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#03 - City Center - Public Works Pay Req 9
STAFF REPORT DATE: October 18, 2022 CONSENT AGENDA ITEM: City Center-Public Works Addition Pay Request #9 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 #9 for the City Center and Public Works Addition project? PROPOSAL: Pay request #9 is for $670,323.13. A copy is included in your packet. FISCAL IMPACT: With this pay request, the project remains within budget. OPTION: 1) Approve pay request #9 2) Don’t approve pay request #9 RECOMMENDATION: “Motion to approve Pay Request #9 for the New City Center and Public Works Addition.” ATTACHMENTS: • Pay Request #9 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 9Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:9/30/2022Lake 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 $5,533,213.39NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$276,660.70 (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)$276,660.70TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$5,256,552.69Net 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)$4,586,229.56Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$670,323.13and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $8,146,235.31 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 10/3/2022Notary Public:By:Date:10/3/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2022-10-05LEO A DALY CITY OF LAKE ELMO - OVERALLAPPLIC. FOR PAYMENT NO.#9H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 9/30/2022 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 Insurance25,000.000.0025,000.0021,204.000.0021,204.0085%3,796.001,060.200Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.0054,791.6711,334.5066,126.1727%176,953.833,306.31ReimburseConstruction Management Reimbursables488,555.000.00488,555.00238,516.2537,057.50275,573.7556%212,981.2513,778.69FeeConstruction Management Fee82,595.000.0082,595.0031,176.834,556.8035,733.6343%46,861.371,786.68TrailerTemporary City Office Trailer53,170.000.0053,170.0033,393.662,458.8935,852.5567%17,317.451,792.63ContingencyConstruction Contingency588,330.00(296,759.00)291,571.000.000.000.000%291,571.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete668,316.0042,542.00710,858.00376,904.00104,104.00481,008.0068%229,850.0024,050.40#0341Strutctural Precast1,755,999.00580.001,756,579.001,635,668.4729,100.031,664,768.5095%91,810.5083,238.43#0510Steel Erection93,400.000.0093,400.0016,000.0030,000.0046,000.0049%47,400.002,300.00#0512Steel Supply485,000.009,215.00494,215.00258,784.18168,994.70427,778.8887%66,436.1221,388.94#0610Carpentry & GC1,027,000.000.001,027,000.00208,436.5412,794.78221,231.3222%805,768.6811,061.57#0750Roofing & Metal Panels1,113,300.000.001,113,300.00298,183.25155,766.40453,949.6541%659,350.3522,697.48#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 & Curtainwall400,410.000.00400,410.00117,705.0036,750.00154,455.0039%245,955.007,722.75#0920Drywall & Fireproofing543,770.0025,699.00569,469.00124,000.0010,000.00134,000.0024%435,469.006,700.00#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 & Carpet131,940.000.00131,940.0089,940.000.0089,940.0068%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 & Heating854,000.000.00854,000.00389,488.583,855.36393,343.9446%460,656.0619,667.20#2300HVAC & Controls962,000.00154,703.001,116,703.00101,898.1512,130.35114,028.5010%1,002,674.505,701.43#2600Electrical1,454,170.0059,225.001,513,395.00237,910.0086,700.00324,610.0021%1,188,785.0016,230.50#3100Earthwork & Site Utilities575,790.004,795.00580,585.00426,603.500.00426,603.5073%153,981.5021,330.18#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 AMOUNTS13,402,788.000.0013,402,788.004,827,610.08705,603.315,533,213.3941%7,869,574.61276,660.70 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 9Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:9/30/2022Lake 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 $2,146,451.79NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$107,322.61 (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)$107,322.61TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$2,039,129.18Net 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)$1,704,810.65Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$334,318.53and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $4,453,411.82 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 10/3/2022Notary Public:By:Date:10/3/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2022-10-05LEO A DALY CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSAPPLIC. FOR PAYMENT NO.