000.000.000%1,113,300.000.00#0790Caulking & Firestopping72,350.000.0072,350.000.000.000.000%72,350.000.00#0810Doors, Frames, Hardware - Supply171,697.000.00171,697.000.000.000.000%171,697.000.00#0833Coiling & Sectional Doors350,000.000.00350,000.000.000.000.000%350,000.000.00#0840Aluminum Storefronts & Curtainwall400,410.000.00400,410.0011,575.003,380.0014,955.004%385,455.00747.75#0920Drywall & Fireproofing543,770.000.00543,770.0018,000.0070,000.0088,000.0016%455,770.004,400.00#0930Tile154,980.000.00154,980.000.000.000.000%154,980.000.00#0950Acoustical Ceilings & Panels126,000.000.00126,000.000.000.000.000%126,000.000.00#0965Resilient Flooring & Carpet131,940.000.00131,940.0067,900.000.0067,900.0051%64,040.003,395.00#0990Painting and Wallcovering157,727.000.00157,727.000.000.000.000%157,727.000.00#1420Conveying Equipment82,000.000.0082,000.000.0021,577.0021,577.0026%60,423.001,078.85#2100Fire Protection112,915.000.00112,915.005,796.000.005,796.005%107,119.00289.80#2200Plumbing & Heating854,000.000.00854,000.0016,513.0456,796.4573,309.499%780,690.513,665.47#2300HVAC & Controls962,000.000.00962,000.0018,000.0036,677.2554,677.256%907,322.752,733.86#2600Electrical1,454,170.00(3,227.66)1,450,942.3423,175.0039,700.0062,875.004%1,388,067.343,143.75#3100Earthwork & Site Utilities575,790.004,795.00580,585.00247,700.00121,645.00369,345.0064%211,240.0018,467.25#3210Asphalt Paving317,200.000.00317,200.009,929.002,280.0012,209.004%304,991.00610.45#3290Landscaping & Fencing144,630.000.00144,630.000.000.000.000%144,630.000.00#TBDHoist12,000.000.0012,000.000.000.000.000%12,000.000.00TOTAL CONTRACT AMOUNTS13,402,788.000.0013,402,788.00901,833.66825,253.671,727,087.3313%11,675,700.6786,354.35 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 5Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:5/31/2022Lake Elmo, MN 55042ARCHITECT FROM (CM): LABORCONST. MANAGERHOFFMANN + UHLHORN CONSTRUCTION, INC.5555 W 78TH ST, SUITE AXFILEMINNEAPOLIS, MN 55439CONTRACT DATE:APPLICATION FOR PAYMENTApplication is made for Payment, as shown below,CHANGE ORDER SUMMARYContinuation Sheet, AIA Document G703, is attached.Change Orders Approved inADDITIONSDEDUCTIONS1. COMMITTED COST$6,492,541.00previous months by Owner2. Net Change by Change Orders$0.00TOTAL$0.00$0.003. SUM TO DATE (Line 1+2)$6,492,541.00Approved this Month4. TOTAL COMPLETED & STORED TO DATE $896,395.33NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$44,819.75 (Column D+E on G703) b. ___ % of Stored Material$0.00 (Column F on G703)Total Retainage (Line 5a + 5b or Total in Column I of G703)$44,819.75TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$851,575.58Net change by Change Orders$0.00 (Line 4 less Line 5 Total)The undersigned Construction Manager certifies that to the best of his 7. LESS PREVIOUS CERTIFICATES FORknowledge, information and belief the Work covered by this Application for PAYMENT (Line 6 from prior Certificate)$510,991.16Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$340,584.42and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $5,640,965.42 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 6/2/2022Notary Public:By:Date:6/2/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$In Accordance with the Contract Documents, based on on-site observations and the(Attach explaination if amount certified differs from the amount applied for).data comprising the above application, the Architect certifies to the Owner that to theARCHITECT:best of the Architect's knowledge, information and belief the Work has progressed asindicated, the quality of the Work is in accordance with the Contract Documents, andBy:Date:the Contractors are entitled to payment of the Amounts Certified.WASHINGTON COUNTY SHERRIFF SUBSTATIONLEO A DALY2022-06-21 CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSAPPLIC. FOR PAYMENT NO.#5H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 5/31/2022 AIA Document G723,APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification is attached.In tabulations below, amounts are stated to the nearest dollar. ABCDEF GHITEMDESCRIPTION OF WORKSCHEDULEDCHANGEREVISED WORK COMPLETEDTOTAL%BALANCERETAINAGENO.VALUEORDERSSCHEDULEFROMTHIS PERIODCOMPLETED(F/C)TO FINISHVALUEPREV. APPL.AND STORED(C-F)(A+B) TO DATE (D+E)InsuranceBuilders Risk Insurance25,000.000.0025,000.000.000.000.000%25,000.000.000Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.0016,459.606,021.0922,480.699%220,599.311,124.03ReimburseConstruction Management Reimbursables488,555.000.00488,555.0092,191.2541,672.50133,863.7527%354,691.256,693.19FeeConstruction Management Fee82,595.000.0082,595.005,824.075,329.5111,153.5814%71,441.42557.68TrailerTemporary City Office Trailer53,170.000.0053,170.0021,099.212,458.8923,558.1044%29,611.901,177.91ContingencyConstruction Contingency588,330.00(10,782.34)577,547.660.000.000.000%577,547.660.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete428,316.000.00428,316.000.0050,000.0050,000.0012%378,316.002,500.00#0341Strutctural Precast333,704.000.00333,704.000.000.000.000%333,704.000.00#0510Steel Erection93,400.000.0093,400.000.000.000.000%93,400.000.00#0610Carpentry & GC459,000.000.00459,000.00129,274.2948,600.00177,874.2939%281,125.718,893.71#0750Roofing & Metal Panels614,800.000.00614,800.000.000.000.000%614,800.000.00#0790Caulking & Firestopping54,050.000.0054,050.000.000.000.000%54,050.000.00#0833Coiling & Sectional Doors175,000.000.00175,000.000.000.000.000%175,000.000.00#0840Aluminum Storefronts & Curtainwall78,450.000.0078,450.006,995.003,380.0010,375.0013%68,075.00518.75#0920Drywall & Fireproofing314,360.000.00314,360.0018,000.0025,000.0043,000.0014%271,360.002,150.00#0930Tile86,880.000.0086,880.000.000.000.000%86,880.000.00#0950Acoustical Ceilings & Panels51,000.000.0051,000.000.000.000.000%51,000.000.00#0965Resilient Flooring & Carpet41,010.000.0041,010.000.000.000.000%41,010.000.00#0990Painting and Wallcovering128,196.000.00128,196.000.000.000.000%128,196.000.00#1420Conveying Equipment35,260.000.0035,260.000.000.000.000%35,260.000.00#2100Fire Protection55,395.000.0055,395.005,796.000.005,796.0010%49,599.00289.80#2200Plumbing & Heating363,000.000.00363,000.000.0045,005.6745,005.6712%317,994.332,250.28#2300HVAC & Controls300,000.000.00300,000.000.008,677.258,677.253%291,322.75433.86#2600Electrical646,070.00(2,100.00)643,970.0011,380.0013,570.0024,950.004%619,020.001,247.50#3100Earthwork & Site Utilities366,400.004,245.00370,645.00101,850.00108,795.00210,645.0057%160,000.0010,532.25#3210Asphalt Paving136,566.000.00136,566.001,592.000.001,592.001%134,974.0079.60#3290Landscaping & Fencing83,490.000.0083,490.000.000.000.000%83,490.000.00#TBDHoist12,000.000.0012,000.000.000.000.000%12,000.000.00TOTAL CONTRACT AMOUNTS6,492,541.000.006,483,903.66537,885.42358,509.91896,395.3314%5,587,508.3344,819.75 INVOICE SUMMARY-PAYMENT APPLICATION NO. #5CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSPERIOD ENDING 5/31/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE1General ConditionsH+U Construction5/31/22Applic #5$6,021.09$301.05$5,720.04ReimburseConstruction Management ReimbursablesH+U Construction5/31/22Applic #5$41,672.50$2,083.63$39,588.87FeeConstruction Management FeeH+U Construction5/31/22Applic #5$5,329.51$266.48$5,063.03TrailerTemporary City Office TrailerH+U Construction5/31/22Applic #3$2,458.89$122.94$2,335.95#0330Cast-In-Place ConcreteAxel H. Ohman, Inc.5/31/22Applic #1$50,000.00$2,500.00$47,500.00#0610Carpentry & GCEbert Construction5/31/22Applic #6$48,600.00$2,430.00$46,170.00#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.5/31/22Applic #3$3,380.00$169.00$3,211.00#0920Drywall & FireproofingCommercial Drywall5/31/22Applic #3$25,000.00$1,250.00$23,750.00#2200Plumbing & HeatingPeterson Sheet Metal5/31/22Applic #1$45,005.67$2,250.28$42,755.39#2300HVAC & ControlsSt. Cloud Refrigeration5/31/22Applic #1$8,677.25$433.86$8,243.39#2600ElectricalVinco, Inc.5/31/22Applic #3$13,570.00$678.50$12,891.50#3100Earthwork & Site UtilitiesPark Construction Company5/31/22Applic #2$108,795.00$5,439.75$103,355.25SUBTOTAL AMOUNT DUE$358,509.91$17,925.49$340,584.42 TOTAL AMOUNT DUE $340,584.42 INVOICE : 220145 PROJECT: J21001 MAY 31, 2022 PAGE 1 OF 2 TO:CITY OF LAKE ELMO 3880 Laverne Ave N Lake Elmo, MN 55042 ATTN:ACCOUNTING RE:LAKE ELMO CITY CENTER & LAKE ELMO PUBLIC WORKS ADDITION Invoice for Construction Management services performed during the month of May, 2022 CONSTRUCTION MANAGEMENT REIMBURSABLES Project Director 1.50 hrs. @ 150.00 $225.00 Project Controller 3.00 hrs. @ 125.00 $375.00 Senior Project Manager 66.00 hrs. @ 125.00 $8,250.00 Project Manager 102.00 hrs. @ 105.00 $10,710.00 Project Administrator/Accountant 18.50 hrs. @ 65.00 $1,202.50 Project Superintendent 182.00 hrs. @ 105.00 $19,110.00 Truck, Travel, & Small Tools 1 mo. @ 1,400.00 $1,400.00 Field Office Equipment 1 mo. @ 400.00 $400.00 $41,672.50 GENERAL CONDITIONS Temporary City Office Trailer $2,458.89 Plan Prints/Shipping $233.15 Expendable Supplies $1,570.00 Temporary Toilets $193.28 Safety & OSHA $622.09 Trash Removal $160.00 Scaffold Rental $1,217.63 Utility Service - Xcel $161.00 Sunde Land Surveying $1,863.94 $8,479.98 $50,152.48 Contractor's Pay Applications May 31, 2022 #0330-Labor Axel H. Ohman, Inc.$50,000.00 #0330-Material Axel H. Ohman, Inc.$60,000.00 #0341-Material Wells Concrete $7,706.80 #0512-Material Construction Systems, Inc.$251,409.18 #0610-Labor Ebert Construction $48,600.00 Subtotal Construction Management Reimbursables Subtotal Reimbursable Expenses Total INVOICE : 220145 PROJECT: J21001 MAY 31, 2022 PAGE 2 OF 2 TO:CITY OF LAKE ELMO 3880 Laverne Ave N Lake Elmo, MN 55042 ATTN:ACCOUNTING RE:LAKE ELMO CITY CENTER & LAKE ELMO PUBLIC WORKS ADDITION Contractor's Pay Applications May 31, 2022 #0840-Labor Empirehouse Inc.$3,380.00 #0920-Labor Commercial Drywall, Inc.$25,000.00 #0920-Material Commercial Drywall, Inc.$45,000.00 #1420-Material Schindler Elevator Corporation $21,577.00 #2200-Labor Peterson Sheet Metal, Inc.$45,005.67 #2200-Material Peterson Sheet Metal, Inc.$11,790.78 #2300-Labor St.Cloud Refrigeration, Inc.$8,677.25 #2300-Material St.Cloud Refrigeration, Inc.$28,000.00 #2600-Labor Vinco, Inc.$13,570.00 #2600-Material Vinco, Inc.$26,130.00 #3100-Labor Park Construction Company $108,795.00 #3100-Material Park Construction Company $12,850.00 #3210-Material Ebert Construction $2,280.00 $769,771.68 $5,329.51 $825,253.67 Retainage Current Retainge 41,262.67 Prior Retainage 45,091.68 Retainage-To-Date 86,354.35 Total Amount Due $783,990.99 CONSTRUCTION MANAGEMENT FEE Total Contractor's Pay Applications May 1 - May 31 Total Before Retainage Customer No. C51148 H U Construction 5555 W78th St Suite A Minneapolis, MN 55439 Bill to:Ship to:City of Lake Elmo 24x60 Doublewide Office s/n 15809A/10B Gabe 651-395-0055 3800 Laverne Ave. North Lake Elmo, MN 55042 Satellite Quote No. RC520567 Contract No Matt Lawellin Salesperson 06/09/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:05/10/2022 INV570263 Tracy DickensonAccount Rep: PO Box 860700 Minneapolis, MN 55486-0700 Phone: (763) 553-1900 Rental Insurance Status: Customer No. C51148 H U Construction 5555 W78th St Suite A Minneapolis, MN 55439 Bill to:Ship to:City of Lake Elmo 24x60 Doublewide Office s/n 15809A/10B Gabe 651-395-0055 3800 Laverne Ave. North Lake Elmo, MN 55042 Satellite Quote No. RC520567 Contract No Matt Lawellin Salesperson 06/09/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:05/10/2022 INV570263 Tracy DickensonAccount Rep: PO Box 860700 Minneapolis, MN 55486-0700 Phone: (763) 553-1900 Rental Insurance Status: Customer No. C51148 H U Construction 5555 W78th St Suite A Minneapolis, MN 55439 Bill to:Ship to:City of Lake Elmo 24x60 Doublewide Office s/n 15809A/10B Gabe 651-395-0055 3800 Laverne Ave. North Lake Elmo, MN 55042 Satellite Quote No. RC520567 Contract No Matt Lawellin Salesperson 06/09/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:05/10/2022 INV570263 Tracy DickensonAccount Rep: PO Box 860700 Minneapolis, MN 55486-0700 Phone: (763) 553-1900 NO INS No.Description Serial No. Rental From Date Rental To Date Qty.Unit Price Amount Customer Project RC520567 0 0.00 0.00 FA204334 24x60 Doublewide Office w/RR s/n 15809A/10B 15809A/10B 05/10/22 06/06/22 1 2,000.00 2,000.00 RR not utilized no need to winterize. STEPS Steps - Rental 05/10/22 06/06/22 2 45.00 90.00 44130 Damage Waiver Chg - No Insurance on File 1 200.00 200.00 Subtotal:2,290.00 Tax:168.89 Total:2,458.89 Thank You For Your Business! 