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#03 - City Center-Public Works Pay Request 12
STAFF REPORT DATE: February 7, 2023 CONSENT AGENDA ITEM: City Center-Public Works Addition Pay Request #12 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 #12 for the City Center and Public Works Addition project? PROPOSAL: Pay request #12 is for $542,371.03. A copy is included in your packet. FISCAL IMPACT: With this pay request, the project remains within budget. OPTION: 1) Approve pay request #12 2) Don’t approve pay request #12 RECOMMENDATION: “Motion to approve Pay Request #12 for the New City Center and Public Works Addition.” ATTACHMENTS: • Pay Request #12 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 12Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:12/31/2022Lake Elmo, MN 55042ARCHITECT FROM (CM): OVERALLCONST. MANAGERHOFFMANN + UHLHORN CONSTRUCTION, INC.5555 W 78TH ST, SUITE AXFILEMINNEAPOLIS, MN 55439CONTRACT DATE:APPLICATION FOR PAYMENTApplication is made for Payment, as shown below,CHANGE ORDER SUMMARYContinuation Sheet, AIA Document G703, is attached.Change Orders Approved inADDITIONSDEDUCTIONS1. COMMITTED COST$13,402,788.00previous months by Owner2. Net Change by Change Orders$0.00TOTAL$0.00$0.003. SUM TO DATE (Line 1+2)$13,402,788.00Approved this Month4. TOTAL COMPLETED & STORED TO DATE $8,191,701.36NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$409,585.13 (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)$409,585.13TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$7,782,116.23Net 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)$7,239,745.20Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$542,371.03and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $5,620,671.77 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 1/5/2023Notary Public:By:Date:1/5/2023My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-01-16 CITY OF LAKE ELMO - OVERALLAPPLIC. FOR PAYMENT NO.#12H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 12/31/2022 AIA Document G723,APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification is attached.In tabulations below, amounts are stated to the nearest dollar. ABCDEF GHITEMDESCRIPTION OF WORKSCHEDULEDCHANGEREVISED WORK COMPLETEDTOTAL%BALANCERETAINAGENO.VALUEORDERSSCHEDULEFROMTHIS PERIODCOMPLETED(F/C)TO FINISHVALUEPREV. APPL.AND STORED(C-F)(A+B) TO DATE (D+E)InsuranceBuilders Risk Insurance25,000.000.0025,000.0021,204.000.0021,204.0085%3,796.001,060.200Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.00109,201.5116,549.08125,750.5952%117,329.416,287.53ReimburseConstruction Management Reimbursables488,555.000.00488,555.00344,413.7537,143.75381,557.5078%106,997.5019,077.88FeeConstruction Management Fee82,595.000.0082,595.0049,215.213,686.9952,902.2064%29,692.802,645.11TrailerTemporary City Office Trailer53,170.000.0053,170.0040,770.332,518.9443,289.2781%9,880.732,164.46ContingencyConstruction Contingency588,330.00(576,991.00)11,339.000.000.000.000%11,339.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete668,316.0042,542.00710,858.00599,508.000.00599,508.0084%111,350.0029,975.40#0341Strutctural Precast1,755,999.00580.001,756,579.001,743,529.006,525.001,750,054.00100%6,525.0087,502.70#0510Steel Erection93,400.0015,196.00108,596.0064,000.007,000.0071,000.0065%37,596.003,550.00#0512Steel Supply485,000.0074,767.00559,767.00502,545.880.00502,545.8890%57,221.1225,127.29#0610Carpentry & GC1,027,000.0027,818.001,054,818.00246,123.2450,638.93296,762.1728%758,055.8314,838.11#0750Roofing & Metal Panels1,113,300.00(60,415.00)1,052,885.00722,743.200.00722,743.2069%330,141.8036,137.16#0790Caulking & Firestopping72,350.000.0072,350.000.000.000.000%72,350.000.00#0810Doors, Frames, Hardware - Supply171,697.000.00171,697.0020,418.7944,981.3365,400.1238%106,296.883,270.01#0833Coiling & Sectional Doors350,000.000.00350,000.000.000.000.000%350,000.000.00#0840Aluminum Storefronts & Curtainwall400,410.00139,476.00539,886.00335,207.0036,542.00371,749.0069%168,137.0018,587.45#0920Drywall & Fireproofing543,770.0046,152.00589,922.00247,714.00110,814.00358,528.0061%231,394.0017,926.40#0930Tile154,980.000.00154,980.000.000.000.000%154,980.000.00#0950Acoustical Ceilings & Panels126,000.000.00126,000.0025,000.000.0025,000.0020%101,000.001,250.00#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 Protection112,915.000.00112,915.0069,265.0027,759.0097,024.0086%15,891.004,851.20#2200Plumbing & Heating854,000.0048,745.00902,745.00546,579.8193,557.87640,137.6871%262,607.3232,006.88#2300HVAC & Controls962,000.00159,675.001,121,675.00712,083.250.00712,083.2563%409,591.7535,604.16#2600Electrical1,454,170.0077,660.001,531,830.00461,610.00118,500.00580,110.0038%951,720.0029,005.50#3100Earthwork & Site Utilities575,790.004,795.00580,585.00508,502.5014,700.00523,202.5090%57,382.5026,160.13#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 AMOUNTS13,402,788.000.0013,402,788.007,620,784.47570,916.898,191,701.3661%5,211,086.64409,585.13 APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 12Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:12/31/2022Lake Elmo, MN 55042ARCHITECT FROM (CM): LABORCONST. MANAGERHOFFMANN + UHLHORN CONSTRUCTION, INC.5555 W 78TH ST, SUITE AXFILEMINNEAPOLIS, MN 55439CONTRACT DATE:APPLICATION FOR PAYMENTApplication is made for Payment, as shown below,CHANGE ORDER SUMMARYContinuation Sheet, AIA Document G703, is attached.Change Orders Approved inADDITIONSDEDUCTIONS1. COMMITTED COST$6,492,541.00previous months by Owner2. Net Change by Change Orders$0.00TOTAL$0.00$0.003. SUM TO DATE (Line 1+2)$6,492,541.00Approved this Month4. TOTAL COMPLETED & STORED TO DATE $3,246,111.62NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$162,305.62 (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)$162,305.62TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$3,083,806.00Net 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)$2,794,849.04Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$288,956.96and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $3,408,735.00 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 1/5/2023Notary Public:By:Date:1/5/2023My Commission expires:31-Jan-23ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-01-16 CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSAPPLIC. FOR PAYMENT NO.