HomeMy WebLinkAbout#02 - City Center Pay Request 15STAFF REPORT
DATE: April 18, 2023
CONSENT
AGENDA ITEM: City Center-Public Works Addition Pay Request #15
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 #15 for the City Center and Public Works Addition project?
PROPOSAL:
Pay request #15 is for $1,070,810.10. A copy is included in your packet.
FISCAL IMPACT:
With this pay request, the project remains within budget.
OPTION:
1) Approve pay request #15
2) Don’t approve pay request #15
RECOMMENDATION:
“Motion to approve Pay Request #15 for the New City Center and Public Works Addition.”
ATTACHMENTS:
• Pay Request #15
APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 15Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:3/31/2023Lake 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 $10,808,627.29NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$540,431.44 (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)$540,431.44TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$10,268,195.85Net 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)$9,197,385.75Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$1,070,810.10and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $3,134,592.15 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 4/4/2023Notary Public:By:Date:4/4/2023My Commission expires:31-Jan-28ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-04-05
CITY OF LAKE ELMO - OVERALLAPPLIC. FOR PAYMENT NO.#15H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 3/31/2023 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(8,075.00)235,005.00146,142.6317,251.21163,393.8470%71,611.168,169.69ReimburseConstruction Management Reimbursables488,555.008,075.00496,630.00463,058.7533,571.25496,630.00100%0.0024,831.50FeeConstruction Management Fee82,595.000.0082,595.0062,523.087,279.2869,802.3685%12,792.643,490.12TrailerTemporary City Office Trailer53,170.000.0053,170.0048,207.052,458.8950,665.9495%2,504.062,533.30ContingencyConstruction Contingency588,330.00(349,709.00)238,621.000.000.000.000%238,621.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete668,316.0056,740.00725,056.00707,706.000.00707,706.0098%17,350.0035,385.30#0341Strutctural Precast1,755,999.00580.001,756,579.001,750,054.000.001,750,054.00100%6,525.0087,502.70#0510Steel Erection93,400.0015,196.00108,596.0089,000.0010,000.0099,000.0091%9,596.004,950.00#0512Steel Supply485,000.0074,767.00559,767.00502,545.8830,398.72532,944.6095%26,822.4026,647.23#0610Carpentry & GC1,027,000.0027,818.001,054,818.00360,567.10279,360.60639,927.7061%414,890.3031,996.39#0750Roofing & Metal Panels1,113,300.00(59,665.00)1,053,635.00784,356.000.00784,356.0074%269,279.0039,217.80#0790Caulking & Firestopping72,350.007,545.0079,895.0010,005.504,684.5014,690.0018%65,205.00734.50#0810Doors, Frames, Hardware - Supply171,697.006,792.00178,489.0074,764.740.0074,764.7442%103,724.263,738.24#0833Coiling & Sectional Doors350,000.00(28,970.00)321,030.000.00321,030.00321,030.00100%0.0016,051.50#0840Aluminum Storefronts & Curtainwall400,410.00139,476.00539,886.00468,109.0057,645.00525,754.0097%14,132.0026,287.70#0920Drywall & Fireproofing543,770.0046,152.00589,922.00508,080.5012,103.00520,183.5088%69,738.5026,009.18#0930Tile154,980.000.00154,980.0038,440.0043,050.0081,490.0053%73,490.004,074.50#0950Acoustical Ceilings & Panels126,000.000.00126,000.0060,000.000.0060,000.0048%66,000.003,000.00#0965Resilient Flooring & Carpet131,940.00275.00132,215.0089,940.0021,400.10111,340.1084%20,874.905,567.01#0990Painting and Wallcovering157,727.00670.00158,397.0060,023.0032,800.0092,823.0059%65,574.004,641.15#1420Conveying Equipment82,000.000.0082,000.0021,577.000.0021,577.0026%60,423.001,078.85#2100Fire Protection112,915.000.00112,915.00107,498.003,267.00110,765.0098%2,150.005,538.25#2200Plumbing & Heating854,000.0057,999.00911,999.00824,761.2848,521.98873,283.2696%38,715.7443,664.16#2300HVAC & Controls962,000.00159,675.001,121,675.00983,744.7564,462.001,048,206.7593%73,468.2552,410.34#2600Electrical1,454,170.0077,660.001,531,830.00817,610.00137,885.00955,495.0062%576,335.0047,774.75#3100Earthwork & Site Utilities575,790.0021,220.00597,010.00539,627.500.00539,627.5090%57,382.5026,981.38#3210Asphalt Paving317,200.00(1,549.00)315,651.0014,489.000.0014,489.005%301,162.00724.45#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 AMOUNTS13,402,788.00252,672.0013,655,460.009,681,458.761,127,168.5310,808,627.2979%2,846,832.71540,431.44
APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 15Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:3/31/2023Lake 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 $4,495,308.89NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$224,765.51 (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)$224,765.51TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$4,270,543.38Net 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)$3,960,609.02Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$309,934.36and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $2,221,997.62 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 4/4/2023Notary Public:By:Date:4/4/2023My Commission expires:31-Jan-28ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-04-05
CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSAPPLIC. FOR PAYMENT NO.#15H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 3/31/2023 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(8,075.00)235,005.00146,142.6317,251.21163,393.8470%71,611.168,169.69ReimburseConstruction Management Reimbursables488,555.008,075.00496,630.00463,058.7533,571.25496,630.00100%0.0024,831.50FeeConstruction Management Fee82,595.000.0082,595.0062,523.087,279.2869,802.3685%12,792.643,490.12TrailerTemporary City Office Trailer53,170.000.0053,170.0048,207.052,458.8950,665.9495%2,504.062,533.30ContingencyConstruction Contingency588,330.00(349,709.00)238,621.000.000.000.000%238,621.000.00TestingTesting & Special Inspections28,000.000.0028,000.000.000.000.000%28,000.000.00#0330Cast-In-Place Concrete428,316.0032,818.00461,134.00451,284.000.00451,284.0098%9,850.0022,564.20#0341Strutctural Precast333,704.000.00333,704.00327,179.000.00327,179.0098%6,525.0016,358.95#0510Steel Erection93,400.0015,196.00108,596.0089,000.0010,000.0099,000.0091%9,596.004,950.00#0610Carpentry & GC459,000.006,684.00465,684.00266,432.4538,410.60304,843.0565%160,840.9515,242.15#0750Roofing & Metal Panels614,800.00(31,650.00)583,150.00438,466.000.00438,466.0075%144,684.0021,923.30#0790Caulking & Firestopping54,050.004,324.0058,374.008,425.504,684.5013,110.0022%45,264.00655.50#0833Coiling & Sectional Doors175,000.00(143,500.00)31,500.000.0031,500.0031,500.00100%0.001,575.00#0840Aluminum Storefronts & Curtainwall78,450.0045,349.00123,799.0099,389.0016,870.00116,259.0094%7,540.005,812.95#0920Drywall & Fireproofing314,360.0027,273.00341,633.00283,776.0011,700.00295,476.0086%46,157.0014,773.80#0930Tile86,880.000.0086,880.0011,200.0019,210.0030,410.0035%56,470.001,520.50#0950Acoustical Ceilings & Panels51,000.000.0051,000.0015,000.000.0015,000.0029%36,000.00750.00#0965Resilient Flooring & Carpet41,010.000.0041,010.000.0020,135.1020,135.1049%20,874.901,006.76#0990Painting and Wallcovering128,196.00558.00128,754.0043,705.0026,700.0070,405.0055%58,349.003,520.25#1420Conveying Equipment35,260.000.0035,260.000.000.000.000%35,260.000.00#2100Fire Protection55,395.000.0055,395.0049,978.003,267.0053,245.0096%2,150.002,662.25#2200Plumbing & Heating363,000.0041,624.00404,624.00363,252.4723,146.88386,399.3595%18,224.6519,319.97#2300HVAC & Controls300,000.0016,250.00316,250.00239,719.7522,562.00262,281.7583%53,968.2513,114.09#2600Electrical646,070.0024,446.00670,516.00270,245.0037,500.00307,745.0046%362,771.0015,387.25#3100Earthwork & Site Utilities366,400.0018,676.00385,076.00341,858.500.00341,858.5089%43,217.5017,092.93#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 AMOUNTS6,492,541.00252,672.006,200,880.004,169,062.18326,246.714,495,308.8972%1,705,571.11224,765.51