20050 75th Ave N Hamel, MN 55340-9459 Phone No.: 763-420-2001 Fax No.: 763-420-2034 Satellite Shelters, Inc - Minneapolis InvoiceSatellite Shelters, Inc - Minneapolis Lockbox Remit to address:Page 1 of 1 ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90502785/5/2022 INVOICEDATE Page 1/1 5555 WEST 78TH STREET SUITE AMINNEAPOLIS, MN 55439 P: (952) 837-3309 F: (952) 831-1268 H+U CONSTRUCTION BILL TO:SHIP TO: Luke Nelson 5555 WEST 78TH STREETSUITE A MINNEAPOLIS, MN 55439 P: (952) 837-3309F: (952) 831-1268 H+U CONSTRUCTION 54MNO90469575/5/2022NET30ARC DELIVERY1016013PR-15R OrderOrder Due DatePayment TermsShipping MethodCustomer IDPurchase Order # Lake ElmoJ21001Lisa Knox Project NameProject NumberOrdered By Extended PricePriceDescriptionItem NumberUOM Quantity BO Quantity Shipped Quantity Ordered 1 set of 5 (30.00x42.00) $4.95$0.10989Bond Prints - First Set1600SQFT0.0045.0045.00 $35.00$35.00Supply / Delivery Charge5201EACH011 $3.95$3.95Energy / Fuel Surcharge5205EACH011 $47.21Total Due Amount Received $47.21Total $0.00Trade Discount $0.00Freight $3.31Tax $0.00Misc $43.90SubtotalllakotasBiller: $47.215/5/202254MNI90502781016013 AMOUNT DUEDOC DATEINVOICECUSTOMER NO ARC DOCUMENT SOLUTIONS LLC NEW REMIT TO ADDRESS PO BOX 645913CINCINNATI, OH 45264-5913 (216) 539-1501 We accept: Visa | MasterCard | American Express | Discover Card/Check Number:______________________ Exp. Date: __________ Signature:_______________________________ Amount: $___________ REMIT PAYMENT TO HTTPS://PAY.ARCREMOTE.COM/P/A6D6EE32-BA2B-42E8-8B9E-1CC0A2BA9A88 QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90504935/16/2022 INVOICEDATE Page 1/1 5555 WEST 78TH STREET SUITE AMINNEAPOLIS, MN 55439 P: (952) 837-3309 F: (952) 831-1268 H+U CONSTRUCTION BILL TO:SHIP TO: Luke Nelson 5555 WEST 78TH STREETSUITE A MINNEAPOLIS, MN 55439 P: (612) 438-0258 H+U CONSTRUCTION 54MNO90471465/11/2022NET30ARC DELIVERY1016013ASI 12R OrderOrder Due DatePayment TermsShipping MethodCustomer IDPurchase Order # Lake ElmoJ21001Lisa Knox Project NameProject NumberOrdered By Extended PricePriceDescriptionItem NumberUOM Quantity BO Quantity Shipped Quantity Ordered 1 set of 9 (30.00x42.00) $8.90$0.10989Bond Prints - First Set1600SQFT0.0081.0081.00 $35.00$35.00Supply / Delivery Charge5201EACH011 $3.95$3.95Energy / Fuel Surcharge5205EACH011 $51.45Total Due Amount Received $51.45Total $0.00Trade Discount $0.00Freight $3.60Tax $0.00Misc $47.85SubtotalllakotasBiller: $51.455/16/202254MNI90504931016013 AMOUNT DUEDOC DATEINVOICECUSTOMER NO ARC DOCUMENT SOLUTIONS LLC NEW REMIT TO ADDRESS PO BOX 645913CINCINNATI, OH 45264-5913 (216) 539-1501 We accept: Visa | MasterCard | American Express | Discover Card/Check Number:______________________ Exp. Date: __________ Signature:_______________________________ Amount: $___________ REMIT PAYMENT TO HTTPS://PAY.ARCREMOTE.COM/P/8748403A-7C7C-48C5-97A6-3655FB9A2D45 QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90504945/16/2022 INVOICEDATE Page 1/1 5555 WEST 78TH STREET SUITE AMINNEAPOLIS, MN 55439 P: (952) 837-3309 F: (952) 831-1268 H+U CONSTRUCTION BILL TO:SHIP TO: Luke Nelson 5555 WEST 78TH STREETSUITE A MINNEAPOLIS, MN 55439 P: (612) 438-0258 H+U CONSTRUCTION 54MNO90471475/11/2022NET30ARC DELIVERY1016013ASI 10 OrderOrder Due DatePayment TermsShipping MethodCustomer IDPurchase Order # Lake ElmoJ21001Lisa Knox Project NameProject NumberOrdered By Extended PricePriceDescriptionItem NumberUOM Quantity BO Quantity Shipped Quantity Ordered 1 set of 22 (30.00x42.00) $29.70$0.15Wide Format Smart Color Prints Full Size - First Set 1634SQFT0.00198.00198.00 $31.93Total Due Amount Received $31.93Total $0.00Trade Discount $0.00Freight $2.23Tax $0.00Misc $29.70SubtotalllakotasBiller: $31.935/16/202254MNI90504941016013 AMOUNT DUEDOC DATEINVOICECUSTOMER NO ARC DOCUMENT SOLUTIONS LLC NEW REMIT TO ADDRESS PO BOX 645913CINCINNATI, OH 45264-5913 (216) 539-1501 We accept: Visa | MasterCard | American Express | Discover Card/Check Number:______________________ Exp. Date: __________ Signature:_______________________________ Amount: $___________ REMIT PAYMENT TO HTTPS://PAY.ARCREMOTE.COM/P/270C14E5-3440-47C9-B1D9-D487C7947EA4 QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90506285/20/2022 INVOICEDATE Page 1/1 5555 WEST 78TH STREET SUITE AMINNEAPOLIS, MN 55439 P: (952) 837-3309 F: (952) 831-1268 H+U CONSTRUCTION BILL TO:SHIP TO: Luke Nelson 5555 WEST 78TH STREETSUITE A MINNEAPOLIS, MN 55439 P: (952) 837-3309F: (952) 831-1268 H+U CONSTRUCTION 54MNO90472475/18/2022NET30ARC DELIVERY1016013ASI 16 OrderOrder Due DatePayment TermsShipping MethodCustomer IDPurchase Order # Lake ElmoJ21001Lisa Knox Project NameProject NumberOrdered By Extended PricePriceDescriptionItem NumberUOM Quantity BO Quantity Shipped Quantity Ordered 1 set of 14 (30.00x42.00) $13.85$0.10989Bond Prints - First Set1600SQFT0.00126.00126.00 $35.00$35.00Supply / Delivery Charge5201EACH011 $3.95$3.95Energy / Fuel Surcharge5205EACH011 $56.78Total Due Amount Received $56.78Total $0.00Trade Discount $0.00Freight $3.98Tax $0.00Misc $52.80SubtotalllakotasBiller: $56.785/20/202254MNI90506281016013 AMOUNT DUEDOC DATEINVOICECUSTOMER NO ARC DOCUMENT SOLUTIONS LLC NEW REMIT TO ADDRESS PO BOX 645913CINCINNATI, OH 45264-5913 (216) 539-1501 We accept: Visa | MasterCard | American Express | Discover Card/Check Number:______________________ Exp. Date: __________ Signature:_______________________________ Amount: $___________ REMIT PAYMENT TO HTTPS://PAY.ARCREMOTE.COM/P/C02DCC31-6060-4803-A94C-4CA8F80F721C QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90506565/23/2022 INVOICEDATE Page 1/1 5555 WEST 78TH STREET SUITE AMINNEAPOLIS, MN 55439 P: (952) 837-3309 F: (952) 831-1268 H+U CONSTRUCTION BILL TO:SHIP TO: Luke Nelson 5555 WEST 78TH STREETSUITE A MINNEAPOLIS, MN 55439 P: (952) 837-3309F: (952) 831-1268 H+U CONSTRUCTION 54MNO90473065/23/2022NET30ARC DELIVERY1016013Wet Sprinkler Systems OrderOrder Due DatePayment TermsShipping MethodCustomer IDPurchase Order # Lake ElmoJ21001Lisa Knox Project NameProject NumberOrdered By Extended PricePriceDescriptionItem NumberUOM Quantity BO Quantity Shipped Quantity Ordered 1 set of 2 (36.00x48.00) $2.64$0.10989Bond Prints - First Set1600SQFT0.0024.0024.00 $35.00$35.00Supply / Delivery Charge5201EACH011 $3.95$3.95Energy / Fuel Surcharge5205EACH011 $44.72Total Due Amount Received $44.72Total $0.00Trade Discount $0.00Freight $3.13Tax $0.00Misc $41.59SubtotalllakotasBiller: $44.725/23/202254MNI90506561016013 AMOUNT DUEDOC DATEINVOICECUSTOMER NO ARC DOCUMENT SOLUTIONS LLC NEW REMIT TO ADDRESS PO BOX 645913CINCINNATI, OH 45264-5913 (216) 539-1501 We accept: Visa | MasterCard | American Express | Discover Card/Check Number:______________________ Exp. Date: __________ Signature:_______________________________ Amount: $___________ REMIT PAYMENT TO HTTPS://PAY.ARCREMOTE.COM/P/146C7321-B45C-4B1B-BE11-2C2B13005C84 QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90506575/23/2022 INVOICEDATE Page 1/1 5555 WEST 78TH STREET SUITE AMINNEAPOLIS, MN 55439 P: (952) 837-3309 F: (952) 831-1268 H+U CONSTRUCTION BILL TO:SHIP TO: Luke Nelson 5555 WEST 78TH STREETSUITE A MINNEAPOLIS, MN 55439 P: (952) 837-3309F: (952) 831-1268 H+U CONSTRUCTION 54MNO90473215/23/2022NET30ARC DELIVERY1016013ASI 19R OrderOrder Due DatePayment TermsShipping MethodCustomer IDPurchase Order # Lake ElmoJ21001Lisa Knox Project NameProject NumberOrdered By Extended PricePriceDescriptionItem NumberUOM Quantity BO Quantity