#12H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 12/31/2022 AIA Document G723,APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification is attached.In tabulations below, amounts are stated to the nearest dollar. ABCDEF GHITEMDESCRIPTION OF WORKSCHEDULEDCHANGEREVISED WORK COMPLETEDTOTAL%BALANCERETAINAGENO.VALUEORDERSSCHEDULEFROMTHIS PERIODCOMPLETED(F/C)TO FINISHVALUEPREV. APPL.AND STORED(C-F)(A+B) TO DATE (D+E)InsuranceBuilders Risk Insurance25,000.000.0025,000.0021,204.000.0021,204.0085%3,796.001,060.200Payment and Performance Bond127,464.000.00127,464.00127,424.000.00127,424.00100%40.006,371.201General Conditions243,080.000.00243,080.00109,201.5116,549.08125,750.5952%117,329.416,287.53ReimburseConstruction Management Reimbursables488,555.000.00488,555.00344,413.7537,143.75381,557.5078%106,997.5019,077.88FeeConstruction Management Fee82,595.000.0082,595.0049,215.213,686.9952,902.2064%29,692.802,645.11TrailerTemporary City Office Trailer53,170.000.0053,170.0040,770.332,518.9443,289.2781%9,880.732,164.46ContingencyConstruction Contingency588,330.00(576,991.00)11,339.000.000.000.000%11,339.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete428,316.0028,053.00456,369.00380,019.000.00380,019.0083%76,350.0019,000.95#0341Strutctural Precast333,704.000.00333,704.00320,654.006,525.00327,179.0098%6,525.0016,358.95#0510Steel Erection93,400.0015,196.00108,596.0064,000.007,000.0071,000.0065%37,596.003,550.00#0610Carpentry & GC459,000.006,684.00465,684.00203,523.2432,397.93235,921.1751%229,762.8311,796.06#0750Roofing & Metal Panels614,800.00(31,650.00)583,150.00407,570.200.00407,570.2070%175,579.8020,378.51#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 & Curtainwall78,450.0045,349.00123,799.0038,895.0026,874.0065,769.0053%58,030.003,288.45#0920Drywall & Fireproofing314,360.0027,273.00341,633.00112,881.0050,108.00162,989.0048%178,644.008,149.45#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 Protection55,395.000.0055,395.0013,219.0027,759.0040,978.0074%14,417.002,048.90#2200Plumbing & Heating363,000.0033,151.00396,151.00201,133.4061,502.54262,635.9466%133,515.0613,131.80#2300HVAC & Controls300,000.0016,250.00316,250.0045,158.250.0045,158.2514%271,091.752,257.91#2600Electrical646,070.0024,446.00670,516.00143,745.0022,000.00165,745.0025%504,771.008,287.25#3100Earthwork & Site Utilities366,400.004,245.00370,645.00317,327.5010,100.00327,427.5088%43,217.5016,371.38#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 AMOUNTS6,492,541.000.006,084,547.002,941,946.39304,165.233,246,111.6253%2,838,435.38162,305.62 INVOICE SUMMARY-PAYMENT APPLICATION NO. #12CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSPERIOD ENDING 12/31/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE1General ConditionsH+U Construction12/31/22Applic #12$16,549.08$827.45$15,721.63ReimburseConstruction Management ReimbursablesH+U Construction12/31/22Applic #12$37,143.75$1,857.19$35,286.56FeeConstruction Management FeeH+U Construction12/31/22Applic #12$3,686.99$184.35$3,502.64TrailerTemporary City Office TrailerH+U Construction12/31/22Applic #10$2,518.94$125.95$2,392.99#0341Strutctural PrecastWells Concrete12/31/22Applic #5$6,525.00$326.25$6,198.75#0510Steel ErectionA.M.E. Construction Corp12/31/22Applic #4$7,000.00$350.00$6,650.00#0610Carpentry & GCEbert Construction12/31/22Applic #12$32,397.93$1,619.90$30,778.03#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.12/31/22Applic #6$26,874.00$1,343.70$25,530.30#0920Drywall & FireproofingCommercial Drywall12/31/22Applic #9$50,108.00$2,505.40$47,602.60#2100Fire ProtectionNova Fire Protection, Inc.12/31/22Applic #3$27,759.00$1,387.95$26,371.05#2200Plumbing & HeatingPeterson Sheet Metal12/31/22Applic #7$61,502.54$3,075.13$58,427.41#2600ElectricalVinco, Inc.12/31/22Applic #10$22,000.00$1,100.00$20,900.00#3100Earthwork & Site UtilitiesPark Construction Company12/31/22Applic #9$10,100.00$505.00$9,595.00SUBTOTAL AMOUNT DUE$304,165.23$15,208.27$288,956.96 TOTAL AMOUNT DUE $288,956.96 INVOICE : 220346 PROJECT: J21001 DECEMBER 31, 2022 PAGE 1 OF 2 TO:CITY OF LAKE ELMO 3880 Laverne Ave N Lake Elmo, MN 55042 ATTN:ACCOUNTING RE:LAKE ELMO CITY CENTER & LAKE ELMO PUBLIC WORKS ADDITION Invoice for Construction Management services performed during the month of December, 2022 CONSTRUCTION MANAGEMENT REIMBURSABLES Senior Project Manager 43.50 hrs. @ 125.00 $5,437.50 Project Manager 122.00 hrs. @ 105.00 $12,810.00 Project Administrator/Accountant 14.25 hrs. @ 65.00 $926.25 Project Superintendent 154.00 hrs. @ 105.00 $16,170.00 Truck, Travel, & Small Tools 1 mo. @ 1,400.00 $1,400.00 Field Office Equipment 1 mo. @ 400.00 $400.00 $37,143.75 GENERAL CONDITIONS Temporary City Office Trailer $2,518.94 Expendable Supplies $680.04 Drinking Water $23.13 Temp Heaters/Fans $934.36 Temporary Toilets $612.04 Safety & OSHA $718.75 Xcel Energy - Utility Service $445.94 Trash Removal $1,167.00 Scaffold Rental $3,367.55 Trailer $1,350.00 Skid Steer $2,167.27 Braun Intertec Corporation $5,083.00 $19,068.02 $56,211.77 Subtotal Construction Management Reimbursables Subtotal Reimbursable Expenses Total INVOICE : 220346 PROJECT: J21001 DECEMBER 31, 2022 PAGE 2 OF 2 TO:CITY OF LAKE ELMO 3880 Laverne Ave N Lake Elmo, MN 55042 ATTN:ACCOUNTING RE:LAKE ELMO CITY CENTER & LAKE ELMO PUBLIC WORKS ADDITION Contractor's Pay Applications December 31, 2022 #0341-Labor Wells Concrete $6,525.00 #0510-Labor A.M.E. Construction Corp $7,000.00 #0610-Labor Ebert Construction $32,397.93 #0610-Material Ebert Construction $18,241.00 #0810-Material Twin City Hardware Company $44,981.33 #0840-Labor Empirehouse Inc.