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#07 - City Center Pay Request
STAFF REPORT DATE: July 19, 2022 CONSENT AGENDA ITEM: City Center-Public Works Addition Pay Request #6 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 #6 for the City Center and Public Works Addition project? PROPOSAL: Pay request #6 is for $639,420.83. A copy is included in your packet. FISCAL IMPACT: With this pay request, the project remains within budget. OPTION: 1) Approve pay request #6 2) Don’t approve pay request #6 RECOMMENDATION: “Motion to approve Pay Request #6 for the New City Center and Public Works Addition.” ATTACHMENTS: • Pay Request #6 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 6Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:6/30/2022Lake 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 $2,400,161.89NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$120,008.08 (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)$120,008.08TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$2,280,153.81Net 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)$1,640,732.98Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$639,420.83and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $11,122,634.19 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 7/5/2022Notary Public:By:Date:7/5/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2022-07-12 CITY OF LAKE ELMO - OVERALLAPPLIC. FOR PAYMENT NO.#6H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 6/30/2022 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 Insurance25,000.000.0025,000.000.0021,204.0021,204.0085%3,796.001,060.200Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.0022,480.6911,945.1234,425.8114%208,654.191,721.29ReimburseConstruction Management Reimbursables488,555.000.00488,555.00133,863.7536,180.00170,043.7535%318,511.258,502.19FeeConstruction Management Fee82,595.000.0082,595.0011,153.584,346.7315,500.3119%67,094.69775.02TrailerTemporary City Office Trailer53,170.000.0053,170.0023,558.102,458.8926,016.9949%27,153.011,300.85ContingencyConstruction 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 Concrete668,316.000.00668,316.00110,000.000.00110,000.0016%558,316.005,500.00#0341Strutctural Precast1,755,999.000.001,755,999.0090,080.00290,924.00381,004.0022%1,374,995.0019,050.20#0510Steel Erection93,400.000.0093,400.000.0016,000.0016,000.0017%77,400.00800.00#0512Steel Supply485,000.009,215.00494,215.00251,409.180.00251,409.1851%242,805.8212,570.46#0610Carpentry & GC1,027,000.000.001,027,000.00186,474.2910,962.25197,436.5419%829,563.469,871.83#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 & Curtainwall400,410.000.00400,410.0014,955.000.0014,955.004%385,455.00747.75#0920Drywall & Fireproofing543,770.000.00543,770.0088,000.005,000.0093,000.0017%450,770.004,650.00#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 & Carpet131,940.000.00131,940.0067,900.0022,040.0089,940.0068%42,000.004,497.00#0990Painting and Wallcovering157,727.000.00157,727.000.000.000.000%157,727.000.00#1420Conveying Equipment82,000.000.0082,000.0021,577.000.0021,577.0026%60,423.001,078.85#2100Fire Protection112,915.000.00112,915.005,796.000.005,796.005%107,119.00289.80#2200Plumbing & Heating854,000.000.00854,000.0073,309.49103,917.67177,227.1621%676,772.848,861.36#2300HVAC & Controls962,000.000.00962,000.0054,677.2547,220.90101,898.1511%860,101.855,094.91#2600Electrical1,454,170.00(3,227.66)1,450,942.3462,875.0063,360.00126,235.009%1,324,707.346,311.75#3100Earthwork & Site Utilities575,790.004,795.00580,585.00369,345.0037,515.00406,860.0070%173,725.0020,343.00#3210Asphalt