Shipped Quantity Ordered 1 set of 1 (30.00x42.00) $0.99$0.10989Bond Prints - First Set1600SQFT0.009.009.00 $1.06Total Due Amount Received $1.06Total $0.00Trade Discount $0.00Freight $0.07Tax $0.00Misc $0.99SubtotalllakotasBiller: $1.065/23/202254MNI90506571016013 AMOUNT DUEDOC DATEINVOICECUSTOMER NO ARC DOCUMENT SOLUTIONS LLC NEW REMIT TO ADDRESS PO BOX 645913CINCINNATI, OH 45264-5913 (216) 539-1501 We accept: Visa | MasterCard | American Express | Discover Card/Check Number:______________________ Exp. Date: __________ Signature:_______________________________ Amount: $___________ REMIT PAYMENT TO HTTPS://PAY.ARCREMOTE.COM/P/B1D28496-B1E9-43DA-B0BE-1E4F87FB5E68 QuickPay Online Payment Scan or Click Branch:100 St. Paul 1288267 Invoice Date Page INVOICE 3241401 ORDER NUMBER Columbus, MN 55025 9205 Lake Drive NE Viking Industrial Center 1 of 1651-646-6141 INVOICE 5/17/2022 Please Note New Remittance Address Bill To:Ship To: Lake Elmo, MN 55042 3800 Laverne Ave N H+U Construction - Lake Elmo City CenterH+U Construction 5555 West 78th Street Suite A Minneapolis, MN 55439 Customer ID:106629 Ordered By: Gabe . Delivery Instructions:Contact Gabe 651.395.0055 DOUG GEIST Tracking #:Carrier: Net Due Date Discount AmountDisc Due DateTerm DescriptionPO Number Lake Elmo Net 30 6/16/2022 6/16/2022 0.00 Primary Salesrep NameOrder Date Pick Ticket No Taker 5/11/2022 09:27:25 2268514 Douglas P. Geist TWOODBURY Item ID Item DescriptionOrderedShippedRemaining Quantities UOM Disp.Unit Size Pricing UOM Unit PriceUnit Size Price Extended 14.00 0.00 EA V9M2-BASE15 EA 21.263514 297.69 1.0 1.0000 14.00 15LB BASE ONLY FOR DELINEATOR POST 15 Pound Base Only (for use with POST42A - 42" Delineator Post) 14.00 0.00 EA V9M2-POST42A EA 14.800000 207.20 1.0 1.0000 14.00 DELINEATOR POST W/2 3 REFL BANDS Delineator Post ONLY with two 3" Reflective Bands (use with BASE15 - 15 lb. base) SUB-TOTAL:Total Lines:2 504.89 MN STATE TAX 34.72: MN SPECIAL TAX 2.53: 542.14AMOUNT DUE: ORIGINAL12.17.2242 - 11/12/15 Goods may be returned within 30 days of this invoice for credit, exchange or replacement only with authoriztion, and subject to inspection and restocking charges. ALL Respiratory, Fall Protection, Special Order and Custom Items are NON-RETURNABLE. Interest at 1.5% per month (18% annum) will be charged on past due accounts. Rev 2 Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221 Invoice #W862038 5/18/2022 W862038 1 of 2 Bill To C57180Hoffman & Uhlhorn Const Inc5555 W 78th StSte AMinneapolis MN 55439United States Location L136962Lake Elmo Public Facilities3800 Laverne Ave NLake Elmo MN 55042United States Invoice Total $193.28 Balance Due $193.28 Due Date: 6/15/2022 Terms Due Date PO #Sales Rep Builders Club# Net 28 6/15/2022 -Jeff Foley Qty Item Days Sales Order #Service Level Rate Amount 1 RENTAL RegularUnit Apr 20-May 17 28 385563 -$4.00 $4.00 1 SERVICEService Apr 20-May 17 28 385563 1X/wk $70.00 $70.00 1 SERVICEClimateSvc Apr 20 to May 17 28 385563 1X/wk $16.00 $16.00 1 RENTAL HandSani Apr 20-May 17 28 385563 -$0.00 $0.00 1 RENTALRegularUnit Apr 20-May 17 28 386930 -$4.00 $4.00 1 SERVICE Service Apr 20-May 17 28 386930 1X/wk $70.00 $70.00 1 SERVICEClimateSvc Apr 20 to May 17 28 386930 1X/wk $16.00 $16.00 1 RENTAL HandSani Apr 20-May 17 28 386930 -$0.00 $0.00 0 TAX-MNTax-MN ---$0.00 $12.38 0 TAX-WASH Tax-WASH ---$0.00 $0.90 Subtotal $193.28 Invoice Total $193.28 Credits/Payments Applied $0.00 Balance Due $193.28 Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221 Invoice #W862038 5/18/2022 W862038 2 of 2 Biffs Inc.Remittance Slip Make Checks Payable To Customer L136962 Hoffman & Uhlhorn Const Inc : Lake Elmo Public Facilities Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202 Please return this portion with your payment. Invoice #W862038 Amount Due $193.28 Amount Paid ______________________ Branch:100 St. Paul 1248816 Invoice Date Page INVOICE 3241907 ORDER NUMBER Columbus, MN 55025 9205 Lake Drive NE Viking Industrial Center 1 of 1651-646-6141 INVOICE 5/24/2022 Please Note New Remittance Address Bill To:Ship To: Lake Elmo, MN 55042 3800 Laverne Ave N H+U Construction - Lake Elmo City CenterH+U Construction 5555 West 78th Street Suite A Minneapolis, MN 55439 Customer ID:106629 Ordered By: Gabe . Delivery Instructions:Contact Gabe 651.395.0055 DOUG GEIST Tracking #:Carrier: Net Due Date Discount AmountDisc Due DateTerm DescriptionPO Number Lake Elmo Net 30 6/23/2022 6/23/2022 0.00 Primary Salesrep NameOrder Date Pick Ticket No Taker 3/24/2022 10:45:41 2267874 Douglas P. Geist TWOODBURY Item ID Item DescriptionOrderedShippedRemaining Quantities UOM Disp.Unit Size Pricing UOM Unit PriceUnit Size Price Extended 4.00 0.00 EA V66-FM-RF EA 144.840000 579.36 1.0 1.0000 6.00 FIRE-MATE FIRE EXTING STAND HOLDER RED Fire-Mate Fire Extinguisher Stand Holder - Red SUB-TOTAL:Total Lines:1 579.36 MN STATE TAX 39.83: MN SPECIAL TAX 2.90: 622.09AMOUNT DUE: ORIGINAL12.17.2242 - 11/12/15 Goods may be returned within 30 days of this invoice for credit, exchange or replacement only with authoriztion, and subject to inspection and restocking charges. ALL Respiratory, Fall Protection, Special Order and Custom Items are NON-RETURNABLE. Interest at 1.5% per month (18% annum) will be charged on past due accounts. Rev 2 Invoice Date 5/20/2022 Invoice # 342808Customer HU Construction, Inc. 5555 W 78th St Suite A Minneapolis, MN 55439 Service Address LECC 3880 Laverne Ave N Lake Elmo, MN 55042 P.O. No.Terms Net 30 Total Balance Due Payments/Credits All invoices paid by credit card are subject to a convenience fee. Questions on this invoice? Want your invoices to be emailed? Please send your request to ar@atomicrecycling.com Service Date DescriptionTicket QtyUnit of Measure Rate Amount 5/16/2022 Re-Spot @ $160.00712509 1Each 160.00 160.00 $160.00 $160.00 $0.00 Invoice A116430 Scaffold Service P.O.Box 74008409 Chicago, IL 60674-8409 Send Payment To: Customer H + U CONSTRUCTION 5555 W 78TH ST ATTN: ACCOUNTS PAYABLE MINNEAPOLIS, MN 55439-2702, USA Order PO: J21001 Number A14121 Job Site 11170 - LAKE ELMO CITY STAIR 5/6/2022Date Job Site Shipping Address: 3880 LAVERNE AVE N LAKE ELMO, MN 55042-9627 Created: 5/6/2022 M: Minimum rental appliesR: Rate change applies Rental Items Shipment Part Number Description Qty From To Days 28-Day Ra Total DEL-308542 28-Day Rent Base Rental Package, per 28 Days 1 5/5/2022 5/11/2022 7 (M)$220.0000 0 $55.00 Rent $55.00 Non-Rental Items Number Date Name Description Units No. Units Price/Unit Taxable Total 20-LABOR DEL-308542 5/5/2022 01 -INSTALL Installation of Scaffold EA 1 $979.00 Yes $979.00 30-FREIGHT DEL-308542 5/5/2022 03 - DELIVER Delivery Charges EA 1 $100.00 Yes $100.00 Total Additional Charges $1,079.00 Subtotal $1,217.63 Other tax: (none)$0.00 $83.63 $1,134.00 Sales tax: MN - LAKE ELMO CITY TAX (7.375%) Invoice Total Printed: May 06, 2022 2:46:10 PM Page 1 of 1A116430 Sunde Land Surveying, LLC 9001 E. Bloomington Frwy. #118 Bloomington, MN 55420-3435 Tel: (952) 881-2455 Fax: (952) 888-9526 Billing Questions Contact Maria Way 952-886-3150 www.sunde.com H+U - 3445 Ideal Ave N (2021-006-C:) - Managed by (022 LLA) Invoice Federal ID # 41-1923510 Invoice Date: May 25, 2022 Invoice Num: 56336 Billing Through: May 25, 2022 Luke Nelson H+U Construction 5555 W 78th Street - Suite A Minneapolis, MN 55439- 05/06 - Converted civil CAD file for construction computations. 