$26,874.00 #0840-Material Empirehouse Inc.$9,668.00 #0920-Labor Commercial Drywall, Inc.$50,108.00 #0920-Material Commercial Drywall, Inc.$60,706.00 #2100-Labor Nova Fire Protection, Inc.$27,759.00 #2200-Labor Peterson Sheet Metal, Inc.$61,502.54 #2200-Material Peterson Sheet Metal, Inc.$32,055.33 #2600-Labor Vinco, Inc.$22,000.00 #2600-Material Vinco, Inc.$96,500.00 #3100-Labor Park Construction Company $10,100.00 #3100-Material Park Construction Company $4,600.00 $511,018.13 $3,686.99 $570,916.89 Retainage Current Retainge 28,545.86 Prior Retainage 381,039.27 Retainage-To-Date 409,585.13 Total Amount Due $542,371.03 CONSTRUCTION MANAGEMENT FEE Total Contractor's Pay Applications December 1 - December 31 Total Before Retainage Customer No. C51148 H U Construction 5555 W78th St Suite A Minneapolis, MN 55439 Bill to:Ship to:City of Lake Elmo 24x60 Doublewide Office s/n 15809A/10B Gabe 651-395-0055 3800 Laverne Ave. North Lake Elmo, MN 55042 Satellite Quote No. RC520567 Contract No Matt Lawellin Salesperson 01/19/2023 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:12/20/2022 INV627986 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 01/19/2023 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:12/20/2022 INV627986 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 01/19/2023 Due Date Customer PO No. RQ152297 Lake Elmo DW Trailer Invoice No.: Invoice Date:12/20/2022 INV627986 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 12/20/22 01/16/23 1 2,000.00 2,000.00 RR not utilized no need to winterize. STEPS Steps - Rental 12/20/22 01/16/23 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 Branch:100 St. Paul 1380627 Invoice Date Page INVOICE 3255157 ORDER NUMBER Columbus, MN 55025 9205 Lake Drive NE Viking Industrial Center 1 of 2651-646-6141 INVOICE 12/01/2022 Please Note New Remittance Address Bill To:Ship To: Lake Elmo, MN 55042 3800 Laverne Ave N H+U Construction - Lake Elmo City CenterH+U Construction 5555 West 78th Street Suite A Minneapolis, MN 55439 Customer ID:106629 Ordered By: Gabe . Delivery Instructions:Contact Gabe 651.395.0055 DOUG GEIST 16265910Tracking #:Carrier: Net Due Date Discount AmountDisc Due DateTerm DescriptionPO Number Lake Elmo Net 30 12/31/2022 12/31/2022 0.00 Primary Salesrep NameOrder Date Pick Ticket No Taker 11/30/2022 12:58:11 2285419 Douglas P. Geist TWOODBURY Item ID Item DescriptionOrderedShippedRemaining Quantities UOM Disp.Unit Size Pricing UOM Unit PriceUnit Size Price Extended 2.00 0.00 EA B99S EA 8.200000 16.40 1.0 1.0000 2.00 HEAVY DUTY STEEL HANDLE BRACE (12/bx) 2.00 0.00 EA B3736LH EA 38.420000 76.84 1.0 1.0000 2.00 36" GRAY SOFT FLAGGED EDGES BROOM N/HNDL No Handle (6/cs) Ordered As:035162037366 2.00 0.00 EA BM60 EA 10.400000 20.80 1.0 1.0000 2.00 5' - 15/16 DIA METAL THREAD BROOM HANDLE Lumathread (12/bx) 4.00 0.00 EA V8G-SCGREEN EA 21.646296 86.59 1.0 1.0000 4.00 KLEEN SWEEP GREEN SWEEPING COMPOUND 50# Kleen Sweep Green Sweeping Compound 50LB (1815) 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 Branch:100 St. Paul 1380627 Invoice Date Page INVOICE 3255157 ORDER NUMBER Columbus, MN 55025 9205 Lake Drive NE Viking Industrial Center 2 of 2651-646-6141 INVOICE 12/01/2022 Please Note New Remittance Address Delivery Instructions:Contact Gabe 651.395.0055 DOUG GEIST 16265910Tracking #:Carrier: Item ID Item DescriptionOrderedShippedRemaining Quantities UOM Disp.Unit Size Pricing UOM Unit PriceUnit Size Price Extended SUB-TOTAL:Total Lines:4 200.63 MN STATE TAX 13.79: MN SPECIAL TAX 0.99: 215.41AMOUNT 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 Branch:100 St. Paul 1382004 Invoice Date Page INVOICE 3256516 ORDER NUMBER Columbus, MN 55025 9205 Lake Drive NE Viking Industrial Center 1 of 1651-646-6141 INVOICE 12/21/2022 Please Note New Remittance Address Bill To:Ship To: Lake Elmo, MN 55042 3800 Laverne Ave N H+U Construction - Lake Elmo City CenterH+U Construction 5555 West 78th Street Suite A Minneapolis, MN 55439 Customer ID:106629 Ordered By: Gabe . Delivery Instructions:Contact Gabe 651.395.0055 DOUG GEIST Tracking #:Carrier: Net Due Date Discount AmountDisc Due DateTerm DescriptionPO Number Lake Elmo Net 30 01/20/2023 01/20/2023 0.00 Primary Salesrep NameOrder Date Pick Ticket No Taker 12/21/2022 07:41:37 2287094 Douglas P. Geist TWOODBURY Item ID Item DescriptionOrderedShippedRemaining Quantities UOM Disp.Unit Size Pricing UOM Unit PriceUnit Size Price Extended 2.00 0.00 EA V8G-ICEMELTZAP50 EA 23.200000 46.40 1.0 1.0000 2.00 50 LB BAG OF ICE MELT Snow & Ice Melter; 50LB Bag; Blend of Calcium Chloride and Sodium Chloride effective to -15*F 2.00 0.00 EA CPR16100 EA 193.160000 386.32 1.0 1.0000 2.00 16' X 100' REINFORCED POLY 6 mil Film/18 mil Cross Scrim SUB-TOTAL:Total Lines:2 432.72 MN STATE TAX 29.75: MN SPECIAL TAX 2.16: 464.63AMOUNT 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 133305325-0001 661003 12/12/22 1 of 1 SCHOER,GABE 133305325 LAKE ELMO 3 -H +U CONSTRUCTI BURNSVILLE MN CC PC1171 3700 W PRESERVE BLVD BURNSVILLE,MN 55337 7746 952-707-5050 SUNBELT RENTALS,INC. PO BOX 409211 ATLANTA,GA 30384-9211 870.18 64.18 934.36 REMIT TO: SUNBELT RENTALS,INC.NET 30 Invoices not paid within 30 days may be subject to a 1-½% per month charge. LAKE ELMO CITY CENTER 3880 LAVERNE AVE N LAKE ELMO,MN 55042 9627 651-395-0055 4 WEEK BILL PO BOX 409211 ATLANTA,GA 30384-9211 1oz -4657 -4717 H +U CONSTRUCTION 5555 W EST 78TH STREET,SUITE A MINNEAPOLIS,MN 55439 THERESA CASBOLT theresa.casebolt@sunbeltrentals.com Y PAGE RECEIVED BY CONTRACT NO. PURCHASE ORDER NO. JOB NO. INVOICE TO INVOICE SEND ALL PAYMENTS TO: JOB ADDRESS LOYALTY PLUS NO. Equipment. Service. Guaranteed. INVOICE NO. ACCOUNT NO. INVOICE DATE BRANCH SUBTOTAL SALES TAX INVOICE TOTAL .QTY EQUIPMENT #Min Day Week 4 Week Amount . 