#9H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 9/30/2022 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 Insurance25,000.000.0025,000.0021,204.000.0021,204.0085%3,796.001,060.200Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.0054,791.6711,334.5066,126.1727%176,953.833,306.31ReimburseConstruction Management Reimbursables488,555.000.00488,555.00238,516.2537,057.50275,573.7556%212,981.2513,778.69FeeConstruction Management Fee82,595.000.0082,595.0031,176.834,556.8035,733.6343%46,861.371,786.68TrailerTemporary City Office Trailer53,170.000.0053,170.0033,393.662,458.8935,852.5567%17,317.451,792.63ContingencyConstruction Contingency588,330.00(296,759.00)291,571.000.000.000.000%291,571.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete428,316.0028,053.00456,369.00239,904.0064,615.00304,519.0067%151,850.0015,225.95#0341Strutctural Precast333,704.000.00333,704.00273,300.3229,100.03302,400.3591%31,303.6515,120.02#0510Steel Erection93,400.000.0093,400.0016,000.0030,000.0046,000.0049%47,400.002,300.00#0610Carpentry & GC459,000.000.00459,000.00184,636.544,194.78188,831.3241%270,168.689,441.57#0750Roofing & Metal Panels614,800.000.00614,800.000.00155,766.40155,766.4025%459,033.607,788.32#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 & Fireproofing314,360.0016,224.00330,584.0059,000.005,000.0064,000.0019%266,584.003,200.00#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 & Heating363,000.000.00363,000.00141,166.620.00141,166.6239%221,833.387,058.33#2300HVAC & Controls300,000.0012,406.00312,406.0012,148.157,130.3519,278.506%293,127.50963.93#2600Electrical646,070.0018,008.00664,078.0085,045.00700.0085,745.0013%578,333.004,287.25#3100Earthwork & Site Utilities366,400.004,245.00370,645.00259,067.500.00259,067.5070%111,577.5012,953.38#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 AMOUNTS6,492,541.000.006,274,718.001,794,537.54351,914.252,146,451.7934%4,128,266.21107,322.61 INVOICE SUMMARY-PAYMENT APPLICATION NO. #9CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSPERIOD ENDING 9/30/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE1General ConditionsH+U Construction9/30/22Applic #9$11,334.50$566.73$10,767.77ReimburseConstruction Management ReimbursablesH+U Construction9/30/22Applic #9$37,057.50$1,852.88$35,204.62FeeConstruction Management FeeH+U Construction9/30/22Applic #9$4,556.80$227.84$4,328.96TrailerTemporary City Office TrailerH+U Construction9/30/22Applic #7$2,458.89$122.94$2,335.95#0330Cast-In-Place ConcreteAxel H. Ohman, Inc.9/30/22Applic #4$64,615.00$3,230.75$61,384.25#0341Strutctural PrecastWells Concrete9/30/22Applic #2$29,100.03$1,455.00$27,645.03#0510Steel ErectionA.M.E. Construction Corp9/30/22Applic #2$30,000.00$1,500.00$28,500.00#0610Carpentry & GCEbert Construction9/30/22Applic #9$4,194.78$209.74$3,985.04#0750Roofing & Metal PanelsPalmer West Construction9/30/22Applic #1$155,766.40$7,788.32$147,978.08#0920Drywall & FireproofingCommercial Drywall9/30/22Applic #6$5,000.00$250.00$4,750.00#2300HVAC & ControlsSt. Cloud Refrigeration9/30/22Applic #3$7,130.35$356.52$6,773.83#2600ElectricalVinco, Inc.9/30/22Applic #7$700.00$35.00$665.00SUBTOTAL AMOUNT DUE$351,914.25$17,595.72$334,318.53 TOTAL AMOUNT DUE $334,318.53 INVOICE : 220244 PROJECT: J21001 SEPTEMBER 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 September, 2022 CONSTRUCTION MANAGEMENT REIMBURSABLES Project Director 5.00 hrs. @ 150.00 $750.00 Senior Project Manager 44.50 hrs. @ 125.00 $5,562.50 Project Manager 81.00 hrs. @ 105.00 $8,505.00 Project Administrator/Accountant 14.00 hrs. @ 65.00 $910.00 Project Superintendent 186.00 hrs. @ 105.00 $19,530.00 Truck, Travel, & Small Tools 1 mo. @ 1,400.00 $1,400.00 Field Office Equipment 1 mo. @ 400.00 $400.00 $37,057.50 GENERAL CONDITIONS Temporary City Office Trailer $2,458.89 Plan Prints/Shipping $46.20 Drinking Water $37.68 Temporary Toilets $294.29 Safety & OSHA $718.75 Equipment Rental $1,057.16 Xcel Energy - Utility Service $105.46 Trash Removal $1,167.00 Scaffold Rental $472.46 Trailer $1,350.00 Skid Steer $1,800.00 Sunde Land Surveying $3,225.50 Braun Intertec Corporation $1,060.00 $13,793.39 $50,850.89 Subtotal Construction Management Reimbursables Subtotal Reimbursable Expenses Total INVOICE : 220244 PROJECT: J21001 SEPTEMBER 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 September 30, 2022 #0330-Labor Axel H. Ohman, Inc.$64,615.00 #0330-Material Axel H. Ohman, Inc.$39,489.00 #0341-Labor Wells Concrete $29,100.03 #0510-Labor A.M.E. Construction Corp $30,000.00 #0512-Material Construction Systems, Inc.$168,994.70 #0610-Labor Ebert Construction $4,194.78 #0610-Material Ebert Construction $8,600.00 #0750-Labor Palmer-West Construction $155,766.40 #0840-Material Empirehouse Inc.$36,750.00 #0920-Labor Commercial Drywall, Inc.$5,000.00 #0920-Material Commercial Drywall, Inc.$5,000.00 #2200-Material Peterson Sheet Metal, Inc.$3,855.36 #2300-Labor St.Cloud Refrigeration, Inc.$7,130.35 #2300-Material St.Cloud Refrigeration, Inc.$5,000.00 #2600-Labor Vinco, Inc.$700.00 #2600-Material Vinco, Inc.$86,000.00 $650,195.62 $4,556.80 $705,603.31 Retainage Current Retainge 35,280.19 Prior Retainage 241,380.51 Retainage-To-Date 276,660.70 Total Amount Due $670,323.13 CONSTRUCTION MANAGEMENT FEE Total Contractor's Pay Applications September 1 - September 30 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 10/27/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:09/27/2022 INV606269 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 10/27/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:09/27/2022 INV606269 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 10/27/2022 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:09/27/2022 INV606269 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 09/27/22 10/24/22 1 2,000.00 2,000.00 RR not utilized no need to winterize. STEPS Steps - Rental 09/27/22 10/24/22 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 54MNI90540839/29/2022 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 54MNO90499159/29/2022NET30ARC DELIVERY1016013ASI #26 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: $46.209/29/202254MNI90540831016013 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/7DB5A5F2-5E72-4065-91DD-D5452A4CF7F0 QuickPay Online Payment Scan or Click Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221 Invoice #W880564 9/7/2022 W880564 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: 10/5/2022 Terms Due Date PO #Sales Rep Builders Club# Net 28 10/5/2022 -Jeff Foley Qty Item Days Sales Order #Service Level Rate Amount 1 RENTAL RegularUnit Aug 10-Sep 06 28 385563 -$4.00 $4.00 1 SERVICEService Aug 10-Sep 06 28 385563 1X/wk $70.00 $70.00 1 SERVICEClimateSvc Aug 10 to Sep 06 28 385563 1X/wk $16.00 $16.00 1 RENTAL HandSani Aug 10-Sep 06 28 385563 -$0.00 $0.00 1 RENTALRegularUnit Aug 10-Sep 06 28 386930 -$4.00 $4.00 1 SERVICE Service Aug 10-Sep 06 28 386930 1X/wk $70.00 $70.00 1 SERVICEClimateSvc Aug 10 to Sep 06 28 386930 1X/wk $16.00 $16.00 1 RENTAL HandSani Aug 10-Sep 06 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 #W880565 9/7/2022 W880565 1 of 1 Bill To C57180Hoffman & Uhlhorn Const Inc5555 W 78th StSte AMinneapolis MN 55439United States Location L141353LEPW3445 Ideal Ave NLake Elmo MN 55042United States Invoice Total $101.01 Balance Due $101.01 Due Date: 10/5/2022 Terms Due Date PO #Sales Rep Builders Club# Net 28 10/5/2022 LEPW Jeff Foley Qty Item Days Sales Order #Service Level Rate Amount 1 DELIVERY Delivery Aug 19 1 396954 -$33.00 $33.00 1 RENTALRegularUnit Aug 19-Sep 06 19 