05/09 - Converted structural CAD file and placed in construction computation file. - Will finalize grid computations after the field crew locates building corners. 05/10 - Computed grids B, J.9, 4 and 10 for filed layout. - Used control to establish a baseline and set control points with total. - Located building corners and called in coordinates. - Set grid offsets on 4, 6, 10, B, M & J.9. Hours Professional Services Rate AmountDateEmployeeDescription $140.00$140.00 1.00Construction Comps022 LLA5/6/2022 $210.00$140.00 1.50Construction Comps022 LLA5/9/2022 $140.00$140.00 1.00Construction Comps022 LLA5/10/2022 $660.00$110.00 6.00Stake Grid Lines229 JPF5/10/2022 $636.00$106.00 6.00Stake Grid Lines236 GRP5/10/2022 $1,786.00Total Service Amount: Reimbursable Expenses: EmployeeDate AmountDescription Mileage5/10/2022 229 JPF $38.94 Hubs & Lath5/10/2022 229 JPF $12.00 Iron Monuments5/10/2022 229 JPF $27.00 $77.94Total Expenses: Amount Due This Invoice:$1,863.94 This invoice is due upon receipt For billing questions, please contact Maria Way at 952-886-3150 BillQuick Standard Report Copyright © BQE Software, Inc.Page 1 of 1 47,500.005/31/22 46,170.005/31/22 3,211.00 78,450.00 0.00 78,450.00 10,375.00 518.75 9,856.25 6,645.25 0.00 0.00 10,375.00 Page 1 Certificate of the Subcontractor: I hereby certify that the work performed and the materials supplied to date as shown on the above represent the actual value of accomplishment under the terms of the contract (and all authorized changes thereto) between the undersigned and H+U Construction relating to the above-referenced project. I also certify that Payments, less applicable retention, have been made through the period covered by previous payments received from the contractor, to (1) all my subcontractors (sub-subcontractors) and (2) for all materials and labor used in connection with the performance of this contract. I further certify I have complied with Federal, State and Local tax laws, including Social Security laws and unemployment laws and Workmen's Compensation laws insofar as applicable to the performance of this contract. Furthermore, in consideration of this request of the payments received and upon receipt of the amount of this request, the undersigned does hereby waive, release, and relinquish all claims or right of lien which the undersigned may now have upon the premises above described except for claims or right of lien for contract and/or change order work performed to the extent that payment is being retained or will subsequently become due. Original contract sum Net change by change orders (as per attached breakdown) Contract sum to date Completed to date (as per attached breakdown) Total retainage (5.0%) Total earned less retainage Less previous certificates of payment Sales tax at 0.000% on 0.00 Amount of this request Stored material (as per attached breakdown) Total completed and stored to date Subtotal 3,211.00 Empirehouse Inc. 5200 Quincy StreetMounds View, MN 55112 To: From: Phone: Project:Lake Elmo City Center (L)3880 Laverne Avenue N. Lake Elmo, MN 55042 Application No: 3 Date: 05/01/22 Period To: 05/30/22 Contract For: Contract Date: Contractor Job Number:21152 Date: __________________________________ Subscribed and sworn to before me this _____ day of ____________, _________ (year). Notary public: _____________________________ My commission expires ____________________. Contractor: Empirehouse Inc. By: ____________________________________ Title: ___________________________________ (763) 535-1150 Application and Certificate For Payment H+U Construction5555 West 78th Street Suite A Edina, MN 55439 May 17, 2022 17 May 2022 January 31, 2025 Kristine Hutera, CEO 010500 010600 020550 020551 020552 021050 021550 029050 029051 031050 040550 041050 042050 059000 1,115.00 1,115.00 0.00 0.00 1,115.00 100.00 55.750.00 9,260.00 5,880.00 3,380.00 0.00 9,260.00 100.00 463.000.00 12,085.00 0.00 0.00 0.00 0.00 0.00 0.0012,085.00 6,820.00 0.00 0.00 0.00 0.00 0.00 0.006,820.00 2,225.00 0.00 0.00 0.00 0.00 0.00 0.002,225.00 18,906.00 0.00 0.00 0.00 0.00 0.00 0.0018,906.00 5,962.00 0.00 0.00 0.00 0.00 0.00 0.005,962.00 6,820.00 0.00 0.00 0.00 0.00 0.00 0.006,820.00 2,146.00 0.00 0.00 0.00 0.00 0.00 0.002,146.00 2,146.00 0.00 0.00 0.00 0.00 0.00 0.002,146.00 1,560.00 0.00 0.00 0.00 0.00 0.00 0.001,560.00 2,340.00 0.00 0.00 0.00 0.00 0.00 0.002,340.00 195.00 0.00 0.00 0.00 0.00 0.00 0.00195.00 6,870.00 0.00 0.00 0.00 0.00 0.00 0.006,870.00 78,450.00 6,995.00 3,380.00 0.00 10,375.00 13.22 518.7568,075.00 To:H+U Construction From (Subcontractor):Empirehouse Inc. Project:Lake Elmo City Center (L) Application and Certificate For Payment -- page 2 Application No: 3 Date: 05/01/22 Item Number Description ScheduledValue Work Completed Previous Application This Period Materials Presently Stored Completed and Stored to Date %Balance to Finish Retention Memo Bonds Submittals/PM/CAD/Admin SF Installation CW Installation Housekeeping Window Installation Skylight Installation Ballistic Window Install Hurricane Window Install Mock-up Installation Borrowed Lite Installati Heavy Wall Installation Mirrors Installation Equipment Application Total Period To: 05/30/22 Contractor's Job Number: 21152 5/31/22 8,243.39 5/31/22 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702/CMa PAGE ONE OF 2 PAGES APPLICATION NO:02 Distribution to: OWNER PERIOD TO: 05/31/22 LABOR X CONSTRUCTION PROJECT NO.: 21725 MANAGER ARCHITECT CONTRACT DATE:11/04/21 CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract.information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached.completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $366,400.00 2. Net change by Change Orders $4,245.