1.00 36"HIGH VOLUME FAN 115V 18.33 18.33 55.00 165.00 165.00 TA022253 Make:SCHAEFER Model:FAN 36 Ser #:22253 1.00 36"HIGH VOLUME FAN 115V 18.33 18.33 55.00 165.00 165.00 10143518 Make:TEMP AIR Model:83100.212 Ser #:N/A 1.00 36"HIGH VOLUME FAN 115V 18.33 18.33 55.00 165.00 165.00 TA013541 Make:SCHAEFER Model:FAN 36 Ser #:13541 Rental Sub-total:495.00 SALES ITEMS: Qty Item number Unit Price 1 DLPKSRCHG EA 69.000 69.00 TRANSPORTATION SURCHARGE 1 ENVIRONMENTAL EA 6.180 6.18 ENVIRONMENTAL/HAZMAT FEE 2133XXX0000 DELIVERY CHARGE 150.00 PICKUP CHARGE 150.00 BILLED FOR FOUR WEEKS 11/23/22 THRU 12/20/22. Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221 Invoice #W898998 12/28/2022 W898998 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 $367.22 Balance Due $367.22 Due Date: 1/25/2023 Terms Due Date PO #Sales Rep Builders Club# Net 28 1/25/2023 -Jeff Foley Qty Item Days Sales Order #Service Level Rate Amount 1 RENTAL RegularUnit Nov 30-Dec 27 28 385563 -$4.00 $4.00 1 SERVICE Service Nov 30-Dec 27 28 385563 1X/wk $70.00 $70.00 1 SERVICE ClimateSvc Nov 30 to Dec 27 28 385563 1X/wk $40.00 $40.00 1 RENTAL HandSani Nov 30-Dec 27 28 385563 -$0.00 $0.00 1 RENTAL RegularUnit Nov 30-Dec 27 28 386930 -$4.00 $4.00 1 SERVICE Service Nov 30-Dec 27 28 386930 1X/wk $70.00 $70.00 1 SERVICE ClimateSvc Nov 30 to Dec 27 28 386930 1X/wk $40.00 $40.00 1 RENTAL HandSani Nov 30-Dec 27 28 386930 -$0.00 $0.00 1 RENTAL RegularUnit Nov 30-Dec 27 28 398087 -$4.00 $4.00 1 SERVICE Service Nov 30-Dec 27 28 398087 1X/wk $70.00 $70.00 1 SERVICE ClimateSvc Nov 30 to Dec 27 28 398087 1X/wk $40.00 $40.00 1 RENTAL HandSani Nov 30-Dec 27 28 398087 -$0.00 $0.00 0 TAX-MN Tax-MN ---$0.00 $23.51 0 TAX-WASH Tax-WASH ---$0.00 $1.71 Subtotal $367.22 Invoice Total $367.22 Credits/Payments Applied $0.00 Balance Due $367.22 Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221 Invoice #W898998 12/28/2022 W898998 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 #W898998 Amount Due $367.22 Amount Paid ______________________ Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221 Invoice #W898999 12/28/2022 W898999 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 $122.41 Balance Due $122.41 Due Date: 1/25/2023 Terms Due Date PO #Sales Rep Builders Club# Net 28 1/25/2023 LEPW Jeff Foley Qty Item Days Sales Order #Service Level Rate Amount 1 RENTAL RegularUnit Nov 30-Dec 27 28 396954 -$4.00 $4.00 1 SERVICE Service Nov 30-Dec 27 28 396954 1X/wk $70.00 $70.00 1 SERVICE ClimateSvc Nov 30 to Dec 27 28 396954 1X/wk $40.00 $40.00 1 RENTAL HandSani Nov 30-Dec 27 28 396954 -$0.00 $0.00 0 TAX-MN Tax-MN ---$0.00 $7.84 0 TAX-WASH Tax-WASH ---$0.00 $0.57 Subtotal $122.41 Invoice Total $122.41 Credits/Payments Applied $0.00 Balance Due $122.41 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 #W898999 Amount Due $122.41 Amount Paid ______________________ Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221 Invoice #W899001 12/28/2022 W899001 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 $122.41 Balance Due $122.41 Due Date: 1/25/2023 Terms Due Date PO #Sales Rep Builders Club# Net 28 1/25/2023 -Jeff Foley Qty Item Days Sales Order #Service Level Rate Amount 1 RENTAL RegularUnit Nov 30-Dec 27 28 402272 -$4.00 $4.00 1 SERVICE Service Nov 30-Dec 27 28 402272 1X/wk $70.00 $70.00 1 SERVICE ClimateSvc Nov 30 to Dec 27 28 402272 1X/wk $40.00 $40.00 1 RENTAL HandSani Nov 30-Dec 27 28 402272 -$0.00 $0.00 0 TAX-MN Tax-MN ---$0.00 $7.84 0 TAX-WASH Tax-WASH ---$0.00 $0.57 Subtotal $122.41 Invoice Total $122.41 Credits/Payments Applied $0.00 Balance Due $122.41 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 #W899001 Amount Due $122.41 Amount Paid ______________________ OECS OECS - 170064 PO Box 9201 Minneapolis, MN 55480 763-417-9599 accounting@oecscomply.com Invoice 38645 BILL TO H+U Construction 5555 West 78th Street, Suite A Minneapolis, MN 55439 DATE 12/15/2022 PLEASE PAY $2,875.00 DUE DATE 01/29/2023 DATE DESCRIPTION QTY RATE AMOUNT Monthly Safety Services 1 2,875.00 2,875.00 TOTAL DUE $2,875.00 THANK YOU. Invoice Date 12/7/2022 Invoice # 362571Customer 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 We've moved! Please update our address and mail payments to: 315 27th Ave NE, Minneapolis, MN 55418 Service Date DescriptionTicket QtyUnit of Measure Rate Amount 12/2/2022 30 Yard Container750475 1Each 371.00 371.00 12/2/2022 Solid Waste Management Tax calculated at $0.60/yard. This ticket includes $18.00 of solid waste disposal tax. 750475 30Yards 0.60 18.00 $389.00 $389.00 $0.00 Invoice Date 12/27/2022 Invoice # 364015Customer 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 We've moved! Please update our address and mail payments to: 315 27th Ave NE, Minneapolis, MN 55418 Service Date DescriptionTicket QtyUnit of Measure Rate Amount 12/21/2022 30 Yard Container755492 1Each 371.00 371.00 12/21/2022 Solid Waste Management Tax calculated at $0.60/yard. This ticket includes $18.00 of solid waste disposal tax. 755492 30Yards 0.60 18.00 $389.00 $389.00 $0.00 Invoice Date 12/30/2022 Invoice # 364365Customer 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 We've moved! Please update our address and