HomeMy WebLinkAbout#08 - City Center-Public Works Pay Request 18STAFF REPORT
DATE: July 18, 2023
CONSENT
AGENDA ITEM: City Center-Public Works Addition Pay Request #18 SUBMITTED BY: Kristina Handt, City Administrator
BACKGROUND: At the November 3, 2021 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 #18 for the City Center and Public Works Addition project?
PROPOSAL: Pay request #18 is for $684,005.13. A copy is included in your packet.
FISCAL IMPACT:
With this pay request, the project remains within budget. OPTION: 1) Approve pay request #18
2) Don’t approve pay request #18
RECOMMENDATION: “Motion to approve Pay Request #18 for the New City Center and Public Works Addition.” ATTACHMENTS:
• Pay Request #18
APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 18Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:6/30/2023Lake 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 $12,773,059.83NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$638,653.06 (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)$638,653.06TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$12,134,406.77Net 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)$11,450,401.64Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$684,005.13and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $1,268,381.23 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 7/11/2023Notary Public:By:Date:7/11/2023My Commission expires:31-Jan-28ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-07-11
CITY OF LAKE ELMO - OVERALLAPPLIC. FOR PAYMENT NO.#18H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 6/30/2023 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 Conditions243,080.00(40,781.25)202,298.75179,704.538,793.05188,497.5893%13,801.179,424.88ReimburseConstruction Management Reimbursables488,555.00113,431.25601,986.25529,336.2562,650.00591,986.2598%10,000.0029,599.31FeeConstruction Management Fee82,595.000.0082,595.0077,838.902,727.3180,566.2198%2,028.794,028.31TrailerTemporary City Office Trailer53,170.004,872.6158,042.6155,583.722,458.8958,042.61100%0.002,902.13ContingencyConstruction Contingency588,330.00(765,983.61)(177,653.61)0.000.000.000%0.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete668,316.0057,146.00725,462.00707,706.0017,756.00725,462.00100%0.0036,273.10#0341Strutctural Precast1,755,999.00580.001,756,579.001,756,579.000.001,756,579.00100%0.0087,828.95#0510Steel Erection93,400.0016,546.00109,946.00109,946.000.00109,946.00100%0.005,497.30#0512Steel Supply485,000.0079,038.00564,038.00564,038.000.00564,038.00100%0.0028,201.90#0610Carpentry & GC1,027,000.0027,818.001,054,818.00821,152.40202,933.901,024,086.3097%30,731.7051,204.32#0750Roofing & Metal Panels1,113,300.00(59,665.00)1,053,635.00917,528.370.00917,528.3787%136,106.6345,876.42#0790Caulking & Firestopping72,350.007,545.0079,895.0068,634.500.0068,634.5086%11,260.503,431.73#0810Doors, Frames, Hardware - Supply171,697.0026,533.00198,230.00189,062.570.00189,062.5795%9,167.439,453.13#0833Coiling & Sectional Doors350,000.00(28,970.00)321,030.00321,030.000.00321,030.00100%0.0016,051.50#0840Aluminum Storefronts & Curtainwall400,410.00147,119.00547,529.00538,872.007,097.00545,969.00100%1,560.0027,298.45#0920Drywall & Fireproofing543,770.0059,865.00603,635.00535,080.3265,870.50600,950.82100%2,684.1830,047.54#0930Tile154,980.000.00154,980.00120,240.000.00120,240.0078%34,740.006,012.00#0950Acoustical Ceilings & Panels126,000.000.00126,000.00113,000.0013,000.00126,000.00100%0.006,300.00#0965Resilient Flooring & Carpet131,940.00275.00132,215.00132,215.000.00132,215.00100%0.006,610.75#0990Painting and Wallcovering157,727.00670.00158,397.00130,603.0013,869.00144,472.0091%13,925.007,223.60#1420Conveying Equipment82,000.000.0082,000.0021,577.0053,301.8574,878.8591%7,121.153,743.94#2100Fire Protection112,915.000.00112,915.00112,915.000.00112,915.00100%0.005,645.75#2200Plumbing & Heating854,000.0057,999.00911,999.00891,885.3510,457.20902,342.5599%9,656.4545,117.13#2300HVAC & Controls962,000.00169,328.001,131,328.001,102,779.5518,858.701,121,638.2599%9,689.7556,081.91#2600Electrical1,454,170.0082,575.001,536,745.001,215,330.0097,500.001,312,830.0085%223,915.0065,641.50#3100Earthwork & Site Utilities575,790.0024,203.00599,993.00575,695.0010,183.00585,878.0098%14,115.0029,293.90#3210Asphalt Paving317,200.0019,856.00337,056.00116,093.97132,549.00248,642.9774%88,413.0312,432.15#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 AMOUNTS13,402,788.000.0013,402,788.0012,053,054.43720,005.4012,773,059.8395%807,381.78638,653.06
APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 18Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:6/30/2023Lake 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 $5,590,959.47NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$279,548.03 (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)$279,548.03TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$5,311,411.44Net 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)$4,893,415.70Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$417,995.74and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $1,181,129.56 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 7/11/2023Notary Public:By:Date:7/11/2023My Commission expires:31-Jan-28ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-07-11
CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSAPPLIC. FOR PAYMENT NO.#18H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 6/30/2023 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 Conditions243,080.00(40,781.25)202,298.75179,704.538,793.05188,497.5893%13,801.179,424.88ReimburseConstruction Management Reimbursables488,555.00113,431.25601,986.25529,336.2562,650.00591,986.2598%10,000.0029,599.31FeeConstruction Management Fee82,595.000.0082,595.0077,838.902,727.3180,566.2198%2,028.794,028.31TrailerTemporary City Office Trailer53,170.004,872.6158,042.6155,583.722,458.8958,042.61100%0.002,902.13ContingencyConstruction Contingency588,330.00(765,983.61)(177,653.61)0.000.000.000%0.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete428,316.0032,043.00460,359.00451,284.009,075.00460,359.00100%0.0023,017.95#0341Strutctural Precast333,704.000.00333,704.00333,704.000.00333,704.00100%0.0016,685.20#0510Steel Erection93,400.0016,546.00109,946.00109,946.000.00109,946.00100%0.005,497.30#0610Carpentry & GC459,000.006,684.00465,684.00347,684.8588,467.45436,152.3094%29,531.7021,807.62#0750Roofing & Metal Panels614,800.00(31,650.00)583,150.00494,304.250.00494,304.2585%88,845.7524,715.21#0790Caulking & Firestopping54,050.004,324.0058,374.0050,554.000.0050,554.0087%7,820.002,527.70#0833Coiling & Sectional Doors175,000.00(143,500.00)31,500.0031,500.000.0031,500.00100%0.001,575.00#0840Aluminum Storefronts & Curtainwall78,450.0047,704.00126,154.00119,494.005,100.00124,594.0099%1,560.006,229.70#0920Drywall & Fireproofing314,360.0037,519.00351,879.00306,905.8242,289.00349,194.8299%2,684.1817,459.74#0930Tile86,880.000.0086,880.0052,140.000.0052,140.0060%34,740.002,607.00#0950Acoustical Ceilings & Panels51,000.000.0051,000.0048,000.003,000.0051,000.00100%0.002,550.00#0965Resilient Flooring & Carpet41,010.000.0041,010.0041,010.000.0041,010.00100%0.002,050.50#0990Painting and Wallcovering128,196.00558.00128,754.00102,930.0013,869.00116,799.0091%11,955.005,839.95#1420Conveying Equipment35,260.000.0035,260.000.0031,734.0031,734.0090%3,526.001,586.70#2100Fire Protection55,395.000.0055,395.0055,395.000.0055,395.00100%0.002,769.75#2200Plumbing & Heating363,000.0041,624.00404,624.00394,166.8010,457.20404,624.00100%0.0020,231.20#2300HVAC & Controls300,000.0023,433.00323,433.00299,904.5513,838.70313,743.2597%9,689.7515,687.16#2600Electrical646,070.0026,733.00672,803.00498,952.0081,000.00579,952.0086%92,851.0028,997.60#3100Earthwork & Site Utilities366,400.0021,659.00388,059.00370,176.008,083.00378,259.0097%9,800.0018,912.95#3210Asphalt Paving136,566.008,081.00144,647.0051,821.2856,452.92108,274.2075%36,372.805,413.71#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 AMOUNTS6,492,541.000.005,895,838.005,150,963.95439,995.525,590,959.4795%482,532.14279,548.03
INVOICE SUMMARY-PAYMENT APPLICATION NO. #18CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSPERIOD ENDING 6/30/2023ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE1General ConditionsH+U Construction6/30/23Applic #18$8,793.05$439.65$8,353.40ReimburseConstruction Management ReimbursablesH+U Construction6/30/23Applic #17$62,650.00$3,132.50$59,517.50FeeConstruction Management FeeH+U Construction6/30/23Applic #18$2,727.31$136.37$2,590.94TrailerTemporary City Office TrailerH+U Construction6/30/23Applic #16$2,458.89$122.94$2,335.95#0330Cast-In-Place ConcreteAxel H. Ohman, Inc.6/30/23Applic #10$9,075.00$453.75$8,621.25#0610Carpentry & GCEbert Construction6/30/23Applic #17-18$88,467.45$4,423.37$84,044.08#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.6/30/23Applic #11$5,100.00$255.00$4,845.00#0920Drywall & FireproofingCommercial Drywall6/30/23Applic #15$42,289.00$2,114.45$40,174.55#0950Acoustical Ceilings & PanelsAcoustics Associates6/30/23Applic #3$3,000.00$150.00$2,850.00#0990Painting and WallcoveringSteinbrecher Painting Company6/30/23Applic #6$13,869.00$693.45$13,175.55#1420Conveying EquipmentSchindler Elevator6/30/23Applic #1$31,734.00$1,586.70$30,147.30#2200Plumbing & HeatingPeterson Sheet Metal6/30/23Applic #12$10,457.20$522.86$9,934.34#2300HVAC & ControlsSt. Cloud Refrigeration6/30/23Applic #11$13,838.70$691.94$13,146.76#2600ElectricalVinco, Inc.6/30/23Applic #16$81,000.00$4,050.00$76,950.00#3100Earthwork & Site UtilitiesPark Construction Company6/30/23Applic #12$8,083.00$404.15$7,678.85#3210Asphalt PavingEbert Construction6/30/23Applic #3$56,452.92$2,822.65$53,630.27SUBTOTAL AMOUNT DUE$439,995.52$21,999.78$417,995.74 TOTAL AMOUNT DUE $417,995.74
INVOICE : 230180
PROJECT: J21001
MAY 31, 2023
PAGE 1 OF 2
TO:CITY OF LAKE ELMO
3880 Laverne Ave N
Lake Elmo, MN 55042
ATTN:ACCOUNTING
RE:LAKE ELMO CITY CENTER &
LAKE ELMO PUBLIC WORKS ADDITION