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 ± 2) $$370,645.00 4. TOTAL COMPLETED & STORED TO DATE $210,645.00 (Column G on G703)By: Date: 5. RETAINAGE: a.5.0 % of Completed Work $10,532.25 State of: Minnesota County of: (Column D + E on G703)Subscribed and sworn to before me this day of b.0.0 % of Stored Material $0.00 Notary Public: (Column F on G703)My Commission expires: Total Retainage (Lines 5a + 5b or Total in Column I of G703) $10,532.25 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $200,112.75 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 Less Line 5 Total)comprising the application, the Construction Manager and Architect certify to the 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has PAYMENT (Line 6 from prior Certificate) $96,757.50 progressed as indicated, the qualtity of the Work is in accordance with the Contract 8. CURRENT PAYMENT DUE $103,355.25 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE $170,532.25 (Line 3 less Line 6)AMOUNT CERTIFIED $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied for. Initial all Total changes approved figures on this Application and on the Continuation Sheet that changed to conform to the in previous months by Owner $0.00 $0.00 amount certified.) CONSTRUCTION MANAGER: Total approved this Month $4,245.00 $0.00 By: Date: ARCHITECT: TOTALS $4,245.00 $0.00 By: Date: NET CHANGES by Change Order This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702/CMa · APPLICATION AND CERTIFICATION FOR PAYMENT · CONSTRUCTION MANAGER-ADVISER EDITION · 1992 EDITION · AIA · ©1992 G702/CMa - 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity VIA ARCHITECT: Park Construction Company 1481 81st Ave NE CONSTRUCTION MANAGER-ADVISER EDITION Minneapolis, MN 55439 FROM CONTRACTOR: $4,245.00 Lake Elmo City Center & Public Works Addition Minneapolis, MN 55432 VIA CONSTRUCTION MANAGER: TO CONSTRUCTION MANAGER: PROJECT: H+U Construction 5555 West 78th Street, Suite A 5/20/22 Hennepin 20 May 103,355.25 5/31/22 PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO:01 Contractor's signed certification is attached.PROJECT APPLICATION DATE:04/20/22 In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:04/30/22 Use Column I on Contracts where variable retainage for line items may apply.H+U PROJECT NO.: PARK PROJECT NO.:21725 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %BALANCE RETAINAGE NO.VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G ÷ C)TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C - G)RATE) (D + E)(NOT IN TO DATE D OR E)(D+E+F) LABOR EROSION CONTROL $28,000.00 $14,000.00 $7,000.00 $21,000.00 75.00%$7,000.00 $1,050.00 SITE REMOVALS $28,050.00 $25,600.00 $2,450.00 $28,050.00 100.00%$1,402.50 MASS GRADING $32,500.00 $13,000.00 $5,000.00 $18,000.00 55.38%$14,500.00 $900.00 BUILDING EXCAVATION & BACKFILL $41,000.00 $13,600.00 $13,600.00 33.17%$27,400.00 $680.00 FINE GRADING $101,000.00 $15,000.00 $15,000.00 14.85%$86,000.00 $750.00 SANITARY SEWER $18,700.00 $18,700.00 $18,700.00 100.00%$935.00 WATER MAIN $18,500.00 $18,500.00 $18,500.00 100.00%$925.00 STORM SEWER $73,250.00 $58,600.00 $58,600.00 80.00%$14,650.00 $2,930.00 CRANE ACCESS ROAD $4,700.00 $0.00 0.00%$4,700.00 $0.00 HOUSEKEEPING $11,550.00 $2,900.00 $2,900.00 $5,800.00 50.22%$5,750.00 $290.00 SHOP DRAWINGS/O&M MANUALS/AS-BUILTS/TRAINING $4,400.00 $4,400.00 $4,400.00 100.00%$220.00 BOND $1,720.00 $1,720.00 $1,720.00 100.00%$86.00 INSURANCE $3,030.00 $3,030.00 $3,030.00 100.00%$151.50 CHANGE ORDERS - LABOR CO #2 - ADDITIONAL TREE REMOVAL $2,090.00 $2,090.00 $2,090.00 100.00%$104.50 CO #3 - ADJUSTMENTS TO SAN MH-01 $2,155.00 $2,155.00 $2,155.00 100.00%$107.75 $0.00 $0.00 $0.00 GRAND TOTALS $370,645.00 $101,850.00 $108,795.00 $0.00 $210,645.00 56.83%$160,000.00 $10,532.25 AIA DOCUMENT G703 · CONTINUATION SHEET FOR G702 · 1992 EDITION · AIA · © 1992 G703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5292 Lake Elmo City Center & Public Works Addition PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 5Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:5/31/2022Lake Elmo, MN 55042ARCHITECT FROM (CM): MATERIALCONST. MANAGERHOFFMANN + UHLHORN CONSTRUCTION, INC.5555 W 78TH ST, SUITE AXFILEMINNEAPOLIS, MN 55439CONTRACT DATE:APPLICATION FOR PAYMENTApplication is made for Payment, as shown below,CHANGE ORDER SUMMARYContinuation Sheet, AIA Document G703, is attached.Change Orders Approved inADDITIONSDEDUCTIONS1. COMMITTED COST$6,910,247.00previous months by Owner2. Net Change by Change Orders$0.00TOTAL$0.00$0.003. SUM TO DATE (Line 1+2)$6,910,247.00Approved this Month4. TOTAL COMPLETED & STORED TO DATE $830,692.00NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$41,534.60 (Column D+E on G703) b. ___ % of Stored Material$0.00 (Column F on G703)Total Retainage (Line 5a + 5b or Total in Column I of G703)$41,534.60TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$789,157.40Net change by Change Orders$0.00 (Line 4 less Line 5 Total)The undersigned Construction Manager certifies that to the best of his 7. LESS PREVIOUS CERTIFICATES FORknowledge, information and belief the Work covered by this Application for PAYMENT (Line 6 from prior Certificate)$345,750.83Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$443,406.57and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $6,121,089.60 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 6/2/2022Notary Public:By:Date:6/2/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$In Accordance with the Contract Documents, based on on-site observations and the(Attach explaination if amount certified differs from the amount applied for).data comprising the above application, the Architect certifies to the Owner that to theARCHITECT:best of the Architect's knowledge, information and belief the Work has progressed asindicated, the quality of the Work is in accordance with the Contract Documents, andBy:Date:the Contractors are entitled to payment of the Amounts Certified.WASHINGTON COUNTY SHERRIFF SUBSTATIONLEO A DALY2022-06-21 CITY OF LAKE ELMO - MATERIALAPPLIC. FOR PAYMENT NO.