mail payments to: 315 27th Ave NE, Minneapolis, MN 55418 Service Date DescriptionTicket QtyUnit of Measure Rate Amount 12/28/2022 30 Yard Container754506 1Each 371.00 371.00 12/28/2022 Solid Waste Management Tax calculated at $0.60/yard. This ticket includes $18.00 of solid waste disposal tax. 754506 30Yards 0.60 18.00 $389.00 $389.00 $0.00 Invoice A122764 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 12/22/2022Date Job Site Shipping Address: 3880 LAVERNE AVE N LAKE ELMO, MN 55042-9627 Created: 12/22/2022 M: Minimum rental applies R: 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 11/24/2022 12/21/2022 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: December 22, 2022 6:52:56 AM Page 1 of 1A122764 Invoice A122928 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 12/29/2022Date Job Site Shipping Address: 3880 LAVERNE AVE N LAKE ELMO, MN 55042-9627 Created: 12/29/2022 M: Minimum rental applies R: Rate change applies Rental Items Shipment Part Number Description Qty From To Days 28-Day Ra Total DEL-313409 28-Day Rent 01 Additional Rental Package, per 28 Days 1 12/19/2022 12/25/2022 7 (M)$421.0000 0 $105.25 Rent $105.25 Non-Rental Items Number Date Name Description Units No. Units Price/Unit Taxable Total 20-LABOR DEL-313409 12/19/2022 01 - INSTALL Installation of Scaffold, CO-01 EA 1 $1,958.00 Yes $1,958.00 DEL-313410 12/21/2022 02 - DISMANTLE Dismantle of Scaffold, Original EA 1 $653.00 Yes $653.00 30-FREIGHT DEL-313409 12/19/2022 03 - DELIVER Delivery Charges, CO-01 EA 1 $100.00 Yes $100.00 DEL-313410 12/21/2022 03 - DELIVER Return Charges, Original EA 1 $100.00 Yes $100.00 Total Additional Charges $2,811.00 Subtotal $3,131.32 Other tax: (none)$0.00 $215.07 $2,916.25 Sales tax: MN - LAKE ELMO CITY TAX (7.375%) Invoice Total Printed: December 29, 2022 1:57:07 PM Page 1 of 1A122928 132937196-0002 661003 12/22/22 1 of 1 SCHOER,GABE 132937196 LAKE ELMO 3 -H +U CONSTRUCTI MINNEAPOLIS DOWNTOWN PC781 900 E HENNEPIN AVE MINNEAPOLIS,MN 55414 1314 612-486-4111 SUNBELT RENTALS,INC. PO BOX 409211 ATLANTA,GA 30384-9211 342.05 25.22 367.27 REMIT TO: SUNBELT RENTALS,INC.NET 30 Invoices not paid within 30 days may be subject to a 1-½% per month charge. LAKE ELMO CITY CENTER 3880 LAVERNE AVE N LAKE ELMO,MN 55042 9627 651-395-0055 4 WEEK BILL PO BOX 409211 ATLANTA,GA 30384-9211 1oz -4166 -4215 H +U CONSTRUCTION 5555 W EST 78TH STREET,SUITE A MINNEAPOLIS,MN 55439 THERESA CASBOLT theresa.casebolt@sunbeltrentals.com Y PAGE RECEIVED BY CONTRACT NO. PURCHASE ORDER NO. JOB NO. INVOICE TO INVOICE SEND ALL PAYMENTS TO: JOB ADDRESS LOYALTY PLUS NO. Equipment. Service. Guaranteed. INVOICE NO. ACCOUNT NO. INVOICE DATE BRANCH SUBTOTAL SALES TAX INVOICE TOTAL .QTY EQUIPMENT #Min Day Week 4 Week Amount . 1.00 66"SNOW BUCKET 62.00 62.00 171.00 337.00 337.00 10140245 Make:BOBCAT Model:7184105 Ser #:7184105 Rental Sub-total:337.00 SALES ITEMS: Qty Item number Unit Price 1 ENVIRONMENTAL EA 5.050 5.05 ENVIRONMENTAL/HAZMAT FEE 2133XXX0000 BILLED FOR FOUR WEEKS 12/12/22 THRU 1/08/23. 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 B320296Invoice number Date 12/7/2022 Project ID B2203298 Customer account 27053 Customer PO For Professional Services rendered through 12/3/2022 Lake Elmo Public Facilities Special Inspections & Materials Testing 3800 Laverne Avenue North Lake Elmo, MN 55042 1 - Construction and Materials Testing 1.1 - Soil Observations and Testing $92.00 1.2 - Concrete Observations and Testing $2,602.00 1.4 - Structural Steel Observations $972.00 1.6 - Project Management $307.00 $3,973.00 Total Fees $3,973.00 Amount Previously Invoiced: $16,857.50 Amount Invoiced to Date: $20,830.50 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: B320296 Qty/Hours Rate Amount 1 - Construction and Materials Testing 1.1 - Soil Observations and Testing Consulting Services Detail Excavation Observations 1.00 92.00 92.00 Total 1.1 - Soil Observations and Testing $92.00 1.2 - Concrete Observations and Testing Consulting Services Detail Concrete Observations 10.00 92.00 920.00 Concrete Testing 4.00 82.00 328.00 Concrete Cylinder Pick up 4.50 82.00 369.00 Non-Salary Detail Compressive strength of concrete cylinders (ASTM C 39),per specimen 20.00 30.00 600.00 CMT Trip Charge 11.00 35.00 385.00 Total 1.2 - Concrete Observations and Testing $2,602.00 1.4 - Structural Steel Observations Consulting Services Detail ICC Structural Steel Technician 8.50 102.00 867.00 Non-Salary Detail NDE Trip charge 3.00 35.00 105.00 Total 1.4 - Structural Steel Observations $972.00 1.6 - Project Management Consulting Services Detail Staff Engineer 1.25 132.00 165.00 Project Control Specialist 0.50 120.00 60.00 Project Assistant 1.00 82.00 82.00 Total 1.6 - Project Management $307.00 Total 1 - Construction and Materials Testing $3,973.00 Total Project $3,973.00 Page 2 of 2 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 B321385Invoice number Date 12/13/2022 Project ID B2203298.00 Customer account 27053 Customer PO For Professional Services rendered through 12/9/2022 Lake Elmo Public Facilities - Storm Shelter Storm Shelter Structural Observations 3800 Laverne Avenue North Lake Elmo, MN 55042 1 - Onsite Structural Observations and Project Management 1.1 - Onsite Structural Observations and Project Management $1,110.00 $1,110.00 Total Fees $1,110.00 Amount Previously Invoiced: $2,970.00 Amount Invoiced to Date: $4,080.00 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: B2203298.00 - Lake Elmo Public Facilities - Storm Shelter Invoice number: B321385 Qty/Hours Rate Amount 1 - Onsite Structural Observations and Project Management 1.1 - Onsite Structural Observations and Project Management Non-Salary Detail Site Observation and Report (by