INVOICE SUMMARY-PAYMENT APPLICATION NO. #15CITY OF LAKE ELMO - LABOR & GENERAL CONDITIONSPERIOD ENDING 3/31/2023ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE1General ConditionsH+U Construction3/31/23Applic #15$17,251.21$862.56$16,388.65ReimburseConstruction Management ReimbursablesH+U Construction3/31/23Applic #15$33,571.25$1,678.56$31,892.69FeeConstruction Management FeeH+U Construction3/31/23Applic #15$7,279.28$363.96$6,915.32TrailerTemporary City Office TrailerH+U Construction3/31/23Applic #13$2,458.89$122.94$2,335.95#0510Steel ErectionA.M.E. Construction Corp3/31/23Applic #6$10,000.00$500.00$9,500.00#0610Carpentry & GCEbert Construction3/31/23Applic #15$38,410.60$1,920.53$36,490.07#0790Caulking & FirestoppingCarciofini Company3/31/23Applic #2$4,684.50$234.23$4,450.27#0833Coiling & Sectional DoorsQuality Overhead Door3/31/23Applic #1$31,500.00$1,575.00$29,925.00#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.3/31/23Applic #9$16,870.00$843.50$16,026.50#0920Drywall & FireproofingCommercial Drywall3/31/23Applic #12$11,700.00$585.00$11,115.00#0930TileAdvanced Terrazzo & Tile3/31/23Applic #2$19,210.00$960.50$18,249.50#0965Resilient Flooring & CarpetCommerical Flooring3/31/23Applic #1$20,135.10$1,006.76$19,128.34#0990Painting and WallcoveringSteinbrecher Painting Company3/31/23Applic #3$26,700.00$1,335.00$25,365.00#2100Fire ProtectionNova Fire Protection, Inc.3/31/23Applic #5$3,267.00$163.35$3,103.65#2200Plumbing & HeatingPeterson Sheet Metal3/31/23Applic #10$23,146.88$1,157.34$21,989.54#2300HVAC & ControlsSt. Cloud Refrigeration3/31/23Applic #8$22,562.00$1,128.10$21,433.90#2600ElectricalVinco, Inc.3/31/23Applic #13$37,500.00$1,875.00$35,625.00SUBTOTAL AMOUNT DUE$326,246.71$16,312.33$309,934.38 TOTAL AMOUNT DUE $309,934.38
INVOICE : 230074
PROJECT: J21001
MARCH 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 March, 2023
CONSTRUCTION MANAGEMENT REIMBURSABLES
Project Director 1.50 hrs. @ 150.00 $225.00
Senior Project Manager 40.50 hrs. @ 125.00 $5,062.50
Project Manager 51.50 hrs. @ 105.00 $5,407.50
Project Administrator/Accountant 9.25 hrs. @ 65.00 $601.25
Project Superintendent 195.00 hrs. @ 105.00 $20,475.00
Truck, Travel, & Small Tools 1 mo. @ 1,400.00 $1,400.00
Field Office Equipment 1 mo. @ 400.00 $400.00
$33,571.25
GENERAL CONDITIONS
Temporary City Office Trailer $2,458.89
Expendable Supplies $1,155.25
Drinking Water $23.13
Temp Heaters/Fans $718.55
Temporary Toilets $625.70
Safety & OSHA $1,452.89
Xcel Energy - Utility Service $854.48
Trash Removal $1,945.00
Scaffold Rental $1,977.89
Trailer $1,350.00
Skid Steer $7,148.32
$19,710.10
$53,281.35
Subtotal Construction Management Reimbursables
Subtotal General Conditions
Total
INVOICE : 230074
PROJECT: J21001
MARCH 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 February 28, 2023
#0510-Labor A.M.E. Construction Corp $10,000.00
#0512-Material Construction Systems, Inc.$30,398.72
#0610-Labor Ebert Construction $38,410.60
#0610-Material Ebert Construction $240,950.00
#0790-Labor Carciofini Company $4,684.50
#0833-Labor Quality Overhead Door $31,500.00
#0833-Material Quality Overhead Door $289,530.00
#0840-Labor Empirehouse Inc.$16,870.00
#0840-Material Empirehouse Inc.$40,775.00
#0920-Labor Commercial Drywall, Inc.$11,700.00
#0920-Material Commercial Drywall, Inc.$403.00
#0930-Labor Advanced Terrazzo & Tile Co.$19,210.00
#0930-Material Advanced Terrazzo & Tile Co.$23,840.00
#0965-Labor Commercial Flooring Services $20,135.10
#0965-Material Commercial Flooring Services $1,265.00
#0990-Labor Steinbrecher Painting Company $26,700.00
#0990-Material Steinbrecher Painting Company $6,100.00
#2100-Labor Nova Fire Protection, Inc.$3,267.00
#2200-Labor Peterson Sheet Metal, Inc.$23,146.88
#2200-Material Peterson Sheet Metal, Inc.$25,375.10
#2300-Labor St.Cloud Refrigeration, Inc.$22,562.00
#2300-Material St.Cloud Refrigeration, Inc.$41,900.00
#2600-Labor Vinco, Inc.$37,500.00
#2600-Material Vinco, Inc.$100,385.00
$1,066,607.90
$7,279.28
$1,127,168.53
Retainage
Current Retainge 56,358.43
Prior Retainage 484,073.01
Retainage-To-Date 540,431.44
Total Amount Due $1,070,810.10
CONSTRUCTION MANAGEMENT FEE
Total Contractor's Pay Applications February 1 - February 28
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
04/13/2023
Due Date Customer PO No.