#5H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 5/31/2022 AIA Document G723,APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification is attached.In tabulations below, amounts are stated to the nearest dollar. ABCDEF GHITEMDESCRIPTION OF WORKSCHEDULEDCHANGEREVISED WORK COMPLETEDTOTAL%BALANCERETAINAGENO.VALUEORDERSSCHEDULEFROMTHIS PERIODCOMPLETED(F/C)TO FINISHVALUEPREV. APPL.AND STORED(C-F)(A+B) TO DATE (D+E)#0330Cast-In-Place Concrete240,000.000.00240,000.000.0060,000.0060,000.0025%180,000.003,000.00#0341Strutctural Precast1,422,295.000.001,422,295.0082,373.207,706.8090,080.006%1,332,215.004,504.00#0512Steel Supply485,000.009,215.00494,215.000.00251,409.18251,409.1851%242,805.8212,570.46#0610Carpentry & GC568,000.000.00568,000.008,600.000.008,600.002%559,400.00430.00#0750Roofing & Metal Panels498,500.000.00498,500.000.000.000.000%498,500.000.00#0790Caulking & Firestopping18,300.000.0018,300.000.000.000.000%18,300.000.00#0810Doors, Frames, Hardware - Supply171,697.000.00171,697.000.000.000.000%171,697.000.00#0833Coiling & Sectional Doors175,000.000.00175,000.000.000.000.000%175,000.000.00#0840Aluminum Storefronts & Curtainwall321,960.000.00321,960.004,580.000.004,580.001%317,380.00229.00#0920Drywall & Fireproofing229,410.000.00229,410.000.0045,000.0045,000.0020%184,410.002,250.00#0930Tile68,100.000.0068,100.000.000.000.000%68,100.000.00#0950Acoustical Ceilings & Panels75,000.000.0075,000.000.000.000.000%75,000.000.00#0965Resilient Flooring & Carpet90,930.000.0090,930.0067,900.000.0067,900.0075%23,030.003,395.00#0990Painting and Wallcovering29,531.000.0029,531.000.000.000.000%29,531.000.00#1420Conveying Equipment46,740.000.0046,740.000.0021,577.0021,577.0046%25,163.001,078.85#2100Fire Protection57,520.000.0057,520.000.000.000.000%57,520.000.00#2200Plumbing & Heating491,000.000.00491,000.0016,513.0411,790.7828,303.826%462,696.181,415.19#2300HVAC & Controls662,000.000.00662,000.0018,000.0028,000.0046,000.007%616,000.002,300.00#2600Electrical808,100.00(1,127.66)806,972.3411,795.0026,130.0037,925.005%769,047.341,896.25#3100Earthwork & Site Utilities209,390.00550.00209,940.00145,850.0012,850.00158,700.0076%51,240.007,935.00#3210Asphalt Paving180,634.000.00180,634.008,337.002,280.0010,617.006%170,017.00530.85#3290Landscaping & Fencing61,140.000.0061,140.000.000.000.000%61,140.000.00TOTAL CONTRACT AMOUNTS6,910,247.000.006,918,884.34363,948.24466,743.76830,692.0012%6,088,192.3441,534.60 INVOICE SUMMARY-PAYMENT APPLICATION NO. #5CITY OF NEWPORT - MATERIALPERIOD ENDING 5/31/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE#0330Cast-In-Place ConcreteAxel H. Ohman, Inc.5/31/22Applic #1$60,000.00$3,000.00$57,000.00#0341Strutctural PrecastWells Concrete5/31/22Applic #2$7,706.80$385.34$7,321.46#0512Steel SupplyConstruction Systems, Inc.5/31/22Applic #1$251,409.18$12,570.46$238,838.72#0920Drywall & FireproofingCommercial Drywall5/31/22Applic #1$45,000.00$2,250.00$42,750.00#1420Conveying EquipmentSchindler Elevator5/31/22Applic #1$21,577.00$1,078.85$20,498.15#2200Plumbing & HeatingPeterson Sheet Metal5/31/22Applic #2$11,790.78$589.54$11,201.24#2300HVAC & ControlsSt. Cloud Refrigeration5/31/22Applic #2$28,000.00$1,400.00$26,600.00#2600ElectricalVinco, Inc.5/31/22Applic #3$26,130.00$1,306.50$24,823.50#3100Earthwork & Site UtilitiesPark Construction Company5/31/22Applic #2$12,850.00$642.50$12,207.50#3210Asphalt PavingEbert Construction5/31/22Applic #3$2,280.00$114.00$2,166.00SUBTOTAL AMOUNT DUE$466,743.76$23,337.19$443,406.57 TOTAL AMOUNT DUE $443,406.57 57,000.005/31/22 0.00485,000.00251,409.1812,570.4612,570.46238,838.72238,838.72238,838.725/31/220.00246,161.28 $0.00$0.00$485,000.00$7,375.00$251,409.18$251,409.1851%$242,805.82$12,570.46 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 TO OWNER:PROJECT: H + U CONSTRUCTION LAKE ELMO CITY HALL APPLICATION NO:1 ATTN ACCOUNTS PAYABLE 3880 LAVERNE AVE NORTH PERIOD TO:03/31/22 7500 OLSON MEMORIAL HWY LAKE ELMO MN 55042 PROJECT NOS: MINNEAPLIS MN 55427 CONTRACT DATE:01/00/00 FROM CONTRACTOR:Schindler Elevator Corporation REMIT TO: P.O. Box 70433 Chicago, IL 60673-0433 CONTRACT FOR:Elevator / Escalator Installation CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, inform- Application is made for payment, as shown below, in connection with the Contract.ation and belief the Work covered by this Application for Payment has been completed Continuation Sheet, AIA Document G703, is attached.in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments 1 ORIGINAL CONTRACT SUM………………………….46,740.00 received from the Owner, and that current payment shown herein is now due. 2 Net change by Change Orders………………………0.00 CONTRACTOR: SCHINDLER ELEVATOR CORPORATION 3 CONTRACT SUM TO DATE (Line 1 + 2)………….46,740.00 By:#REF!Date:3/4/2022 4 TOTAL COMPLETED & STORED TO DATE………….21,577.00 State of :Ohio 5 RETENTION:County of:Lucas Subscribed and sworn to before a.5.00 % of Completed Work 1,078.85 me this 4th day of March 2022 (Columns D + E on G703) b.5 % of Stored Material Notary Public: (Column F on G703)My Commission expires: Total Retention (Line 5a + 5b or Total in Column I of G703) …………………………1,078.85 ARCHITECT'S CERTIFICATE FOR PAYMENT 6 TOTAL EARNED LESS RETENTION ……………………20,498.15 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 less Line 5 Total)comprising this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the 7 LESS PREVIOUS CERTIFICATES FOR PAYMENT quality of the Work is in accordance with the Contract Documents, and the Contractor is (Line 6 from prior Certificate)……………………………….0.00 entitled to payment of the AMOUNT CERTIFIED. 8 CURRENT PAYMENT DUE ……………………………….20,498.15 AMOUNT CERTIFIED…………………………………………………………….. (Attached explanation if amount certified differs from amount applied for. Initial 9 BALANCE TO FINISH, INCLUDING RETENTION all figures on Application and on the Continuation Sheet that are changed to (Line 3 less Line 6)26,241.85 conform to the amount certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in By: Date: previous months by Owner This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- Total approved this Month tractor named herein. Issuance, payment and acceptance of payment are without TOTALS prejudice to any rights of the Owner or Contractor under this Contract. NET CHANGES by Change order $ 20,498.15 Schindler Elevator Corporation CONTINUATION SHEET REMIT TO:P.O. BOX 70433 APPLICATION NUMBER:1 AIA DOCUMENT G703 CHICAGO, IL 60673-0433 APPLICATION DATE:Mar-22 PERIOD FROM:03/01/22 TO:03/31/22 A B C D E F G H I ItemG.O.