Invoice for Construction Management services performed during the month of May, 2023
CONSTRUCTION MANAGEMENT REIMBURSABLES
Project Director 1.00 hrs. @ 150.00 $150.00
Project Controller 5.00 hrs. @ 125.00 $625.00
Senior Project Manager 67.00 hrs. @ 125.00 $8,375.00
Project Manager 125.00 hrs. @ 105.00 $13,125.00
Project Administrator/Accountant 13.00 hrs. @ 65.00 $845.00
Project Superintendent 318.00 hrs. @ 105.00 $33,390.00
Assistant Superintendent 132.00 hrs. @ 95.00 $12,540.00
Truck, Travel, & Small Tools 2 mo. @ 1,400.00 $2,800.00
Field Office Equipment 2 mo. @ 400.00 $800.00
$62,650.00
GENERAL CONDITIONS
Temporary City Office Trailer $2,458.89
Plan Prints/Shipping $134.82
Drinking Water $8.59
Temporary Toilets $386.56
Safety & OSHA $950.12
Xcel Energy - Utility Service $134.46
Trash Removal $1,900.00
Skid Steer $2,700.00
Braun Intertec Corporation $2,578.50
$11,251.94
$73,901.94
Subtotal Construction Management Reimbursables
Subtotal General Conditions
Total
INVOICE : 230180
PROJECT: J21001
MAY 31, 2023
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, 2023
#0330-Labor Axel H. Ohman, Inc.$9,075.00
#0330-Material Axel H. Ohman, Inc.$8,681.00
#0610-Labor Ebert Construction $88,467.45
#0610-Material Ebert Construction $114,466.45
#0840-Labor Empirehouse Inc.$5,100.00
#0840-Material Empirehouse Inc.$1,997.00
#0920-Labor Commercial Drywall, Inc.$42,289.00
#0920-Material Commercial Drywall, Inc.$23,581.50
#0950-Labor Acoustic Associates, Inc.$3,000.00
#0950-Material Acoustic Associates, Inc.$10,000.00
#0990-Labor Steinbrecher Painting Company $13,869.00
#1420-Labor Schindler Elevator Corporation $31,734.00
#1420-Material Schindler Elevator Corporation $21,567.85
#2200-Labor Peterson Sheet Metal, Inc.$10,457.20
#2300-Labor St.Cloud Refrigeration, Inc.$13,838.70
#2300-Material St.Cloud Refrigeration, Inc.$5,020.00
#2600-Labor Vinco, Inc.$81,000.00
#2600-Material Vinco, Inc.$16,500.00
#3100-Labor Park Construction Company $8,083.00
#3100-Material Park Construction Company $2,100.00
#3210-Labor Ebert Construction $56,452.92
#3210-Material Ebert Construction $76,096.08
$643,376.15
$2,727.31
$720,005.40
Retainage
Current Retainge 36,000.27
Prior Retainage 602,652.79
Retainage-To-Date 638,653.06
Total Amount Due $684,005.13
CONSTRUCTION MANAGEMENT FEE
Total Contractor's Pay Applications June 1 - June 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
07/06/2023
Due Date Customer PO No.
RQ152297 Lake Elmo DW Trailer
Invoice No.:
Invoice Date:06/06/2023
INV670696
Tracy DickensonA/R Account Rep:
PO Box 860700
Minneapolis, MN 55486-0700
Phone: (763) 553-1900
Rental Insurance Status: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 06/06/23 07/03/23 1 2,000.00 2,000.00
RR not utilized no need to winterize.
STEPS Steps - Rental 06/06/23 07/03/23 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 54MNI90601226/2/2023
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:
Pat Sullivan
10360 W River RoadBrooklyn Park, MN 55444
P: (651) 253-3173
H+U CONSTRUCTION Job Trailer
54MNO90546216/1/2023NET30ARC DELIVERY1016013PR 01
OrderOrder Due DatePayment TermsShipping MethodCustomer IDPurchase Order #
Lake Elmo ASI 35J21001Lisa 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
$35.00$35.00Courier Charge5202EACH011
$5.00$5.00Energy / Fuel Surcharge5205EACH011
$44.08Total Due
Amount Received
$44.08Total
$0.00Trade Discount
$0.00Freight
$3.09Tax
$0.00Misc
$40.99SubtotaltronneiBiller:
$44.086/2/202354MNI90601221016013
AMOUNT DUEDOC DATEINVOICECUSTOMER NO
ARC DOCUMENT SOLUTIONS LLC
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PO BOX 645913CINCINNATI, OH 45264-5913
(216) 539-1501
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ARC DOCUMENT SOLUTIONS LLC
4730 PARK GLEN RD
SAINT LOUIS PARK MN 55416-5701 54MNI90601936/8/2023
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
54MNO90547546/8/2023NET30ARC DELIVERY1016013ASI 36
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 (30.00x42.00)
$1.98$0.10989Bond Prints - First Set1600SQFT0.0018.0018.00
$35.00$35.00Supply / Delivery Charge5201EACH011
$5.00$5.00Energy / Fuel Surcharge5205EACH011
$45.37Total Due
Amount Received
$45.37Total
$0.00Trade Discount
$0.00Freight
$3.39Tax
$0.00Misc
$41.98SubtotalllakotasBiller:
$45.376/8/202354MNI90601931016013
AMOUNT DUEDOC DATEINVOICECUSTOMER NO
ARC DOCUMENT SOLUTIONS LLC
NEW REMIT TO ADDRESS
PO BOX 645913CINCINNATI, OH 45264-5913
(216) 539-1501
ARC.AR.CENTRAL@E-ARC.COM
We accept: Visa | MasterCard | American Express | Discover
Card/Check Number:______________________ Exp. Date: __________
Signature:_______________________________ Amount: $___________
REMIT PAYMENT TO
HTTPS://PAY.ARCREMOTE.COM/P/B29DE358-1605-4923-B4C1-50A471487780
QuickPay Online Payment
Scan or Click
ARC DOCUMENT SOLUTIONS LLC
4730 PARK GLEN RD
SAINT LOUIS PARK MN 55416-5701 54MNI90606756/23/2023
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
54MNO90550696/23/2023NET30ARC DELIVERY1016013ASI 37
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 (30.00x42.00)