RQ152297 Lake Elmo DW Trailer
Invoice No.:
Invoice Date:03/14/2023
INV649164
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
04/13/2023
Due Date Customer PO No.
RQ152297 Lake Elmo DW Trailer
Invoice No.:
Invoice Date:03/14/2023
INV649164
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
04/13/2023
Due Date Customer PO No.
RQ152297 Lake Elmo DW Trailer
Invoice No.:
Invoice Date:03/14/2023
INV649164
Tracy DickensonAccount Rep:
PO Box 860700
Minneapolis, MN 55486-0700
Phone: (763) 553-1900
NO INS
Payment Terms:NET30
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 03/14/23 04/10/23 1 2,000.00 2,000.00
RR not utilized no need to winterize.
STEPS Steps - Rental 03/14/23 04/10/23 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
1399108
Invoice Date Page
INVOICE
3260334
ORDER NUMBER
Columbus, MN 55025
9205 Lake Drive NE
Viking Industrial Center
1 of 2651-646-6141
INVOICE
03/01/2023
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 03/31/2023 03/31/2023 0.00
Primary Salesrep NameOrder Date Pick Ticket No Taker
02/24/2023 09:37:51 2291382 Douglas P. Geist TWOODBURY
Item ID
Item DescriptionOrderedShippedRemaining
Quantities
UOM
Disp.Unit Size
Pricing
UOM Unit
PriceUnit Size
Price
Extended
6.00 0.00 EA V8G-SCGREEN EA 21.646296 129.88
1.0 1.0000
6.00
KLEEN SWEEP GREEN SWEEPING
COMPOUND 50#
Kleen Sweep Green Sweeping Compound 50LB (1815)
2.00 0.00 ROLL V8H-CM420 ROLL 96.294000 192.59
1.0 1.0000
2.00
CARPET MASK TINTED 36 X 200FT
Carpet Mask Tinted 36 in X 200
1.00 0.00 EA V8H-A2436 EA 196.760000 196.76
1.0 1.0000
1.00
T-STYLE ROLL APPLICATOR FOR CARPET
MASK
Multi-use Applicator for Carpet Mask 24",30" 36"
2.00 0.00 EA V9O-2681200 EA 38.610000 77.22
1.0 1.0000
2.00
ALUM SCOOP SHOVEL D HANDLE
Aluminum Scoop Shovel With 27'' Wood pLoy D-Grip Handle 14.75'' x 18.75'' Blade
2.00 0.00 EA B474DS EA 14.420000 28.84
1.0 1.0000
2.00
9" BLUE FLAGGED DUO-SWEEP WRHSE
BROOM
7" Trim W/48" Handle (12/cs)
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
1399108
Invoice Date Page
INVOICE
3260334
ORDER NUMBER
Columbus, MN 55025
9205 Lake Drive NE
Viking Industrial Center
2 of 2651-646-6141
INVOICE
03/01/2023
Please Note New Remittance Address
Delivery Instructions:Contact Gabe 651.395.0055
DOUG GEIST Tracking #:Carrier:
Item ID
Item DescriptionOrderedShippedRemaining
Quantities
UOM
Disp.Unit Size
Pricing
UOM Unit
PriceUnit Size
Price
Extended
SUB-TOTAL:Total Lines:5 625.29
MN STATE TAX 43.33:
MN SPECIAL TAX 3.15:
TRUCK DELIVERY 5.00:
676.77AMOUNT 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:300
Columbus
1399123
Invoice Date Page
INVOICE
3260335
ORDER NUMBER
Columbus, MN 55025
9205 Lake Drive NE
Viking Industrial Center
1 of 1651-646-6141
INVOICE
03/01/2023
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