Paving317,200.000.00317,200.0012,209.000.0012,209.004%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 AMOUNTS13,402,788.000.0013,402,788.001,727,087.33673,074.562,400,161.8918%11,002,626.11120,008.08 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 6Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:6/30/2022Lake 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 $1,099,047.71NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$54,952.37 (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)$54,952.37TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$1,044,095.34Net 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)$851,575.58Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$192,519.76and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $5,448,445.66 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 7/5/2022Notary Public:By:Date:7/5/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2022-07-12 CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSAPPLIC. FOR PAYMENT NO.#6H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 6/30/2022 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 Insurance25,000.000.0025,000.000.0021,204.0021,204.0085%3,796.001,060.200Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.0022,480.6911,945.1234,425.8114%208,654.191,721.29ReimburseConstruction Management Reimbursables488,555.000.00488,555.00133,863.7536,180.00170,043.7535%318,511.258,502.19FeeConstruction Management Fee82,595.000.0082,595.0011,153.584,346.7315,500.3119%67,094.69775.02TrailerTemporary City Office Trailer53,170.000.0053,170.0023,558.102,458.8926,016.9949%27,153.011,300.85ContingencyConstruction 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 Concrete428,316.000.00428,316.0050,000.000.0050,000.0012%378,316.002,500.00#0341Strutctural Precast333,704.000.00333,704.000.000.000.000%333,704.000.00#0510Steel Erection93,400.000.0093,400.000.0016,000.0016,000.0017%77,400.00800.00#0610Carpentry & GC459,000.000.00459,000.00177,874.29762.25178,636.5439%280,363.468,931.83#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 & Curtainwall78,450.000.0078,450.0010,375.000.0010,375.0013%68,075.00518.75#0920Drywall & Fireproofing314,360.000.00314,360.0043,000.000.0043,000.0014%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 & Heating363,000.000.00363,000.0045,005.6758,594.49103,600.1629%259,399.845,180.01#2300HVAC & Controls300,000.000.00300,000.008,677.253,470.9012,148.154%287,851.85607.41#2600Electrical646,070.00(2,100.00)643,970.0024,950.0016,180.0041,130.006%602,840.002,056.50#3100Earthwork & Site Utilities366,400.004,245.00370,645.00210,645.0031,510.00242,155.0065%128,490.0012,107.75#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 AMOUNTS6,492,541.000.006,483,903.66896,395.33202,652.381,099,047.7117%5,384,855.9554,952.37 INVOICE SUMMARY-PAYMENT APPLICATION NO. #6CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSPERIOD ENDING 6/30/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUEInsuranceBuilders Risk InsuranceH+U Construction6/30/22Applic #1$21,204.00$1,060.20$20,143.801General ConditionsH+U Construction6/30/22Applic #6$11,945.12$597.26$11,347.86ReimburseConstruction Management ReimbursablesH+U Construction6/30/22Applic #6$36,180.00$1,809.00$34,371.00FeeConstruction Management FeeH+U Construction6/30/22Applic #6$4,346.73$217.34$4,129.39TrailerTemporary City Office TrailerH+U Construction6/30/22Applic #4$2,458.89$122.94$2,335.95#0510Steel ErectionA.M.E. Construction Corp6/30/22Applic #1$16,000.00$800.00$15,200.00#0610Carpentry & GCEbert Construction6/30/22Applic #7$762.25$38.11$724.14#2200Plumbing & HeatingPeterson Sheet Metal6/30/22Applic #2$58,594.49$2,929.72$55,664.77#2300HVAC & ControlsSt. Cloud Refrigeration6/30/22Applic #2$3,470.90$173.55$3,297.35#2600ElectricalVinco, Inc.6/30/22Applic #4$16,180.00$809.00$15,371.00#3100Earthwork & Site UtilitiesPark Construction Company6/30/22Applic #3$31,510.00$1,575.50$29,934.50SUBTOTAL AMOUNT DUE$202,652.38$10,132.62$192,519.76 TOTAL AMOUNT DUE $192,519.76 INVOICE : 220160 PROJECT: J21001 JUNE 30, 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 June, 2022 CONSTRUCTION MANAGEMENT REIMBURSABLES Project Director 5.00 hrs. @ 150.00 $750.00 Project Controller 6.00 hrs. @ 125.00 $750.00 Senior Project Manager 32.50 hrs. @ 125.00 $4,062.50 Project Manager 75.00 hrs. @ 105.00 $7,875.00 Project Administrator/Accountant 18.50 hrs. @ 65.00 $1,202.50 Project Superintendent 188.00 hrs. @ 105.00 $19,740.00 Truck, Travel, & Small Tools 1 mo. @ 1,400.00 $1,400.00 Field Office Equipment 1 mo. @ 400.00 $400.00 $36,180.00 GENERAL CONDITIONS Builders' Risk Insurance $21,204.00 Temporary City Office Trailer $2,458.89 Plan Prints/Shipping $163.65 Expendable Supplies $394.97 Drinking Water $64.22 Temporary Toilets $193.28 Equipment Rental $1,175.27 Xcel Energy - Utility Service $106.77 Scaffold Rental $236.23 Mobilize Trailer $2,340.00 Mobilize Skid Steer $2,058.73 Braun Intertec Corporation $5,212.00 $35,608.01 $71,788.01 Contractor's Pay Applications June 30, 2022 #0341-Material Wells Concrete $290,924.00 #0510-Labor A.M.E. Construction Corp $16,000.00 #0610-Labor Ebert Construction $762.25 #0610-Material Ebert Construction $10,200.00 Subtotal Construction Management Reimbursables Subtotal Reimbursable Expenses Total INVOICE : 220160 PROJECT: J21001 JUNE 30, 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 June 30, 2022 #0920-Labor Commercial Drywall, Inc.$5,000.00 #0965-Material Commercial Flooring Services $22,040.00 #2200-Labor Peterson Sheet Metal, Inc.$58,594.49 #2200-Material Peterson Sheet Metal, Inc.$45,323.18 #2300-Labor St.Cloud Refrigeration, Inc.$3,470.90 #2300-Material St.Cloud Refrigeration, Inc.$43,750.00 #2600-Labor Vinco, Inc.$16,180.00 #2600-Material Vinco, Inc.$47,180.00 #3100-Labor Park Construction Company $31,510.00 #3100-Material Park Construction Company $6,005.00 $596,939.82 $4,346.73 $673,074.56 Retainage Current Retainge 33,653.73 Prior Retainage 86,354.35 Retainage-To-Date 120,008.08 Total Amount Due $639,420.83 CONSTRUCTION MANAGEMENT FEE Total Contractor's Pay Applications June 1 - June 30 Total Before Retainage Arthur J. Gallagher Risk Management Services, Inc.HANKI1 3600 American Blvd. West, Suite 500 Bloomington, MN 55431 Invoice # 4322435 1 of 1 ACCOUNT NUMBER DATEPhone:(952)358-7500 Fax:(952)358-7501 HUHOLDI-01 6/29/2022 BALANCE DUE ON AMOUNT DUE 6/29/2022 $21,204.00 H.U. Holdings LLC 5555 W 78th Street Suite A Edina, MN 55439 Builders Risk PolicyNumber: EBN 064 82 21 Company: Cincinnati Insurance Company Effective: 4/1/2022 to 5/1/2023 Item #Trans Eff Date Due Date Trans Description Amount 27759572 4/1/2022 6/29/2022 NEWB New Business Premium $21,047.00 27759587 4/1/2022 6/29/2022 TERR Terrorism Charge $157.00 Total Invoice Balance:$21,204.00 Please return this portion with your payment. Include your invoice number on your remittance to expedite processing. HANKI1 Joe Uhlhorn Invoice # 43224355555 W 78th Street Suite A Edina, MN 55439 ACCOUNTNUMBER DATE HUHOLDI-01 6/29/2022 BALANCE DUE ON AMOUNT DUE 6/29/2022 $21,204.00 AMOUNT PAID Please send your remittance to: Arthur J. Gallagher Risk Management Services, Inc. 39735 Treasury Center Chicago, IL 60694-9700 *** SAVE TIME AND MONEY! PAY THIS INVOICE ONLINE AT WWW.AJG.COM/EZPAY. *** 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 