$1.98$0.10989Bond Prints - First Set1600SQFT0.0018.0018.00
$35.00$35.00Supply / Delivery Charge5201EACH011
$5.00$5.00Energy / Fuel Surcharge5205EACH011
$45.37Total Due
Amount Received
$45.37Total
$0.00Trade Discount
$0.00Freight
$3.39Tax
$0.00Misc
$41.98SubtotaltronneiBiller:
$45.376/23/202354MNI90606751016013
AMOUNT DUEDOC DATEINVOICECUSTOMER NO
ARC DOCUMENT SOLUTIONS LLC
NEW REMIT TO ADDRESS
PO BOX 645913CINCINNATI, OH 45264-5913
(216) 539-1501
ARC.AR.CENTRAL@E-ARC.COM
We accept: Visa | MasterCard | American Express | Discover
Card/Check Number:______________________ Exp. Date: __________
Signature:_______________________________ Amount: $___________
REMIT PAYMENT TO
HTTPS://PAY.ARCREMOTE.COM/P/B8EB2F25-0E8B-4C2E-97BD-31D0B5A988D0
QuickPay Online Payment
Scan or Click
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221
Invoice
#W917508
6/14/2023
W917508
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: 7/12/2023
Terms Due Date PO #Sales Rep Builders Club#
Net 28 7/12/2023 -Jeff Foley
Qty Item Days Sales Order #Service Level Rate Amount
1 RENTAL
RegHS May 17-Jun 13
28 386930 -$4.00 $4.00
1 SERVICEService May 17-Jun 13
28 386930 1X/wk $70.00 $70.00
1 SERVICEClimateSvc May 17 to Jun 13
28 386930 1X/wk $16.00 $16.00
1 RENTAL
zHandSani May 17-Jun 13
28 386930 -$0.00 $0.00
1 RENTALRegHS May 17-Jun 13
28 398087 -$4.00 $4.00
1 SERVICE
Service May 17-Jun 13
28 398087 1X/wk $70.00 $70.00
1 SERVICEClimateSvc May 17 to Jun 13
28 398087 1X/wk $16.00 $16.00
1 RENTAL
zHandSani May 17-Jun 13
28 398087 -$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
#W917508
6/14/2023
W917508
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 #W917508
Amount Due $193.28
Amount Paid ______________________
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221
Invoice
#W917509
6/14/2023
W917509
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 $96.64
Balance Due $96.64
Due Date: 7/12/2023
Terms Due Date PO #Sales Rep Builders Club#
Net 28 7/12/2023 LEPW Jeff Foley
Qty Item Days Sales Order #Service Level Rate Amount
1 RENTAL
RegHS May 17-Jun 13
28 396954 -$4.00 $4.00
1 SERVICEService May 17-Jun 13
28 396954 1X/wk $70.00 $70.00
1 SERVICEClimateSvc May 17 to Jun 13
28 396954 1X/wk $16.00 $16.00
1 RENTAL
zHandSani May 17-Jun 13
28 396954 -$0.00 $0.00
0 TAX-MNTax-MN
---$0.00 $6.19
0 TAX-WASH
Tax-WASH
---$0.00 $0.45
Subtotal $96.64
Invoice Total $96.64
Credits/Payments Applied $0.00
Balance Due $96.64
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 #W917509
Amount Due $96.64
Amount Paid ______________________
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221
Invoice
#W917511
6/14/2023
W917511
1 of 1
Bill To
C57180Hoffman & Uhlhorn Const Inc5555 W 78th StSte AMinneapolis MN 55439United States
Location
L143501LECC3880 Laverne Ave NLake Elmo MN 55042United States
Invoice Total $96.64
Balance Due $96.64
Due Date: 7/12/2023
Terms Due Date PO #Sales Rep Builders Club#
Net 28 7/12/2023 -Jeff Foley
Qty Item Days Sales Order #Service Level Rate Amount
1 RENTAL
RegHS May 17-Jun 13
28 402272 -$4.00 $4.00
1 SERVICEService May 17-Jun 13
28 402272 1X/wk $70.00 $70.00
1 SERVICEClimateSvc May 17 to Jun 13
28 402272 1X/wk $16.00 $16.00
1 RENTAL
zHandSani May 17-Jun 13
28 402272 -$0.00 $0.00
0 TAX-MNTax-MN
---$0.00 $6.19
0 TAX-WASH
Tax-WASH
---$0.00 $0.45
Subtotal $96.64
Invoice Total $96.64
Credits/Payments Applied $0.00
Balance Due $96.64
Biffs Inc.Remittance Slip
Make Checks Payable To Customer L143501 Hoffman & Uhlhorn Const Inc : LECC
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202
Please return this portion with your payment.
Invoice #W917511
Amount Due $96.64
Amount Paid ______________________
Branch:100
St. Paul
1407741
Invoice Date Page
INVOICE
3266848
ORDER NUMBER
Columbus, MN 55025
9205 Lake Drive NE
Viking Industrial Center
1 of 1651-646-6141
INVOICE
06/06/2023
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 07/06/2023 07/06/2023 0.00
Primary Salesrep NameOrder Date Pick Ticket No Taker
06/01/2023 13:50:49 2299301 Douglas P. Geist TWOODBURY
Item ID
Item DescriptionOrderedShippedRemaining
Quantities
UOM
Disp.Unit Size
Pricing
UOM Unit
PriceUnit Size PriceExtended
12.00 0.00 PAIR V5G-SB8610DTM PAIR 6.912000 82.94
1.0 1.0000
12.00
EVER-LITE SAFETY GLASS CLEAR AF
Ever-Lite Panoramic View Safety Glasses with HMAX Coated Wraparound Lens - Abrasion, Chemical & U
12.00 0.00 PAIR V5G-SB8620DTM PAIR 7.584000 91.01
1.0 1.0000
12.00
EVER-LITE SAFETY GLASS GRAY AF
Ever-Lite Panoramic View Safety Glasses with HMAX Coated Wraparound Lens - Abrasion, Chemical & U
SUB-TOTAL:Total Lines:2 173.95
MN STATE TAX 12.51:
MN SPECIAL TAX 0.91:
TRUCK DELIVERY 8.00:
195.37AMOUNT 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
OECS
OECS - 170064 PO Box 9201
Minneapolis, MN 55480
763-417-9599
accounting@oecscomply.com
Invoice 40659
BILL TO
H+U Construction
5555 West 78th Street, Suite A
Minneapolis, MN 55439
DATE
05/15/2023
PLEASE PAY
$3,019.00
DUE DATE
06/29/2023
DATE DESCRIPTION QTY RATE AMOUNT
Monthly Safety Services 1 3,019.00 3,019.00
TOTAL DUE $3,019.00
THANK YOU.