> P5460 Scheduled Previous This Month Total Completed % Balance Retention #3880 LAVERNE AVE NORTH Value Application In Place Stored & Stored to Finish LAKE ELMO MN 55042 (D + E + F)G/C (C-G) P5460 1 Pre Production & Engineering 21,577.00$ - 21,577.00 0.00 21,577.00 100%0.00 1,078.85 2 Bracket & Rail 4,480.00$ - 0.00 0.00 0.00 0%4,480.00 0.00 3 Machine 5,585.00$ - 0.00 0.00 0.00 0%5,585.00 0.00 4 Car, CWT, Buffers 2,792.00$ - 0.00 0.00 0.00 0%2,792.00 0.00 1 Motor Gen & Starter 2,240.00$ - 0.00 0.00 0.00 0%2,240.00 0.00 2 Controller & Selector 3,928.00$ - 0.00 0.00 0.00 0%3,928.00 0.00 3 Control Accessories 1,688.00$ - 0.00 0.00 0.00 0%1,688.00 0.00 4 Door, Frame, Sills 2,240.00$ - 0.00 0.00 0.00 0%2,240.00 0.00 1 Cab & Cab Doors 1,105.00$ - 0.00 0.00 0.00 0%1,105.00 0.00 2 Door Operator 1,105.00$ - 0.00 0.00 0.00 0%1,105.00 0.00 TOTAL 46,740.00 0.00 21,577.00 0.00 21,577.00 25,163.00 1,078.85 JOB TOTAL 46,740.00 0.00 21,577.00 0.00 21,577.00 46%25,163.00 1,078.85 5/31/22 26,600.00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 6/9/2022 CSDZ,LLC225SouthSixth StreetSTE1900MinneapolisMN55402 Allie Darling 612-322-6041 adarling@csdz.com Phoenix Insurance Company 25623 STCLOUPC Travelers Property Casualty Co.America 25674SCR,Inc.604 Lincoln Ave.NESaintCloud,MN 56304 Charter Oak Fire Insurance Company 25615 The Standard Fire Insurance Company 19070 AXA Insurance Company 33022 Marketing Company 1820452391 A X 1,000,000 X 300,000 10,000 1,000,000 2,000,000 X DTCO0T46964APHX21 12/31/2021 12/31/2022 2,000,000 C 1,000,000 X X X 8100T4736392126G 12/31/2021 12/31/2022 B X X 8,000,000CUP0T485976212612/31/2021 12/31/2022 8,000,000 X 10,000 D X N UB0T48580A2126G 12/31/2021 12/31/2022 2,000,000 2,000,000 2,000,000 FE Lease/Rented EquipProfessionalLiabilityPollutionLiability QT6308R820512TIL21PEC0060504 12/31/202112/31/2021 12/31/202212/31/2022 Limit:Limit perOccurence:Aggregate Limit: $125,000$5,000,000$5,000,000 RE:Lake Elmo City Center,3880 Laverne Avenue North,Lake Elmo,MN 55042,Lake Elmo Public Works Addition,3445 Ideal Avenue North,Lake Elmo,MN55042,contract #2300 -HVAC &Ventilation -Labor,contract #2300 -HVAC &Ventilation -Materials.The City of Lake Elmo is listed as additional insuredregardinggeneralliabilityasrequiredbywrittencontract. Coverage:Installation Floater /Stored MaterialsInsuranceCarrier:Travelers Property Casualty Company of AmericaPolicy#:QT6308R820512PolicyTerm:12/31/2021 -12/31/2022Limit:$600,000 H+U Construction5555West78thStreet,Suite AMinneapolisMN55439 5/31/22 06/09/2022 AssuredPartners of Minnesota LLC 2361 Hwy 36 W St. Paul MN 55113 Sheryl Davison (651) 644-7200 (651) 644-9137 sheryl.davison@assuredpartners.com Vinco, Inc. P. O. Box 907 Forest Lake MN 55025-0907 Continental Cas Co 20443 National Fire Ins Co of Hartford 20478 Continental Ins Co 35289 Starr Indemnity 22-23 Master A Contractual Included XCU Included GL 7015723122 05/01/2022 05/01/2023 1,000,000 100,000 15,000 1,000,000 2,000,000 2,000,000 B BUA 7015723119 05/01/2022 05/01/2023 1,000,000 Uninsured motorist combined single limit 1,000,000 C 0 CUE 7015723136 05/01/2022 05/01/2023 10,000,000 10,000,000 C N WC 7 15723105 05/01/2022 05/01/2023 1,000,000 1,000,000 1,000,000 D Stored Marterial-$725.00 ITC100065179022 05/01/2022 05/01/2023 Project: Lake Elmo City Center - Fire Alarm Material City of Lake Elmo 3880 Laverne Ave N, Suite 100 Lake Elmo MN 55042 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCEDAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702/CMa PAGE ONE OF 2 PAGES APPLICATION NO:02 Distribution to: OWNER PERIOD TO: 05/31/22 MATERIALS X CONSTRUCTION PROJECT NO.: 21725 MANAGER ARCHITECT CONTRACT DATE:11/04/21 CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract.information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached.completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $209,390.00 2. Net change by Change Orders $550.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 ± 2) $$209,940.00 4. TOTAL COMPLETED & STORED TO DATE $158,700.00 (Column G on G703)By: Date: 5. RETAINAGE: a.5.0 % of Completed Work $7,935.00 State of: Minnesota County of: (Column D + E on G703)Subscribed and sworn to before me this day of b.0.0 % of Stored Material $0.00 Notary Public: (Column F on G703)My Commission expires: Total Retainage (Lines 5a + 5b or Total in Column I of G703) $7,935.00 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $150,765.00 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 Less Line 5 Total)comprising the application, the Construction Manager and Architect certify to the 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has PAYMENT (Line 6 from prior Certificate) $138,557.50 progressed as indicated, the qualtity of the Work is in accordance with the Contract 8. CURRENT PAYMENT DUE $12,207.50 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE $59,175.00 (Line 3 less Line 6)AMOUNT CERTIFIED $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied for. Initial all Total changes approved figures on this Application and on the Continuation Sheet that changed to conform to the in previous months by Owner $0.00 $0.00 amount certified.) CONSTRUCTION MANAGER: Total approved this Month $550.00 $0.00 By: Date: ARCHITECT: TOTALS $550.00 $0.00 By: Date: NET CHANGES by Change Order This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702/CMa · APPLICATION AND CERTIFICATION FOR PAYMENT · CONSTRUCTION MANAGER-ADVISER EDITION · 1992 EDITION · AIA · ©1992 G702/CMa - 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity TO CONSTRUCTION MANAGER: PROJECT: H+U Construction 5555 West 78th Street, Suite A $550.00 Lake Elmo City Center & Public Works Addition Minneapolis, MN 55432 VIA CONSTRUCTION MANAGER: VIA ARCHITECT: Park Construction Company 1481 81st Ave NE CONSTRUCTION MANAGER-ADVISER EDITION Minneapolis, MN 55439 FROM CONTRACTOR: 5/20/22 Hennepin 20 May 12,207.50 5/31/22 PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO:01 Contractor's signed certification is attached.PROJECT APPLICATION DATE:04/20/22 In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:04/30/22 Use Column I on Contracts where variable retainage for line items may apply.H+U PROJECT NO.: PARK PROJECT NO.:21725 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %BALANCE RETAINAGE NO.VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G ÷ C)TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C - G)RATE) (D + E)(NOT IN TO DATE D OR E)(D+E+F) MATERIALS EROSION CONTROL $3,800.00 $2,300.00 $2,300.00 60.53%$1,500.00 $115.00 SITE REMOVALS $3,900.00 $3,000.00 $900.00 $3,900.00 100.00%$195.00 MASS GRADING $9,000.00 $3,600.00 $1,400.00 $5,000.00 55.56%$4,000.00 $250.00 BUILDING EXCAVATION & BACKFILL $5,310.00 $2,000.00 $2,000.00 37.66%$3,310.00 $100.00 FINE GRADING $46,000.00 $8,000.00 $8,000.00 17.39%$38,000.00 $400.00 SANITARY SEWER $13,250.00 $13,250.00 $13,250.00 100.00%$662.50 WATER MAIN $29,100.00 $29,100.00 $29,100.00 100.00%$1,455.00 STORM SEWER $94,600.00 $94,600.00 $94,600.00 100.00%$4,730.00 CRANE ACCESS ROAD $4,430.00 $0.00 0.00%$4,430.00 $0.00 CHANGE ORDERS - MATERIALS CO #3 - ADJUSTMENTS TO SAN MH-01 $550.00 $550.00 $550.00 100.00%$27.50 $0.00 $0.00 $0.00 GRAND TOTALS $209,940.00 $145,850.00 $12,850.00 $0.00 $158,700.00 75.59%$51,240.00 $7,935.00 AIA DOCUMENT G703 · CONTINUATION SHEET FOR G702 · 1992 EDITION · AIA · © 1992 G703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5292 Lake Elmo City Center & Public Works Addition PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES 2,166.005/31/22