Gabe Net 30 03/31/2023 03/31/2023 0.00
Primary Salesrep NameOrder Date Pick Ticket No Taker
02/24/2023 06:59:13 2291508 Douglas P. Geist DBRUNER
Item ID
Item DescriptionOrderedShippedRemaining
Quantities
UOM
Disp.Unit Size
Pricing
UOM Unit
PriceUnit Size
Price
Extended
2.00 0.00 EA V9U-H-7928 EA 55.714286 111.43
1.0 1.0000
2.00
55 GALLON TRASH CAN DOLLY
SPECIAL ORDER
2.00 0.00 EA V9U-3689GR EA 100.000000 200.00
1.0 1.0000
2.00
55 GALLON TRASH CAN GRAY
SPECIAL ORDER
SUB-TOTAL:Total Lines:2 311.43
MN STATE TAX 21.41:
MN SPECIAL TAX 1.56:
TRUCK DELIVERY 0.00:
334.40AMOUNT 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
1400917
Invoice Date Page
INVOICE
3261542
ORDER NUMBER
Columbus, MN 55025
9205 Lake Drive NE
Viking Industrial Center
1 of 1651-646-6141
INVOICE
03/21/2023
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 04/20/2023 04/20/2023 0.00
Primary Salesrep NameOrder Date Pick Ticket No Taker
03/20/2023 06:57:57 2292908 Douglas P. Geist TWOODBURY
Item ID
Item DescriptionOrderedShippedRemaining
Quantities
UOM
Disp.Unit Size
Pricing
UOM Unit
PriceUnit Size
Price
Extended
6.00 0.00 EA V8G-SCGREEN EA 21.530556 129.18
1.0 1.0000
6.00
KLEEN SWEEP GREEN SWEEPING
COMPOUND 50#
Kleen Sweep Green Sweeping Compound 50LB (1815)
SUB-TOTAL:Total Lines:1 129.18
MN STATE TAX 9.22:
MN SPECIAL TAX 0.68:
TRUCK DELIVERY 5.00:
144.08AMOUNT 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
133305325-0004
661003
3/06/23
1 of 1
SCHOER,GABE 133305325
LAKE ELMO
3 -H +U CONSTRUCTI
MINNEAPOLIS MN CC CONSTRUCTION
3700 W PRESERVE BLVD
BURNSVILLE,MN 55337 7746
952-707-5050
SUNBELT RENTALS,INC.
PO BOX 409211
ATLANTA,GA 30384-9211
501.18
36.97
538.15
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 -4676 -4747
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 ENVIRONMENTAL EA 6.180 6.18
ENVIRONMENTAL/HAZMAT FEE 2133XXX0000
BILLED FOR FOUR WEEKS 2/15/23 THRU 3/14/23.
133305325-0005
661003
3/24/23
1 of 1
SCHOER,GABE 133305325
LAKE ELMO
3 -H +U CONSTRUCTI
MINNEAPOLIS MN CC CONSTRUCTION
3700 W PRESERVE BLVD
BURNSVILLE,MN 55337 7746
952-707-5050
SUNBELT RENTALS,INC.
PO BOX 409211
ATLANTA,GA 30384-9211
168.00
12.40
180.40
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
RENTAL RETURN
PO BOX 409211
ATLANTA,GA 30384-9211
1oz -4834 -4904
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 55.00
TA022253 Make:SCHAEFER Model:FAN 36 Ser #:22253
Billed from 3/15/23 thru 3/23/23
1.00 36"HIGH VOLUME FAN 115V 18.33 18.33 55.00 165.00 55.00
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 55.00
TA013541 Make:SCHAEFER Model:FAN 36 Ser #:13541
Rental Sub-total:165.00
SALES ITEMS:
Qty Item number Unit Price
1 ENVIRONMENTAL EA 3.000 3.00
ENVIRONMENTAL/HAZMAT FEE 2133XXX0000
FINAL BILL:3/15/23 05:00 PM THRU 3/23/23 05:00 PM.