07/07/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:06/07/2022 INV577315 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 07/07/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:06/07/2022 INV577315 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 07/07/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:06/07/2022 INV577315 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 06/07/22 07/04/22 1 2,000.00 2,000.00 RR not utilized no need to winterize. STEPS Steps - Rental 06/07/22 07/04/22 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 54MNI90510886/2/2022 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 54MNO90475646/2/2022NET30ARC 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 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: $1.066/2/202254MNI90510881016013 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/0BEAE5D4-4B5B-4CDB-BDC2-7F10E8ADB049 QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90510756/2/2022 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 54MNO90475065/31/2022NET30ARC DELIVERY1016013ASI 21 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 6 (30.00x42.00) $5.93$0.10989Bond Prints - First Set1600SQFT0.0054.0054.00 $35.00$35.00Supply / Delivery Charge5201EACH011 $3.95$3.95Energy / Fuel Surcharge5205EACH011 $48.27Total Due Amount Received $48.27Total $0.00Trade Discount $0.00Freight $3.39Tax $0.00Misc $44.88SubtotalllakotasBiller: $48.276/2/202254MNI90510751016013 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/86D9AFC6-703E-4E72-BF9D-7228A731684A QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90511426/7/2022 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 54MNO90476506/9/2022NET30ARC DELIVERY1016013Rev 2 Sprinkler Shop 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: $44.726/7/202254MNI90511421016013 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/7BFA3E26-6C9F-40EA-A8BA-936B8266D516 QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90511436/7/2022 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 54MNO90476516/9/2022NET30ARC DELIVERY1016013ASI #08 Misc 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 10 (30.00x42.00) $9.89$0.10989Bond Prints - First Set1600SQFT0.0090.0090.00 $10.63Total Due Amount Received $10.63Total $0.00Trade Discount $0.00Freight $0.74Tax $0.00Misc $9.89SubtotalllakotasBiller: $10.636/7/202254MNI90511431016013 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/A0AD03A6-26EA-4214-A03B-DD2FF0F0A1DC QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90516606/28/2022 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 54MNO90479406/24/2022NET30ARC DELIVERY1016013ASI 11 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 3 (30.00x42.00) $2.97$0.10989Bond Prints - First Set1600SQFT0.0027.0027.00 $35.00$35.00Supply / Delivery Charge5201EACH011 $5.00$5.00Energy / Fuel Surcharge5205EACH011 $46.20Total Due Amount Received $46.20Total $0.00Trade Discount $0.00Freight $3.23Tax $0.00Misc $42.97SubtotalllakotasBiller: $46.206/28/202254MNI90516601016013 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/9A755696-855E-42BF-A327-FDCA5975E6F2 QuickPay Online Payment Scan or Click ARC DOCUMENT SOLUTIONS LLC 4730 PARK GLEN RD SAINT LOUIS PARK MN 55416-5701 54MNI90516716/28/2022 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 54MNO90480496/24/2022NET30ARC DELIVERY1016013ASI #22 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 12 (30.00x42.00) $11.87$0.10989Bond Prints - First Set1600SQFT0.00108.00108.00 $12.77Total Due Amount Received $12.77Total $0.00Trade Discount $0.00Freight $0.90Tax $0.00Misc $11.87SubtotalllakotasBiller: $12.776/28/202254MNI90516711016013 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/6732BC30-06B2-4F61-9E25-588FB45848BC QuickPay Online Payment Scan or Click Branch:100 St. Paul 1342848 Invoice Date Page INVOICE 3244224 ORDER NUMBER Columbus, MN 55025 9205 Lake Drive NE Viking Industrial Center 1 of 1651-646-6141 INVOICE 6/23/2022 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 7/23/2022 7/23/2022 0.00 Primary Salesrep NameOrder Date Pick Ticket No Taker 6/23/2022 11:18:11 2272292 Douglas P. Geist TWOODBURY Item ID Item DescriptionOrderedShippedRemaining Quantities UOM Disp.Unit Size Pricing UOM Unit PriceUnit Size Price Extended 20.00 0.00 EA V9M2-BASE15 EA 18.392000 367.84 1.0 1.0000 20.00 15LB BASE ONLY FOR DELINEATOR POST 15 Pound Base Only (for use with POST42A - 42" Delineator Post) SUB-TOTAL:Total Lines:1 367.84 MN STATE TAX 25.29: MN SPECIAL TAX 1.84: 394.97AMOUNT 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 #W866504 6/15/2022 W866504 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: 7/13/2022 Terms Due Date PO #Sales Rep Builders Club# Net 28 7/13/2022 -Jeff Foley Qty Item Days Sales Order #Service Level Rate Amount 1 RENTAL RegularUnit May 18-Jun 14 28 385563 -$4.00 $4.00 1 SERVICEService May 18-Jun 14 28 385563 1X/wk $70.00 $70.00 1 SERVICEClimateSvc May 18 to Jun 14 28 385563 1X/wk $16.00 $16.00 1 RENTAL HandSani May 18-Jun 14 28 385563 -$0.00 $0.00 1 RENTALRegularUnit May 18-Jun 14 28 386930 -$4.00 $4.00 1 SERVICE Service May 18-Jun 14 28 386930 1X/wk $70.00 $70.00 1 SERVICEClimateSvc May 18 to Jun 14 28 386930 1X/wk $16.00 $16.00 1 RENTAL HandSani May 18-Jun 14 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 #W866504 6/15/2022 W866504 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 #W866504 Amount Due $193.28 Amount Paid ______________________ 126521501-0001 PO BOX 409211 ATLANTA, GA 30384-9211 661003 6/15/22 1 LAKE ELMO H + U CONSTRUCTION 3880 LAVERNE AVE N LAKE ELMO, MN 55042 9627 C#: 952-837-3309 J#: 651-395-0055 3880 LAVERNE AVE N, LAKE ELMO 3 - H + U CONSTRUCTI 126521501 SHAKOPEE MN PC1016 800 VALLEY INDUSTRIAL CIR S SHAKOPEE, MN 55379 1852 952-656-9400 1016 1094.55 80.72 1175.27 H + U CONSTRUCTION 5555 WEST 78TH STREET, SUITE A MINNEAPOLIS, MN 55439 . QTY EQUIPMENT # Min Day Week 4 Week Amount . 1.00 BOX BROOM 145.00 145.00 425.00 970.00 970.00 10212412 Make: BRADCO Model: 21560M-0022 Ser #: 1928039 Rental Sub-total: 970.00 SALES ITEMS: Qty Item number Unit Price 1 ENVIRONMENTAL EA 14.550 14.55 ENVIRONMENTAL/HAZMAT FEE 2133XXX0000 PICKUP CHARGE 110.00 BILLED FOR FOUR WEEKS 5/31/22 THRU 6/27/22. . 1094.55. 4 WEEK BILL NET 30 ANNA CLARK anna.clark@sunbeltrentals.com DOMINIC, DOMINIC Invoice A117195 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 6/9/2022Date Job Site Shipping Address: 3880 LAVERNE AVE N LAKE ELMO, MN 55042-9627 Created: 6/8/2022 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 5/12/2022 6/8/2022 28 $220.0000 0 $220.00 Rent $220.00 Subtotal $236.23 Other tax: (none)$0.00 $16.23 $220.00 Sales tax: MN - LAKE ELMO CITY TAX (7.375%) Invoice Total Printed: June 08, 2022 9:38:00 PM Page 1 of 1A117195 1 Zach Green From:Nicole Rugh Sent:Tuesday, May 31, 2022 3:02 PM To:Zach Green Subject:FW: [External] Receipt from Schmit Towing Follow Up Flag:Follow up Flag Status:Flagged Hi Zach, Please see below receipt and notes from Joe… Nikki Rugh Marketing Manager H+U Construction 5555 West 78th Street, Suite A Minneapolis, MN 55439 O: 612 438 0258 C: 612 638 7150 E: nrugh@hu-construction.com www.hu-construction.com + To learn more about our work, click here! From: Joseph Uhlhorn <juhlhorn@hu-construction.com> Sent: Tuesday, May 31, 2022 2:59 PM To: Nicole Rugh <nrugh@hu-construction.com> Subject: RE: [External] Receipt from Schmit Towing Yes, that is. It should be split between Newport and Lake Elmo for demobilizing the skid loader from Newport and mobilizing the skid loader to Lake Elmo. I paid it this morning. Joe From: Nicole Rugh <nrugh@hu-construction.com> Sent: Tuesday, May 31, 2022 1:18 PM To: Joseph Uhlhorn <juhlhorn@hu-construction.com> Subject: FW: [External] Receipt from Schmit Towing Hi Joe, Is the below receipt from you/legit? I received this morning, so wanted to be sure… Nikki Rugh 2 Marketing Manager H+U Construction 5555 West 78th Street, Suite A Minneapolis, MN 55439 O: 612 438 0258 C: 612 638 7150 E: nrugh@hu-construction.com www.hu-construction.com + To learn more about our work, click here! From: Schmit Towing via Square <receipts@messaging.squareup.com> Sent: Tuesday, May 31, 2022 10:26 AM To: Nicole Rugh <nrugh@hu-construction.com> Subject: [External] Receipt from Schmit Towing Receipt for $517.46 at Schmit Towing on May 31 2022 at 10:25 AM. Square automatically sends receipts to the email address you used at any Square seller. Learn more Schmit Towing Let Schmit Towing know how your experience was $517.46 Custom Amount × 1 $517.46 22-72477 INVOICE Braun Intertec Corporation Lockbox #446035 PO BOX 64384 Saint Paul, MN 55164-0384 (952) 995-2000 (952) 995-2020 Telephone Fax PLEASE REMIT TO Tax I.D.41-1684205 Hoffmann + Uhlhorn Construction, Inc. (H+U Construction) 5555 West 78th Street, Suite A Minneapolis, MN 55439 Luke Nelson B297675Invoice number Date 6/10/2022 Project ID B2203298 Customer account 27053 Customer PO For Professional Services rendered through 6/3/2022 Lake Elmo Public Facilities Special Inspections & Materials Testing 3800 Laverne Avenue North Lake Elmo, MN 55042 1 - Construction and Materials Testing 1.1 - Soil Observations and Testing $4,221.00 1.2 - Concrete Observations and Testing $210.00 1.5 - Pavement Observations & Testing $284.00 1.6 - Project Management $497.00 $5,212.00 Total Fees $5,212.00 Amount Previously Invoiced: $0.00 Amount Invoiced to Date: $5,212.00 Please pay from this invoice. Terms: Due on receipt, 1 1/2% per month after 30 days, 18% annual percentage rate, unless otherwise specified by written agreement. Page 1 of 2 Projects: B2203298 - Lake Elmo Public Facilities Invoice number: B297675 Qty/Hours Rate Amount 1 - Construction and Materials Testing 1.1 - Soil Observations and Testing Consulting Services Detail Staff Engineer 2.00 132.00 264.00 Project Engineer 1.00 162.00 162.00 Excavation Observations 11.50 92.00 1,058.00 Compaction Testing - Nuclear 18.50 82.00 1,517.00 Non-Salary Detail Nuclear moisture-density meter charge, per hour 16.50 20.00 330.00 Moisture Density Relationship (Standard), per sample 3.00 180.00 540.00 CMT Trip Charge 10.00 35.00 350.00 Total 1.1 - Soil Observations and Testing $4,221.00 1.2 - Concrete Observations and Testing Non-Salary Detail CMT Trip Charge 6.00 35.00 210.00 Total 1.2 - Concrete Observations and Testing $210.00 1.5 - Pavement Observations & Testing Non-Salary Detail Sieve Analysis with 200 wash, per sample 2.00 142.00 284.00 Total 1.5 - Pavement Observations & Testing $284.00 1.6 - Project Management Consulting Services Detail Staff Engineer 3.00 132.00 396.00 Project Control Specialist 0.50 120.00 60.00 Project Assistant 0.50 82.00 41.00 Total 1.6 - Project Management $497.00 Total 1 - Construction and Materials Testing $5,212.00 Total Project $5,212.00 Page 2 of 2 $ 15,200.006/29/22 724.146/29/22 855,664.7755,664.776/29/22 3,297.35 6/29/22 29,934.506/29/22 