P.E.)1.00 1,110.00 1,110.00 Total 1.1 - Onsite Structural Observations and Project Management $1,110.00 Total 1 - Onsite Structural Observations and Project Management $1,110.00 Total Project $1,110.00 Page 2 of 2 $ 6,650.0012/28/22 30,778.0312/31/22 25,530.30 78,450.00 45,349.00 123,799.00 65,769.00 3,288.45 62,480.55 36,950.25 0.00 0.00 65,769.00 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 25,530.30 Empirehouse Inc. 5200 Quincy Street Mounds View, MN 55112 To: From: Phone: Project:Lake Elmo City Center (L) 3880 Laverne Avenue N. Lake Elmo, MN 55042 Application No: 6 Date: 12/01/22 Period To: 12/31/22 Contract For: Contract Date: Contractor Job Number:21152 Date: __________________________________ Subscribed and sworn to before me this _____ day of ____________, _________ (year). Notary public: _____________________________ My commission expires ____________________. Contractor: Empirehouse Inc. By: ____________________________________ Title: ___________________________________ (763) 535-1150 Application and Certificate For Payment H+U Construction 5555 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: ___________________________________ December 20, 2022 20 December 2022 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 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 0.00 0.00 0.00 0.00 0.00 0.0012,085.00 6,820.00 0.00 3,500.00 0.00 3,500.00 51.32 175.003,320.00 2,225.00 0.00 800.00 0.00 800.00 35.96 40.001,425.00 18,906.00 0.00 0.00 0.00 0.00 0.00 0.0018,906.00 5,962.00 1,560.00 0.00 0.00 1,560.00 26.17 78.004,402.00 6,820.00 0.00 0.00 0.00 0.00 0.00 0.006,820.00 2,146.00 0.00 0.00 0.00 0.00 0.00 0.002,146.00 2,146.00 0.00 2,145.00 0.00 2,145.00 99.95 107.251.00 1,560.00 0.00 0.00 0.00 0.00 0.00 0.001,560.00 2,340.00 0.00 0.00 0.00 0.00 0.00 0.002,340.00 195.00 0.00 0.00 0.00 0.00 0.00 0.00195.00 6,870.00 3,400.00 0.00 0.00 3,400.00 49.49 170.003,470.00 1,360.00 0.00 0.00 0.00 0.00 0.00 0.001,360.00 43,989.00 23,560.00 20,429.00 0.00 43,989.00 100.00 2,199.450.00 123,799.00 38,895.00 26,874.00 0.00 65,769.00 53.13 3,288.4558,030.00 To:H+U Construction From (Subcontractor):Empirehouse Inc. Project:Lake Elmo City Center (L) Application and Certificate For Payment -- page 2 Application No: 6 Date: 12/01/22 Item Number Description Scheduled Value 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 Application Total Period To: 12/31/22 Contractor's Job Number: 21152 26,371.05 12/28/22 12/28/22 Labor APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702/CMa PAGE ONE OF 2 PAGES APPLICATION NO:09 Distribution to: OWNER PERIOD TO: 12/31/22 LABOR X CONSTRUCTION PROJECT NO.: 21725 MANAGER ARCHITECT CONTRACT DATE:11/04/21 CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract.information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached.completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $366,400.00 2. Net change by Change Orders $4,245.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 ± 2) $$370,645.00 4. TOTAL COMPLETED & STORED TO DATE $327,427.50 (Column G on G703)By: Date: 5. RETAINAGE: a.5.0 % of Completed Work $16,371.38 State of: Minnesota County of: (Column D + E on G703)Subscribed and sworn to before me this day of b.0.0 % of Stored Material $0.00 Notary Public: (Column F on G703)My Commission expires: Total Retainage (Lines 5a + 5b or Total in Column I of G703) $16,371.38 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $311,056.13 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 Less Line 5 Total)comprising the application, the Construction Manager and Architect certify to the 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has PAYMENT (Line 6 from prior Certificate) $301,461.13 progressed as indicated, the qualtity of the Work is in accordance with the Contract 8. CURRENT PAYMENT DUE $9,595.00 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE $59,588.88 (Line 3 less Line 6)AMOUNT CERTIFIED $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied for. Initial all Total changes approved figures on this Application and on the Continuation Sheet that changed to conform to the in previous months by Owner $4,245.00 $0.00 amount certified.) CONSTRUCTION MANAGER: Total approved this Month $0.00 By: Date: ARCHITECT: TOTALS $4,245.00 $0.00 By: Date: NET CHANGES by Change Order This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702/CMa · APPLICATION AND CERTIFICATION FOR PAYMENT · CONSTRUCTION MANAGER-ADVISER EDITION · 1992 EDITION · AIA · ©1992 G702/CMa - 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity $4,245.00 Lake Elmo City Center & Public Works Addition Minneapolis, MN 55432 VIA CONSTRUCTION MANAGER: VIA ARCHITECT: Park Construction Company 1481 81st Ave NE TO CONSTRUCTION MANAGER: PROJECT: H+U Construction 5555 West 78th Street, Suite A CONSTRUCTION MANAGER-ADVISER EDITION Minneapolis, MN 55439 FROM CONTRACTOR: 12/20/2022 Hennepin 20 December 9,595.00 12/28/22 PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO:09 Contractor's signed certification is attached.PROJECT APPLICATION DATE:12/20/22 In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:12/31/22 Use Column I on Contracts where variable retainage for line items may apply.H+U PROJECT NO.: PARK PROJECT NO.:21725 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %BALANCE RETAINAGE NO.VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G ÷ C)TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C - G)RATE) (D + E)(NOT IN TO DATE D OR E)(D+E+F) LABOR EROSION CONTROL $28,000.00 $21,000.00 $21,000.00 75.00%$7,000.00 $1,050.00 SITE REMOVALS $28,050.00 $28,050.00 $28,050.00 100.00%$1,402.50 MASS GRADING $32,500.00 $26,000.00 $26,000.00 80.00%$6,500.00 $1,300.00 