5555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
Jun-10-23
1
HU CONSTRUCTION INC
Date Codes Description Reference Quantity Amount
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
315 27th Ave NE
Minneapolis, MN 55418
Phone: (612) 623-8888
www.LRSrecycles.com 1 of 1
1523.1
UC9911
(0001)
LECC
3880 LAVERNE AVE N, LAKE ELMO MN
Serv #002 ROLL OFF 20.00
1.00 $362.0001 - Jun RO SWITCH - NT W.O# 10532 $362.00 GABE 651-395-0055
RO SWITCH - NT
1.00 $362.0007 - Jun RO SWITCH - NT W.O# 11693 $362.00 DAVE 651-395-0055RO SWITCH - NT
$36.0010 - Jun Solid Waste Management Tax C&D TN at $2.00/TN on 18.00TN
Due to increased costs, your next invoice may reflect a price increase.
Pay your bill online at www.LRSrecycles.com Jun-10-23
15555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
HU CONSTRUCTION INC
Payment due upon receipt of this invoice. 1.5% per month (18% per annum) late charges on balances
over 30 days from date of invoice. Payments received after invoice date are not reflected. To ensure proper credit, please include your account number on your check and include the bottom portion of this invoice. When making payment on multiple accounts, please include the account numbers and the amounts of payment. We reserve the right to suspend service without notice on any past due account.
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
$1,130.00 $0.00 $0.00 $0.00 $760.00 $1,130.00Invoice Total Balance DueCurrent31-60 Days 61-90 Days Over 91 Days
1 of 1
1523.1
Please detach coupon and remit with paymentNEW PAYMENT ADDRESS
REMITLRS
315 27th Ave NE
Minneapolis, MN 55418 UC9911
5555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
May-31-23
2
HU CONSTRUCTION INC
Date Codes Description Reference Quantity Amount
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
315 27th Ave NE
Minneapolis, MN 55418
Phone: (612) 623-8888
www.LRSrecycles.com 1 of 1
1523.2
UC8941
(0002)
LEPW
3445 IDEAL AVE N, LAKE ELMO MN
Serv #001 ROLL OFF 20.00
1.00 $362.0031 - May RO SWITCH - NT W.O# 10374 $362.00 PAT 651-235-3173
RO SWITCH - NT
$18.0031 - May Solid Waste Management Tax C&D TN at $2.00/TN on 9.00TN
Due to increased costs, your next invoice may reflect a price increase.
Pay your bill online at www.LRSrecycles.com May-31-23
25555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
HU CONSTRUCTION INC
Payment due upon receipt of this invoice. 1.5% per month (18% per annum) late charges on balances
over 30 days from date of invoice. Payments received after invoice date are not reflected. To ensure proper credit, please include your account number on your check and include the bottom portion of this invoice. When making payment on multiple accounts, please include the account numbers and the amounts of payment. We reserve the right to suspend service without notice on any past due account.
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
$380.00 $0.00 $0.00 $0.00 $380.00 $380.00Invoice Total Balance DueCurrent31-60 Days 61-90 Days Over 91 Days
1 of 1
1523.2
Please detach coupon and remit with paymentNEW PAYMENT ADDRESS
REMITLRS
315 27th Ave NE
Minneapolis, MN 55418 UC8941
5555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
Jun-17-23
1
HU CONSTRUCTION INC
Date Codes Description Reference Quantity Amount
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
315 27th Ave NE
Minneapolis, MN 55418
Phone: (612) 623-8888
www.LRSrecycles.com 1 of 1
1523.1
UC11270
(0001)
LECC
3880 LAVERNE AVE N, LAKE ELMO MN
Serv #002 ROLL OFF 20.00
1.00 $362.0013 - Jun RO SWITCH - NT W.O# 12642 $362.00 GABE 651-395-0055
RO SWITCH - NT
$18.0017 - Jun Solid Waste Management Tax C&D TN at $2.00/TN on 9.00TN
Due to increased costs, your next invoice may reflect a price increase.
Pay your bill online at www.LRSrecycles.com Jun-17-23
15555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
HU CONSTRUCTION INC
Payment due upon receipt of this invoice. 1.5% per month (18% per annum) late charges on balances
over 30 days from date of invoice. Payments received after invoice date are not reflected. To ensure proper credit, please include your account number on your check and include the bottom portion of this invoice. When making payment on multiple accounts, please include the account numbers and the amounts of payment. We reserve the right to suspend service without notice on any past due account.
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
$1,140.00 $370.00 $0.00 $0.00 $380.00 $1,510.00Invoice Total Balance DueCurrent31-60 Days 61-90 Days Over 91 Days
1 of 1
1523.1
Please detach coupon and remit with paymentNEW PAYMENT ADDRESS
REMITLRS
315 27th Ave NE
Minneapolis, MN 55418 UC11270
5555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
Jun-24-23
1
HU CONSTRUCTION INC
Date Codes Description Reference Quantity Amount
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
315 27th Ave NE
Minneapolis, MN 55418
Phone: (612) 623-8888
www.LRSrecycles.com 1 of 1
1523.1
UC11918
(0001)
LECC
3880 LAVERNE AVE N, LAKE ELMO MN
Serv #002 ROLL OFF 20.00
1.00 $362.0022 - Jun RO SWITCH - NT W.O# 14197 $362.00 GABE 651-395-0055
RO SWITCH - NT
$18.0024 - Jun Solid Waste Management Tax C&D TN at $2.00/TN on 9.00TN
Due to increased costs, your next invoice may reflect a price increase.