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 6Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:6/30/2022Lake 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 $1,301,114.18NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$65,055.71 (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)$65,055.71TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$1,236,058.47Net 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)$789,157.40Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$446,901.07and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $5,674,188.53 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 7/5/2022Notary Public:By:Date:7/5/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2022-07-12 CITY OF LAKE ELMO - MATERIALAPPLIC. FOR PAYMENT NO.#6H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 6/30/2022 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 Concrete240,000.000.00240,000.0060,000.000.0060,000.0025%180,000.003,000.00#0341Strutctural Precast1,422,295.000.001,422,295.0090,080.00290,924.00381,004.0027%1,041,291.0019,050.20#0512Steel Supply485,000.009,215.00494,215.00251,409.180.00251,409.1851%242,805.8212,570.46#0610Carpentry & GC568,000.000.00568,000.008,600.0010,200.0018,800.003%549,200.00940.00#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 & Fireproofing229,410.000.00229,410.0045,000.005,000.0050,000.0022%179,410.002,500.00#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 & Carpet90,930.000.0090,930.0067,900.0022,040.0089,940.0099%990.004,497.00#0990Painting and Wallcovering29,531.000.0029,531.000.000.000.000%29,531.000.00#1420Conveying Equipment46,740.000.0046,740.0021,577.000.0021,577.0046%25,163.001,078.85#2100Fire Protection57,520.000.0057,520.000.000.000.000%57,520.000.00#2200Plumbing & Heating491,000.000.00491,000.0028,303.8245,323.1873,627.0015%417,373.003,681.35#2300HVAC & Controls662,000.000.00662,000.0046,000.0043,750.0089,750.0014%572,250.004,487.50#2600Electrical808,100.00(1,127.66)806,972.3437,925.0047,180.0085,105.0011%721,867.344,255.25#3100Earthwork & Site Utilities209,390.00550.00209,940.00158,700.006,005.00164,705.0078%45,235.008,235.25#3210Asphalt Paving180,634.000.00180,634.0010,617.000.0010,617.006%170,017.00530.85#3290Landscaping & Fencing61,140.000.0061,140.000.000.000.000%61,140.000.00TOTAL CONTRACT AMOUNTS6,910,247.000.006,918,884.34830,692.00470,422.181,301,114.1819%5,617,770.1665,055.71 INVOICE SUMMARY-PAYMENT APPLICATION NO. #6CITY OF NEWPORT - MATERIALPERIOD ENDING 6/30/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE#0341Strutctural PrecastWells Concrete6/30/22Applic #3$290,924.00$14,546.20$276,377.80#0610Carpentry & GCEbert Construction6/30/22Applic #4$10,200.00$510.00$9,690.00#0920Drywall & FireproofingCommercial Drywall6/30/22Applic #2$5,000.00$250.00$4,750.00#0965Resilient Flooring & CarpetCommerical Flooring6/30/22Applic #2$22,040.00$1,102.00$20,938.00#2200Plumbing & HeatingPeterson Sheet Metal6/30/22Applic #3$45,323.18$2,266.16$43,057.02#2300HVAC & ControlsSt. Cloud Refrigeration6/30/22Applic #3$43,750.00$2,187.50$41,562.50#2600ElectricalVinco, Inc.6/30/22Applic #4$47,180.00$2,359.00$44,821.00#3100Earthwork & Site UtilitiesPark Construction Company6/30/22Applic #3$6,005.00$300.25$5,704.75SUBTOTAL AMOUNT DUE$470,422.18$23,521.11$446,901.07 TOTAL AMOUNT DUE $446,901.07 Click to buy NOW!P D F -XChange ww w.docu-tr a c k .comClick to buy NOW!P D F -XChange ww w.docu-tra c k .com Click to buy NOW!P D F -XChange ww w.docu-tr a c k .comClick to buy NOW!P D F -XChange ww w.docu-tra c k .com Click to buy NOW!P D F -XChange ww w.docu-tr a c k .comClick to buy NOW!P D F -XChange ww w.docu-tra c k .com 