BUILDING EXCAVATION & BACKFILL $41,000.00 $41,000.00 $41,000.00 100.00%$2,050.00 FINE GRADING $101,000.00 $70,700.00 $10,100.00 $80,800.00 80.00%$20,200.00 $4,040.00 SANITARY SEWER $18,700.00 $18,700.00 $18,700.00 100.00%$935.00 WATER MAIN $18,500.00 $18,500.00 $18,500.00 100.00%$925.00 STORM SEWER $73,250.00 $69,587.50 $69,587.50 95.00%$3,662.50 $3,479.38 CRANE ACCESS ROAD $4,700.00 $0.00 $0.00 0.00%$4,700.00 $0.00 HOUSEKEEPING $11,550.00 $10,395.00 $10,395.00 90.00%$1,155.00 $519.75 SHOP DRAWINGS/O&M MANUALS/AS-BUILTS/TRAINING $4,400.00 $4,400.00 $4,400.00 100.00%$220.00 BOND $1,720.00 $1,720.00 $1,720.00 100.00%$86.00 INSURANCE $3,030.00 $3,030.00 $3,030.00 100.00%$151.50 CHANGE ORDERS - LABOR CO #2 - ADDITIONAL TREE REMOVAL $2,090.00 $2,090.00 $2,090.00 100.00%$104.50 CO #3 - ADJUSTMENTS TO SAN MH-01 $2,155.00 $2,155.00 $2,155.00 100.00%$107.75 $0.00 $0.00 $0.00 GRAND TOTALS $370,645.00 $317,327.50 $10,100.00 $0.00 $327,427.50 88.34%$43,217.50 $16,371.38 AIA DOCUMENT G703 · CONTINUATION SHEET FOR G702 · 1992 EDITION · AIA · © 1992 G703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5292 Lake Elmo City Center & Public Works Addition PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 12Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:12/31/2022Lake Elmo, MN 55042ARCHITECT FROM (CM): MATERIALCONST. MANAGERHOFFMANN + UHLHORN CONSTRUCTION, INC.5555 W 78TH ST, SUITE AXFILEMINNEAPOLIS, MN 55439CONTRACT DATE:APPLICATION FOR PAYMENTApplication is made for Payment, as shown below,CHANGE ORDER SUMMARYContinuation Sheet, AIA Document G703, is attached.Change Orders Approved inADDITIONSDEDUCTIONS1. COMMITTED COST$6,910,247.00previous months by Owner2. Net Change by Change Orders$0.00TOTAL$0.00$0.003. SUM TO DATE (Line 1+2)$6,910,247.00Approved this Month4. TOTAL COMPLETED & STORED TO DATE $4,945,589.74NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$247,279.51 (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)$247,279.51TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$4,698,310.23Net 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)$4,444,896.16Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$253,414.07and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $2,211,936.77 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 1/5/2023Notary Public:By:Date:1/5/2023My 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 SUBSTATION2023-01-16 CITY OF LAKE ELMO - MATERIALAPPLIC. FOR PAYMENT NO.#12H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 12/31/2022 AIA Document G723,APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification is attached.In tabulations below, amounts are stated to the nearest dollar. ABCDEF GHITEMDESCRIPTION OF WORKSCHEDULEDCHANGEREVISED WORK COMPLETEDTOTAL%BALANCERETAINAGENO.VALUEORDERSSCHEDULEFROMTHIS PERIODCOMPLETED(F/C)TO FINISHVALUEPREV. APPL.AND STORED(C-F)(A+B) TO DATE (D+E)#0330Cast-In-Place Concrete240,000.0014,489.00254,489.00219,489.000.00219,489.0086%35,000.0010,974.45#0341Strutctural Precast1,422,295.00580.001,422,875.001,422,875.000.001,422,875.00100%0.0071,143.75#0512Steel Supply485,000.0074,767.00559,767.00502,545.880.00502,545.8890%57,221.1225,127.29#0610Carpentry & GC568,000.0021,134.00589,134.0042,600.0018,241.0060,841.0010%528,293.003,042.05#0750Roofing & Metal Panels498,500.00(28,765.00)469,735.00315,173.000.00315,173.0067%154,562.0015,758.65#0790Caulking & Firestopping18,300.000.0018,300.000.000.000.000%18,300.000.00#0810Doors, Frames, Hardware - Supply171,697.000.00171,697.0020,418.7944,981.3365,400.1238%106,296.883,270.01#0833Coiling & Sectional Doors175,000.000.00175,000.000.000.000.000%175,000.000.00#0840Aluminum Storefronts & Curtainwall321,960.0094,127.00416,087.00296,312.009,668.00305,980.0074%110,107.0015,299.00#0920Drywall & Fireproofing229,410.0018,879.00248,289.00134,833.0060,706.00195,539.0079%52,750.009,776.95#0930Tile68,100.000.0068,100.000.000.000.000%68,100.000.00#0950Acoustical Ceilings & Panels75,000.000.0075,000.0025,000.000.0025,000.0033%50,000.001,250.00#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 Protection57,520.000.0057,520.0056,046.000.0056,046.0097%1,474.002,802.30#2200Plumbing & Heating491,000.0015,594.00506,594.00345,446.4132,055.33377,501.7475%129,092.2618,875.09#2300HVAC & Controls662,000.00143,425.00805,425.00666,925.000.00666,925.0083%138,500.0033,346.25#2600Electrical808,100.0053,214.00861,314.00317,865.0096,500.00414,365.0048%446,949.0020,718.25#3100Earthwork & Site Utilities209,390.00550.00209,940.00191,175.004,600.00195,775.0093%14,165.009,788.75#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 AMOUNTS6,910,247.00(0.00)7,318,241.004,678,838.08266,751.664,945,589.7468%2,372,651.26247,279.51 INVOICE SUMMARY-PAYMENT APPLICATION NO. #12CITY OF NEWPORT - MATERIALPERIOD ENDING 12/31/2022ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE#0610Carpentry & GCEbert Construction12/31/22Applic #9$18,241.00$912.05$17,328.95#0810Doors, Frames, Hardware - SupplyTwin City Hardware12/31/22Applic #2$44,981.33$2,249.07$42,732.26#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.12/31/22Applic #7$9,668.00$483.40$9,184.60#0920Drywall & FireproofingCommercial Drywall12/31/22Applic #7$60,706.00$3,035.30$57,670.70#2200Plumbing & HeatingPeterson Sheet Metal12/31/22Applic #9$32,055.33$1,602.77$30,452.56#2600ElectricalVinco, Inc.12/31/22Applic #10$96,500.00$4,825.00$91,675.00#3100Earthwork & Site UtilitiesPark Construction Company12/31/22Applic #9$4,600.00$230.00$4,370.00SUBTOTAL AMOUNT DUE$266,751.66$13,337.59$253,414.07 TOTAL AMOUNT DUE $253,414.07 17,328.9512/28/22 $ 42,732.26 321,960.00 94,127.00 416,087.00 281,496.40 0.00 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 Empirehouse Inc. 5200 