396954 -$4.00 $2.71 1 SERVICEService Aug 19-Sep 06 19 396954 1X/wk $70.00 $47.50 1 SERVICE ClimateSvc Aug 19 to Sep 06 19 396954 1X/wk $16.00 $10.86 1 DELIVERYDelivery Aug 19 1 396954 -$0.00 $0.00 1 RENTAL HandSani Aug 19-Sep 06 19 396954 -$0.00 $0.00 0 TAX-MNTax-MN ---$0.00 $6.47 0 TAX-WASH Tax-WASH ---$0.00 $0.47 Subtotal $101.01 Invoice Total $101.01 Credits/Payments Applied $0.00 Balance Due $101.01 Biffs Inc.Remittance Slip Make Checks Payable To Customer L141353 Hoffman & Uhlhorn Const Inc : LEPW Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202 Please return this portion with your payment. Invoice #W880565 Amount Due $101.01 Amount Paid ______________________ OECS OECS - 170064 PO Box 9201 Minneapolis, MN 55480 763-417-9599 accounting@oecscomply.com Invoice 37350 BILL TO H+U Construction 5555 West 78th Street, Suite A Minneapolis, MN 55439 DATE 08/15/2022 PLEASE PAY $2,875.00 DUE DATE 09/29/2022 DATE DESCRIPTION QTY RATE AMOUNT August Monthly Services 1 2,875.00 2,875.00 TOTAL DUE $2,875.00 THANK YOU. 126521501-0004 PO BOX 409211 ATLANTA, GA 30384-9211 661003 9/07/22 1 LAKE ELMO LAKE ELMO CITY CENTER 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 984.55 72.61 1057.16 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 BILLED FOR FOUR WEEKS 8/23/22 THRU 9/19/22. . 984.55. 4 WEEK BILL NET 30 ANNA CLARK anna.clark@sunbeltrentals.com DOMINIC, DOMINIC Invoice Date 9/19/2022 Invoice # 354707Customer 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 9/14/2022 30 Yard Container739068 1Each 371.00 371.00 9/14/2022 Solid Waste Management Tax calculated at $0.60/yard. This ticket includes $18.00 of solid waste disposal tax. 739068 30Yards 0.60 18.00 $389.00 $389.00 $0.00 Invoice Date 9/23/2022 Invoice # 355361Customer 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 9/19/2022 30 Yard Container740106 1Each 371.00 371.00 9/19/2022 Solid Waste Management Tax calculated at $0.60/yard. This ticket includes $18.00 of solid waste disposal tax. 740106 30Yards 0.60 18.00 $389.00 $389.00 $0.00 Invoice Date 9/28/2022 Invoice # 355689Customer 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 9/23/2022 30 Yard Container737923 1Each 371.00 371.00 9/23/2022 Solid Waste Management Tax calculated at $0.60/yard. This ticket includes $18.00 of solid waste disposal tax. 737923 30Yards 0.60 18.00 $389.00 $389.00 $0.00 Invoice A119645 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 9/1/2022Date Job Site Shipping Address: 3880 LAVERNE AVE N LAKE ELMO, MN 55042-9627 Created: 9/1/2022 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 8/4/2022 8/31/2022 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: September 01, 2022 6:44:16 AM Page 1 of 1A119645 Invoice A120397 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 9/29/2022Date Job Site Shipping Address: 3880 LAVERNE AVE N LAKE ELMO, MN 55042-9627 Created: 9/29/2022 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 9/1/2022 9/28/2022 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: September 29, 2022 7:12:51 AM Page 1 of 1A120397 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 - 380 Laverne (2021-006-C:) - Managed by (022 LLA) Invoice Federal ID # 41-1923510 Invoice Date: Sep 15, 2022 Invoice Num: 56621 Billing Through: Sep 15, 2022 Luke Nelson H+U Construction 5555 W 78th Street - Suite A Minneapolis, MN 55439- 08/08 - Computed all outside building corners for both building additions. 08/10 - Marked outside building corners in footings with drill on north and west additions. Hours Professional Services Rate AmountDateEmployeeDescription $140.00$140.00 1.00Construction Comps022 LLA8/8/2022 $935.00$110.00 8.50Stake Building(s)229 JPF8/10/2022 $901.00$106.00 8.50Stake Building(s)240 TDM8/10/2022 $1,976.00Total Service Amount: Reimbursable Expenses: EmployeeDate AmountDescription Mileage8/10/2022 229 JPF $45.00 Hubs & Lath8/10/2022 229 JPF $1.00 Iron Monuments8/10/2022 229 JPF $4.50 $50.50Total Expenses: Amount Due This Invoice:$2,026.50 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 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 Const - Ideal Ave (2021-006-B1:) - Managed by (022 LLA) Invoice Federal ID # 41-1923510 Invoice Date: Sep 15, 2022 Invoice Num: 56622 Billing Through: Sep 15, 2022 Luke Nelson H+U Construction 5555 W 78th Street - Suite A Minneapolis, MN 55439- 08/26 - Converted structural CAD file and computed requested grids for field staking. 