Pay your bill online at www.LRSrecycles.com Jun-24-23
15555 W 78TH ST STE A
MINNEAPOLIS, MN 55439-2702
HU CONSTRUCTION INC
Payment due upon receipt of this invoice. 1.5% per month (18% per annum) late charges on balances
over 30 days from date of invoice. Payments received after invoice date are not reflected. To ensure proper credit, please include your account number on your check and include the bottom portion of this invoice. When making payment on multiple accounts, please include the account numbers and the amounts of payment. We reserve the right to suspend service without notice on any past due account.
Invoice No
Page No
Invoice Date
Customer No
Site No
Reference
$1,520.00 $370.00 $0.00 $0.00 $380.00 $1,890.00Invoice Total Balance DueCurrent31-60 Days 61-90 Days Over 91 Days
1 of 1
1523.1
Please detach coupon and remit with paymentNEW PAYMENT ADDRESS
REMITLRS
315 27th Ave NE
Minneapolis, MN 55418 UC11918
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
B344780Invoice number
Date 6/8/2023
Project ID B2203298
Customer account 27053
Customer PO
For Professional Services rendered through 5/26/2023
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 $431.00
1.2 - Concrete Observations and Testing $1,774.50
1.6 - Project Management $373.00
$2,578.50
Total Fees $2,578.50
Amount Previously Invoiced: $26,488.50
Amount Invoiced to Date: $29,067.00
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: B344780
Qty/Hours Rate Amount
1 - Construction and Materials Testing
1.1 - Soil Observations and Testing
Consulting Services Detail
Staff Engineer 3.00 132.00 396.00
Non-Salary Detail
CMT Trip Charge 1.00 35.00 35.00
Total 1.1 - Soil Observations and Testing $431.00
1.2 - Concrete Observations and Testing
Consulting Services Detail
Senior Engineer 0.25 182.00 45.50
Concrete Observations 3.75 92.00 345.00
Concrete Testing 3.75 82.00 307.50
Concrete Cylinder Pick up 3.25 82.00 266.50
Non-Salary Detail
Compressive strength of concrete cylinders
(ASTM C 39),per specimen
20.00 30.00 600.00
CMT Trip Charge 6.00 35.00 210.00
Total 1.2 - Concrete Observations and Testing $1,774.50
1.6 - Project Management
Consulting Services Detail
Staff Engineer 1.25 132.00 165.00
Project Control Specialist 0.50 120.00 60.00
Senior Engineer 0.25 182.00 45.50
Project Assistant 1.25 82.00 102.50
Total 1.6 - Project Management $373.00
Total 1 - Construction and Materials Testing $2,578.50
Total Project $2,578.50
Page 2 of 2
8,621.256/27/23
35,486.166/27/23
48,557.926/27/23
4,845.00
78,450.00
47,704.00
126,154.00
124,594.00
6,229.70
118,364.30
113,519.30
0.00
0.00
124,594.00
Page 1
Certificate of the Subcontractor:
I hereby certify that the work performed and the materials supplied to date as shown on the above represent the actual value of accomplishment under the terms of the contract (and all authorized
changes thereto) between the undersigned and H+U Construction relating to the above-referenced project.
I also certify that Payments, less applicable retention, have been made through the period covered by previous payments received from the contractor, to (1) all my subcontractors (sub-subcontractors) and (2) for all materials and labor used in connection with the performance of this contract.
I further certify I have complied with Federal, State and Local tax laws, including Social Security laws and unemployment laws and Workmen's Compensation laws insofar as applicable to the
performance of this contract.
Furthermore, in consideration of this request of the payments received and upon receipt of the amount of this request, the undersigned does hereby waive, release, and relinquish all claims or right of lien which the undersigned may now have upon the premises above described except for claims or right of lien for contract and/or change order work performed to the extent that payment is being retained or will
subsequently become due.
Original contract sum
Net change by change orders (as per attached breakdown)
Contract sum to date
Completed to date (as per attached breakdown)
Total retainage (5.0%)
Total earned less retainage
Less previous certificates of payment
Sales tax at 0.000% on 0.00
Amount of this request
Stored material (as per attached breakdown)
Total completed and stored to date
Subtotal 4,845.00
Empirehouse Inc.
5200 Quincy StreetMounds View, MN 55112
To:
From:
Phone:
Project:Lake Elmo City Center (L)3880 Laverne Avenue N.
Lake Elmo, MN 55042
Application No: 11 Date: 06/01/23
Period To: 06/30/23
Contract For:
Contract Date:
Contractor Job
Number:21152
Date: __________________________________
Subscribed and sworn to before me this _____ day
of ____________, _________ (year).
Notary public: _____________________________
My commission expires ____________________.
Contractor: Empirehouse Inc.
By: ____________________________________
Title: ___________________________________
(763) 535-1150
Application and Certificate For Payment
H+U Construction5555 West 78th Street
Suite A
Edina, MN 55439
Date: __________________________________
Subscribed and sworn to before me this _____ day
of ____________, _________ (year).
Notary public: _____________________________
My commission expires ____________________.
Contractor: Empirehouse Inc.
By: ____________________________________
Title: ___________________________________
Date: __________________________________
Subscribed and sworn to before me this _____ day
of ____________, _________ (year).
Notary public: _____________________________
My commission expires ____________________.
Contractor: Empirehouse Inc.
By: ____________________________________
Title: ___________________________________
Date: __________________________________
Subscribed and sworn to before me this _____ day
of ____________, _________ (year).
Notary public: _____________________________
My commission expires ____________________.
Contractor: Empirehouse Inc.