Quincy Street Mounds View, MN 55112 To: From: Phone: Project:Lake Elmo City Center (M) 3880 Laverne Avenue N. Lake Elmo, MN 55042 Application No: 7 Date: 12/01/22 Period To: 12/31/22 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 Construction 5555 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: ___________________________________ December 20, 2022 20 December 2022 January 31, 2025 Kristine Hutera, CEO 0.00 305,980.00 305,980.00 15,299.00 290,681.00 9,184.60 9,184.60 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 4,580.00 4,580.00 0.00 0.00 4,580.00 100.00 229.000.00 26,100.00 22,000.00 1,000.00 0.00 23,000.00 88.12 1,150.003,100.00 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 23,000.00 0.00 0.00 23,000.00 39.81 1,150.0034,775.00 47,640.00 0.00 0.00 0.00 0.00 0.00 0.0047,640.00 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 0.00 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 8,020.00 0.00 8,020.00 100.00 401.000.00 648.00 0.00 648.00 0.00 648.00 100.00 32.400.00 468.00 0.00 0.00 0.00 0.00 0.00 0.00468.00 1,529.00 0.00 0.00 0.00 0.00 0.00 0.001,529.00 91,482.00 91,482.00 0.00 0.00 91,482.00 100.00 4,574.100.00 416,087.00 296,312.00 To:H+U Construction From (Subcontractor):Empirehouse Inc. Project:Lake Elmo City Center (M) Application and Certificate For Payment -- page 2 Application No: 7 Date: 12/01/22 Item Number Description Scheduled Value 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 Application Total Period To: 12/31/22 Contractor's Job Number: 21153 0.00 0.00 0.00 9,668.00 0.00 0.00 10,000.00 0.00 305,980.00 73.15 110,107.00 15,299.00 12/28/22 12/28/22 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702/CMa PAGE ONE OF 2 PAGES APPLICATION NO:09 Distribution to: OWNER PERIOD TO: 12/31/22 MATERIALS X CONSTRUCTION PROJECT NO.: 21725 MANAGER ARCHITECT CONTRACT DATE:11/04/21 CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract.information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached.completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $209,390.00 2. Net change by Change Orders $550.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 ± 2) $$209,940.00 4. TOTAL COMPLETED & STORED TO DATE $195,775.00 (Column G on G703)By: Date: 5. RETAINAGE: a.5.0 % of Completed Work $9,788.75 State of: Minnesota County of: (Column D + E on G703)Subscribed and sworn to before me this day of b.0.0 % of Stored Material $0.00 Notary Public: (Column F on G703)My Commission expires: Total Retainage (Lines 5a + 5b or Total in Column I of G703) $9,788.75 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $185,986.25 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 Less Line 5 Total)comprising the application, the Construction Manager and Architect certify to the 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has PAYMENT (Line 6 from prior Certificate) $181,616.25 progressed as indicated, the qualtity of the Work is in accordance with the Contract 8. CURRENT PAYMENT DUE $4,370.00 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE $23,953.75 (Line 3 less Line 6)AMOUNT CERTIFIED $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied for. Initial all Total changes approved figures on this Application and on the Continuation Sheet that changed to conform to the in previous months by Owner $550.00 $0.00 amount certified.) CONSTRUCTION MANAGER: Total approved this Month $0.00 By: Date: ARCHITECT: TOTALS $550.00 $0.00 By: Date: NET CHANGES by Change Order This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702/CMa · APPLICATION AND CERTIFICATION FOR PAYMENT · CONSTRUCTION MANAGER-ADVISER EDITION · 1992 EDITION · AIA · ©1992 G702/CMa - 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity $550.00 Lake Elmo City Center & Public Works Addition Minneapolis, MN 55432 VIA CONSTRUCTION MANAGER: VIA ARCHITECT: Park Construction Company 1481 81st Ave NE TO CONSTRUCTION MANAGER: PROJECT: H+U Construction 5555 West 78th Street, Suite A CONSTRUCTION MANAGER-ADVISER EDITION Minneapolis, MN 55439 FROM CONTRACTOR: 12/20/2022 Hennepin 20 December 4,370.00 12/28/22 PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO:09 Contractor's signed certification is attached.PROJECT APPLICATION DATE:12/20/22 In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:12/31/22 Use Column I on Contracts where variable retainage for line items may apply.H+U PROJECT NO.: PARK PROJECT NO.:21725 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %BALANCE RETAINAGE NO.VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G ÷ C)TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C - G)RATE) (D + E)(NOT IN TO DATE D OR E)(D+E+F) MATERIALS EROSION CONTROL $3,800.00 $2,850.00 $2,850.00 75.00%$950.00 $142.50 SITE REMOVALS $3,900.00 $3,900.00 $3,900.00 100.00%$195.00 MASS GRADING $9,000.00 $7,200.00 $7,200.00 80.00%$1,800.00 $360.00 BUILDING EXCAVATION & BACKFILL $5,310.00 $5,310.00 $5,310.00 100.00%$265.50 FINE GRADING $46,000.00 $32,200.00 $4,600.00 $36,800.00 80.00%$9,200.00 $1,840.00 SANITARY SEWER $13,250.00 $13,250.00 $13,250.00 100.00%$662.50 WATER MAIN $29,100.00 $29,100.00 $29,100.00 100.00%$1,455.00 STORM SEWER $94,600.00 $94,600.00 $94,600.00 100.00%$4,730.00 CRANE ACCESS ROAD $4,430.00 $2,215.00 $2,215.00 50.00%$2,215.00 $110.75 CHANGE ORDERS - MATERIALS CO #3 - ADJUSTMENTS TO SAN MH-01 $550.00 $550.00 $550.00 100.00%$27.50 $0.00 $0.00 $0.00 GRAND TOTALS $209,940.00 $191,175.00 $4,600.00 $0.00 $195,775.00 93.25%$14,165.00 $9,788.75 AIA DOCUMENT G703 · CONTINUATION SHEET FOR G702 · 1992 EDITION · AIA · © 1992 G703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5292 Lake Elmo City Center & Public Works Addition PARK CONSTRUCTION COMPANY SCHEDULE OF VALUES