9,690.006/29/22 12/29/2021 Brown & Brown of Minnesota 530 W Pleasant St, Suite 100 Mankato MN 56001 Bridget Whipps CISR (507) 344-4501 (866) 800-6596 bwhipps@bbmankato.com Greener World Solutions LLC 33908 128th St. Waseca MN 56093 Western National Mutual Insurance Company 15377 Evanston Insurance Company 22/23 Term A Auto AI Status Contractual Liability Y Y CPP1153531 05 01/01/2022 01/01/2023 1,000,000 200,000 10,000 1,000,000 2,000,000 2,000,000 A CPP 1173781 04 01/01/2022 01/01/2023 1,000,000 A 10,000 UMB1025657 05 01/01/2022 01/01/2023 6,000,000 6,000,000 B N Y 10-0001689 01/01/2022 01/01/2023 1,000,000 1,000,000 1,000,000 A Leased/Rented Equipment CPP1153535 05 01/01/2022 01/01/2023 Limit $100,000 Deductible $1,000 [Job #: 210215 Job Type: Lake Elmo City Center]Commercial Drywall Inc and the City of Lake Elmo are additional insured regarding general liability on a primary & non-contributory basis under formsCG2033 & WNGL84. (see attached) Waiver of subrogation applies to general liability and workers compensation. Policy includes $4,924 for materialsstored at 33908 128th St, Waseca. Commercial Drywall, Inc 1550 91st Ave NE, Ste 304 Blaine MN 55449 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE 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 onthis 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 POLICIESBELOW. 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 SUBRWVDADDLINSD 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 COMPENSATIONAND 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 Click to buy NOW!P D F -XChange ww w.docu-tr a c k .comClick to buy NOW!P D F -XChange ww w.docu-tra c k .com Click to buy NOW!P D F -XChange ww w.docu-tr a c k .comClick to buy NOW!P D F -XChange ww w.docu-tra c k .com 20,938.00 06/23/2022 AssuredPartners of Minnesota LLC 2361 Hwy 36 W St. Paul MN 55113 Tim Anderson (651) 644-7200 (651) 644-9137 tim.anderson@assuredpartners.com Commercial Flooring Services, LLC DBA: CFS Interiors & Flooring 940 Apollo Rd, Suite 110 Eagan MN 55121 Phoenix Insurance Company 25623 Travelers Indemnity Company 25658 Travelers Property Casualty Co. of America 25674 Charter Oak Fire Insurance Company 25615 Hanover Insurance Company 22292 22-23 A Contractual Liability Y Y CO2135N414 02/26/2022 02/26/2023 1,000,000 300,000 5,000 1,000,000 2,000,000 2,000,000 B Y Y BA3L594791 02/26/2022 02/26/2023 1,000,000 C 10,000 Y Y CUP0J838898 02/26/2022 02/26/2023 5,000,000 5,000,000 D N Y UB0K210307 02/26/2022 02/26/2023 1,000,000 1,000,000 1,000,000 E Installation Floater/Stored Materials coverage IHX946863610 02/26/2022 02/26/2023 Blanket Jobsite Limit $600,000 Project: Lake Elmo City Center - Lake Elmo, MN. City of Lake Elmo (Owner) and others required by the written contract are included as General Liability Additional Insureds on a primary & non-contributorybasis as required by written contract or agreement per form CGD604, CGT100 & Waiver of Subrogation General Liability form CGD316 and Auto Liability additional insureds per form CAT420 & CAT474. Umbrella/Excess Liability is following form. Waiver of Subrogation in favor of The City of Lake Elmo & others required by the written contract for Workers Compensation. Coverage included for Stored Materials $67,900 value. 30 days prior written notice ofCancellation except 10 days for non payment of premium 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 6/29/22 41,562.50 6/29/22 06/28/2022 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-$16,000 ITC100065179022 05/01/2022 05/01/2023 Project: Lake Elmo City Center - Switchgear 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 5,704.756/29/22