By: ____________________________________
Title: ___________________________________
June 13, 2023
13
June 2023
January 31, 2025 Kristine Hutera, CEO
010500
010600
020550
020551
020552
021050
021550
029050
029051
031050
040550
041050
042050
059000
CO #001-1
CO #001-2
CO #002-1
CO #002-2
1,115.00 1,115.00 0.00 0.00 1,115.00 100.00 55.750.00
9,260.00 9,260.00 0.00 0.00 9,260.00 100.00 463.000.00
12,085.00 12,085.00 0.00 0.00 12,085.00 100.00 604.250.00
6,820.00 6,820.00 0.00 0.00 6,820.00 100.00 341.000.00
2,225.00 2,225.00 0.00 0.00 2,225.00 100.00 111.250.00
18,906.00 18,906.00 0.00 0.00 18,906.00 100.00 945.300.00
5,962.00 5,962.00 0.00 0.00 5,962.00 100.00 298.100.00
6,820.00 6,820.00 0.00 0.00 6,820.00 100.00 341.000.00
2,146.00 2,146.00 0.00 0.00 2,146.00 100.00 107.300.00
2,146.00 2,146.00 0.00 0.00 2,146.00 100.00 107.300.00
1,560.00 0.00 0.00 0.00 0.00 0.00 0.001,560.00
2,340.00 1,150.00 1,190.00 0.00 2,340.00 100.00 117.000.00
195.00 0.00 195.00 0.00 195.00 100.00 9.750.00
6,870.00 6,870.00 0.00 0.00 6,870.00 100.00 343.500.00
1,360.00 0.00 1,360.00 0.00 1,360.00 100.00 68.000.00
43,989.00 43,989.00 0.00 0.00 43,989.00 100.00 2,199.450.00
-3,285.00 0.00 -3,285.00 0.00 -3,285.00 100.00 -164.250.00
5,640.00 0.00 5,640.00 0.00 5,640.00 100.00 282.000.00
126,154.00 119,494.00 5,100.00 0.00 124,594.00 98.76 6,229.701,560.00
To:H+U Construction
From (Subcontractor):Empirehouse Inc.
Project:Lake Elmo City Center (L)
Application and Certificate For Payment -- page 2
Application No: 11 Date: 06/01/23
Item
Number Description ScheduledValue
Work Completed
Previous Application This Period
Materials
Presently Stored
Completed and
Stored to Date
%Balance to Finish Retention Memo
Bonds
Submittals/PM/CAD/Admin
SF Installation
CW Installation
Housekeeping
Window Installation
Skylight Installation
Ballistic Window Install
Hurricane Window Install
Mock-up Installation
Borrowed Lite Installati
Heavy Wall Installation
Mirrors Installation
Equipment
All Glass Door 205A Billing Total
Add Curtainwall Billing Total
Change Vinyl Windows to SF Billing
Total
Add Type W3 windows Billing Total
Application Total
Period To: 06/30/23
Contractor's Job Number: 21152
$ 2,850.00
13,175.556/27/23
6/27/23
13,146.7636
6/27/23
7,678.856/27/23
53,630.276/27/23
APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 18Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:6/30/2023Lake 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 $7,182,100.36NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$359,105.05 (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)$359,105.05TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$6,822,995.31Net 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)$6,556,985.92Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$266,009.39and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $87,251.69 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 7/11/2023Notary Public:By:Date:7/11/2023My Commission expires:31-Jan-28ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-07-11
CITY OF LAKE ELMO - MATERIALAPPLIC. FOR PAYMENT NO.#18H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 6/30/2023 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 Concrete240,000.0025,103.00265,103.00256,422.008,681.00265,103.00100%0.0013,255.15#0341Strutctural Precast1,422,295.00580.001,422,875.001,422,875.000.001,422,875.00100%0.0071,143.75#0512Steel Supply485,000.0079,038.00564,038.00564,038.000.00564,038.00100%0.0028,201.90#0610Carpentry & GC568,000.0021,134.00589,134.00473,467.55114,466.45587,934.00100%1,200.0029,396.70#0750Roofing & Metal Panels498,500.00(28,015.00)470,485.00423,224.120.00423,224.1290%47,260.8821,161.21#0790Caulking & Firestopping18,300.003,221.0021,521.0018,080.500.0018,080.5084%3,440.50904.03#0810Doors, Frames, Hardware - Supply171,697.0026,533.00198,230.00189,062.570.00189,062.5795%9,167.439,453.13#0833Coiling & Sectional Doors175,000.00114,530.00289,530.00289,530.000.00289,530.00100%0.0014,476.50#0840Aluminum Storefronts & Curtainwall321,960.0099,415.00421,375.00419,378.001,997.00421,375.00100%0.0021,068.75#0920Drywall & Fireproofing229,410.0022,346.00251,756.00228,174.5023,581.50251,756.00100%0.0012,587.80#0930Tile68,100.000.0068,100.0068,100.000.0068,100.00100%0.003,405.00#0950Acoustical Ceilings & Panels75,000.000.0075,000.0065,000.0010,000.0075,000.00100%0.003,750.00#0965Resilient Flooring & Carpet90,930.00275.0091,205.0091,205.000.0091,205.00100%0.004,560.25#0990Painting and Wallcovering29,531.00112.0029,643.0027,673.000.0027,673.0093%1,970.001,383.65#1420Conveying Equipment46,740.000.0046,740.0021,577.0021,567.8543,144.8592%3,595.152,157.24#2100Fire Protection57,520.000.0057,520.0057,520.000.0057,520.00100%0.002,876.00#2200Plumbing & Heating491,000.0016,375.00507,375.00497,718.550.00497,718.5598%9,656.4524,885.93#2300HVAC & Controls662,000.00145,895.00807,895.00802,875.005,020.00807,895.00100%0.0040,394.75#2600Electrical808,100.0055,842.00863,942.00716,378.0016,500.00732,878.0085%131,064.0036,643.90#3100Earthwork & Site Utilities209,390.002,544.00211,934.00205,519.002,100.00207,619.0098%4,315.0010,380.95#3210Asphalt Paving180,634.0011,775.00192,409.0064,272.6976,096.08140,368.7773%52,040.237,018.44#3290Landscaping & Fencing61,140.000.0061,140.000.000.000.000%61,140.000.00TOTAL CONTRACT AMOUNTS6,910,247.000.007,506,950.006,902,090.48280,009.887,182,100.3696%324,849.64359,105.05