08/29 - Recovered old control - Located building corners - Staked grid offsets for grids PA, P2, and P6. Hours Professional Services Rate AmountDateEmployeeDescription $280.00$140.00 2.00Construction Comps022 LLA8/26/2022 $440.00$110.00 4.00Stake Grid Lines229 JPF8/29/2022 $424.00$106.00 4.00Stake Grid Lines236 GRP8/29/2022 $1,144.00Total Service Amount: Reimbursable Expenses: EmployeeDate AmountDescription Hubs & Lath8/29/2022 229 JPF $9.00 Iron Monuments8/29/2022 229 JPF $13.50 Mileage8/29/2022 229 JPF $32.50 $55.00Total Expenses: Amount Due This Invoice:$1,199.00 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 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 B309032Invoice number Date 9/9/2022 Project ID B2203298 Customer account 27053 Customer PO For Professional Services rendered through 9/2/2022 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 $464.50 1.5 - Pavement Observations & Testing $137.50 1.6 - Project Management $458.00 $1,060.00 Total Fees $1,060.00 Amount Previously Invoiced: $10,417.00 Amount Invoiced to Date: $11,477.00 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: B309032 Qty/Hours Rate Amount 1 - Construction and Materials Testing 1.1 - Soil Observations and Testing Consulting Services Detail Senior Engineer 0.25 182.00 45.50 Compaction Testing - Nuclear 2.00 82.00 164.00 Non-Salary Detail Nuclear moisture-density meter charge, per hour 2.00 20.00 40.00 Moisture Density Relationship (Standard), per sample 1.00 180.00 180.00 CMT Trip Charge 1.00 35.00 35.00 Total 1.1 - Soil Observations and Testing $464.50 1.5 - Pavement Observations & Testing Consulting Services Detail Sample pick-up 1.25 82.00 102.50 Non-Salary Detail CMT Trip Charge 1.00 35.00 35.00 Total 1.5 - Pavement Observations & Testing $137.50 1.6 - Project Management Consulting Services Detail Staff Engineer 2.25 132.00 297.00 Project Control Specialist 1.00 120.00 120.00 Project Assistant 0.50 82.00 41.00 Total 1.6 - Project Management $458.00 Total 1 - Construction and Materials Testing $1,060.00 Total Project $1,060.00 Page 2 of 2 61,384.259/26/22 $ 28,500.009/26/22 3,985.049/26/22 9/26/22 6,773.83 9/26/22 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 9Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:9/30/2022Lake 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 $3,386,761.60NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$169,338.09 (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)$169,338.09TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$3,217,423.51Net 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)$2,881,418.91Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$336,004.60and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $3,692,823.49 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 10/3/2022Notary Public:By:Date:10/3/2022My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2022-10-05LEO A DALY CITY OF LAKE ELMO - MATERIALAPPLIC. FOR PAYMENT NO.#9H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 9/30/2022 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 Concrete240,000.0014,489.00254,489.00137,000.0039,489.00176,489.0069%78,000.008,824.45#0341Strutctural Precast1,422,295.00580.001,422,875.001,362,368.150.001,362,368.1596%60,506.8568,118.41#0512Steel Supply485,000.009,215.00494,215.00258,784.18168,994.70427,778.8887%66,436.1221,388.94#0610Carpentry & GC568,000.000.00568,000.0023,800.008,600.0032,400.006%535,600.001,620.00#0750Roofing & Metal Panels498,500.000.00498,500.00298,183.250.00298,183.2560%200,316.7514,909.16#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 & Curtainwall321,960.000.00321,960.00107,330.0036,750.00144,080.0045%177,880.007,204.00#0920Drywall & Fireproofing229,410.009,475.00238,885.0065,000.005,000.0070,000.0029%168,885.003,500.00#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 & Carpet90,930.000.0090,930.0089,940.000.0089,940.0099%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 & Heating491,000.000.00491,000.00248,321.963,855.36252,177.3251%238,822.6812,608.87#2300HVAC & Controls662,000.00142,297.00804,297.0089,750.005,000.0094,750.0012%709,547.004,737.50#2600Electrical808,100.0041,217.00849,317.00152,865.0086,000.00238,865.0028%610,452.0011,943.25#3100Earthwork & Site Utilities209,390.00550.00209,940.00167,536.000.00167,536.0080%42,404.008,376.80#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 AMOUNTS6,910,247.000.007,128,070.003,033,072.54353,689.063,386,761.6048%3,741,308.40169,338.09 INVOICE SUMMARY-PAYMENT APPLICATION NO. #9CITY OF NEWPORT - MATERIALPERIOD ENDING 9/30/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE#0330Cast-In-Place ConcreteAxel H. Ohman, Inc.9/30/22Applic #4$39,489.00$1,974.45$37,514.55#0512Steel SupplyConstruction Systems, Inc.9/30/22Applic #4$168,994.70$8,449.74$160,544.96#0610Carpentry & GCEbert Construction9/30/22Applic #7$8,600.00$430.00$8,170.00#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.9/30/22Applic #4$36,750.00$1,837.50$34,912.50#0920Drywall & FireproofingCommercial Drywall9/30/22Applic #4$5,000.00$250.00$4,750.00#2200Plumbing & HeatingPeterson Sheet Metal9/30/22Applic #6$3,855.36$192.77$3,662.59#2300HVAC & ControlsSt. Cloud Refrigeration9/30/22Applic #4$5,000.00$250.00$4,750.00#2600ElectricalVinco, Inc.9/30/22Applic #7$86,000.00$4,300.00$81,700.00SUBTOTAL AMOUNT DUE$353,689.06$17,684.46$336,004.60 TOTAL AMOUNT DUE $336,004.60 37,514.559/26/22 160,544.96869/26/22 8,170.009/26/22 34,912.50 321,960.00 0.00 321,960.00 144,080.00 7,204.00 136,876.00 101,963.50 0.00 36,750.00 107,330.00 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 Tax Exempt Amount of this request Stored material (as per attached breakdown) Total completed and stored to date Subtotal 34,912.50 Empirehouse Inc. 5200 Quincy StreetMounds View, MN 55112 To: From: Phone: Project:Lake Elmo City Center (M)3880 Laverne Avenue N. Lake Elmo, MN 55042 Application No: 4 Date: 09/01/22 Period To: 09/30/22 Contract For: Contract Date: Contractor Job Number:21153 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 September 23, 2022 23 September 2022 01.31.2025 Kristine Hutera, CEO 010500 010600 020500 020502 021000 021001 021002 030500 030501 030502 040500 041000 042000 055000 4,580.00 4,580.00 0.00 0.00 4,580.00 100.00 229.000.00 26,100.00 11,000.00 0.00 5,000.00 16,000.00 61.30 800.0010,100.00 49,080.00 49,080.00 0.00 0.00 49,080.00 100.00 2,454.000.00 17,575.00 17,575.00 0.00 0.00 17,575.00 100.00 878.750.00 57,775.00 0.00 0.00 0.00 0.00 0.00 0.0057,775.00 47,640.00 0.00 0.00 0.00 0.00 0.00 0.0047,640.00 63,500.00 0.00 0.00 31,750.00 31,750.00 50.00 1,587.5031,750.00 17,565.00 17,565.00 0.00 0.00 17,565.00 100.00 878.250.00 7,530.00 7,530.00 0.00 0.00 7,530.00 100.00 376.500.00 10,000.00 0.00 0.00 0.00 0.00 0.00 0.0010,000.00 6,010.00 0.00 0.00 0.00 0.00 0.00 0.006,010.00 6,465.00 0.00 0.00 0.00 0.00 0.00 0.006,465.00 120.00 0.00 0.00 0.00 0.00 0.00 0.00120.00 8,020.00 0.00 0.00 0.00 0.00 0.00 0.008,020.00 321,960.00 107,330.00 0.00 36,750.00 144,080.00 44.75 7,204.00177,880.00 To:H+U Construction From (Subcontractor):Empirehouse Inc. Project:Lake Elmo City Center (M) Application and Certificate For Payment -- page 2 Application No: 4 Date: 09/01/22 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 Metal Materials CW Metal Materials Jeld-wen Vinyl Windows StormDefend Windows Bullet Resistant Windows SF Glass Materials CW Glass Materials Skyligtht Glass Material Interior Glass Materials Heavy Wall Glass Materia Mirror Materials Testing Application Total Period To: 09/30/22 Contractor's Job Number: 21153 9/26/22 4,750.00 9/26/22 09/20/2022 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 Material-$86,000 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