INVOICE SUMMARY-PAYMENT APPLICATION NO. #18CITY OF LAKE ELMO - MATERIALPERIOD ENDING 6/30/2023ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE#0330Cast-In-Place ConcreteAxel H. Ohman, Inc.6/30/23Applic #9$8,681.00$434.05$8,246.95#0610Carpentry & GCEbert Construction6/30/23Applic #13$114,466.45$5,723.32$108,743.13#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.6/30/23Applic #13$1,997.00$99.85$1,897.15#0920Drywall & FireproofingCommercial Drywall6/30/23Applic #13$23,581.50$1,179.08$22,402.42#0950Acoustical Ceilings & PanelsAcoustics Associates6/30/23Applic #4$10,000.00$500.00$9,500.00#1420Conveying EquipmentSchindler Elevator6/30/23Applic #2$21,567.85$1,078.39$20,489.46#2300HVAC & ControlsSt. Cloud Refrigeration6/30/23Applic #12$5,020.00$251.00$4,769.00#2600ElectricalVinco, Inc.6/30/23Applic #16$16,500.00$825.00$15,675.00#3100Earthwork & Site UtilitiesPark Construction Company6/30/23Applic #12$2,100.00$105.00$1,995.00#3210Asphalt PavingEbert Construction6/30/23Applic #7$76,096.08$3,804.80$72,291.28SUBTOTAL AMOUNT DUE$280,009.88$14,000.49$266,009.39 TOTAL AMOUNT DUE $266,009.39
8,246.956/27/23
108,743.136/27/23
1,897.15
321,960.00
99,415.00
421,375.00
421,375.00
20,568.75
400,806.25
398,909.10
0.00
0.00
421,375.00
Page 1
Certificate of the Subcontractor:
I hereby certify that the work performed and the materials supplied to date as shown on the above represent the actual value of accomplishment under the terms of the contract (and all authorized
changes thereto) between the undersigned and H+U Construction relating to the above-referenced project.
I also certify that Payments, less applicable retention, have been made through the period covered by previous payments received from the contractor, to (1) all my subcontractors (sub-subcontractors) and (2) for all materials and labor used in connection with the performance of this contract.
I further certify I have complied with Federal, State and Local tax laws, including Social Security laws and unemployment laws and Workmen's Compensation laws insofar as applicable to the
performance of this contract.
Furthermore, in consideration of this request of the payments received and upon receipt of the amount of this request, the undersigned does hereby waive, release, and relinquish all claims or right of lien which the undersigned may now have upon the premises above described except for claims or right of lien for contract and/or change order work performed to the extent that payment is being retained or will
subsequently become due.
Original contract sum
Net change by change orders (as per attached breakdown)
Contract sum to date
Completed to date (as per attached breakdown)
Total retainage (4.9%)
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 1,897.15
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: 13 Date: 06/01/23
Period To: 06/30/23
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
Date: __________________________________
Subscribed and sworn to before me this _____ day
of ____________, _________ (year).
Notary public: _____________________________
My commission expires ____________________.
Contractor: Empirehouse Inc.
By: ____________________________________
Title: ___________________________________
Date: __________________________________
Subscribed and sworn to before me this _____ day
of ____________, _________ (year).
Notary public: _____________________________
My commission expires ____________________.
Contractor: Empirehouse Inc.
By: ____________________________________
Title: ___________________________________
Date: __________________________________
Subscribed and sworn to before me this _____ day
of ____________, _________ (year).
Notary public: _____________________________
My commission expires ____________________.
Contractor: Empirehouse Inc.
By: ____________________________________
Title: ___________________________________
June 13, 2023
13
June 2023
January 31, 2025 Kristine Hutera, CEO
010500
010600
020500
020502
021000
021001
021002
030500
030501
030502
040500
041000
042000
055000
CO #001-1
CO #001-2
CO #001-3
CO #001-4
CO #002-1
CO #002-2
4,580.00 4,580.00 0.00 0.00 4,580.00 100.00 229.000.00
26,100.00 26,100.00 0.00 0.00 26,100.00 100.00 1,305.000.00
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 57,775.00 0.00 0.00 57,775.00 100.00 2,888.750.00
47,640.00 47,640.00 0.00 0.00 47,640.00 100.00 2,382.000.00
63,500.00 63,500.00 0.00 0.00 63,500.00 100.00 3,175.000.00
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 10,000.00 0.00 0.00 10,000.00 100.00 0.000.00
6,010.00 6,010.00 0.00 0.00 6,010.00 100.00 300.500.00
6,465.00 6,465.00 0.00 0.00 6,465.00 100.00 323.250.00
120.00 120.00 0.00 0.00 120.00 100.00 6.000.00
8,020.00 8,020.00 0.00 0.00 8,020.00 100.00 401.000.00
648.00 648.00 0.00 0.00 648.00 100.00 32.400.00
468.00 0.00 468.00 0.00 468.00 100.00 23.400.00
1,529.00 0.00 1,529.00 0.00 1,529.00 100.00 76.450.00
91,482.00 91,482.00 0.00 0.00 91,482.00 100.00 4,574.100.00
-6,826.00 -6,826.00 0.00 0.00 -6,826.00 100.00 -341.300.00
12,114.00 12,114.00 0.00 0.00 12,114.00 100.00 605.700.00
421,375.00 419,378.00 1,997.00 0.00 421,375.00 100.00 20,568.750.00
To:H+U Construction
From (Subcontractor):Empirehouse Inc.
Project:Lake Elmo City Center (M)
Application and Certificate For Payment -- page 2
Application No: 13 Date: 06/01/23
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
Precast Revisions Billing Total
Change Door 110 to All Glass Billing Total
All Glass Door 205A Billing Total
Add Curtainwall Billing Total
Change Vinyl windows to SF Billing
Total
Add Type W3 Windows Billing Total
Application Total
Period To: 06/30/23
Contractor's Job Number: 21153
82
$ 9,500.00
4,769.00
6/27/23
1,995.006/27/23
72,291.286/27/23