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221
Invoice
#W907615
3/22/2023
W907615
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 $355.57
Balance Due $355.57
Due Date: 4/19/2023
Terms Due Date PO #Sales Rep Builders Club#
Net 28 4/19/2023 -Jeff Foley
Qty Item Days Sales Order #Service Level Rate Amount
1 RENTAL
RegHS Feb 22-Feb 28
7 385563 -$4.00 $1.00
1 SERVICE
Service Feb 22-Feb 28
7 385563 2X/wk $70.00 $35.00
1 SERVICE
ClimateSvc Feb 22 to Feb 28
7 385563 2X/wk $40.00 $20.00
1 RENTAL
zHandSani Feb 22-Feb 28
7 385563 -$0.00 $0.00
1 RENTAL
RegHS Feb 22-Mar 21
28 386930 -$4.00 $4.00
1 SERVICE
Service Feb 28-Mar 21
22 386930 1X/wk $70.00 $55.00
1 SERVICE
ClimateSvc Feb 28 to Mar 21
22 386930 1X/wk $40.00 $31.43
1 SERVICE
Service Feb 22-Feb 27
6 386930 2X/wk $70.00 $30.00
1 SERVICE
ClimateSvc Feb 22 to Feb 27
6 386930 2X/wk $40.00 $17.14
1 RENTAL
zHandSani Feb 22-Mar 21
28 386930 -$0.00 $0.00
1 RENTAL
RegHS Feb 22-Mar 21
28 398087 -$4.00 $4.00
1 SERVICE
Service Feb 28-Mar 21
22 398087 1X/wk $70.00 $55.00
1 SERVICE
ClimateSvc Feb 28 to Mar 21
22 398087 1X/wk $40.00 $31.43
1 SERVICE
Service Feb 22-Feb 27
6 398087 2X/wk $70.00 $30.00
1 SERVICE
ClimateSvc Feb 22 to Feb 27
6 398087 2X/wk $40.00 $17.14
1 RENTAL
zHandSani Feb 22-Mar 21
28 398087 -$0.00 $0.00
0 TAX-MN
Tax-MN
---$0.00 $22.77
0 TAX-WASH
Tax-WASH
---$0.00 $1.66
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221
Invoice
#W907615
3/22/2023
W907615
2 of 2
Subtotal $355.57
Invoice Total $355.57
Credits/Payments Applied $0.00
Balance Due $355.57
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 #W907615
Amount Due $355.57
Amount Paid ______________________
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221
Invoice
#W907616
3/22/2023
W907616
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: 4/19/2023
Terms Due Date PO #Sales Rep Builders Club#
Net 28 4/19/2023 LEPW Jeff Foley
Qty Item Days Sales Order #Service Level Rate Amount
1 RENTAL
RegHS Feb 22-Mar 21
28 396954 -$4.00 $4.00
1 SERVICE
Service Feb 22-Mar 21
28 396954 1X/wk $70.00 $70.00
1 SERVICE
ClimateSvc Feb 22 to Mar 21
28 396954 1X/wk $40.00 $40.00
1 RENTAL
zHandSani Feb 22-Mar 21
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 #W907616
Amount Due $122.41
Amount Paid ______________________
Biffs, Inc6430 County Rd 101 EShakopee MN 55379-5202952.403.1221
Invoice
#W907617
3/22/2023
W907617
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 $147.72
Balance Due $147.72
Due Date: 4/19/2023
Terms Due Date PO #Sales Rep Builders Club#
Net 28 4/19/2023 -Jeff Foley
Qty Item Days Sales Order #Service Level Rate Amount
1 RENTAL
RegHS Feb 22-Mar 21
28 402272 -$4.00 $4.00
1 SERVICE
Service Feb 28-Mar 21
22 402272 1X/wk $70.00 $55.00
1 SERVICE
ClimateSvc Feb 28 to Mar 21
22 402272 1X/wk $40.00 $31.43
1 SERVICE
Service Feb 22-Feb 27
6 402272 2X/wk $70.00 $30.00
1 SERVICE
ClimateSvc Feb 22 to Feb 27
6 402272 2X/wk $40.00 $17.14
1 RENTAL
zHandSani Feb 22-Mar 21
28 402272 -$0.00 $0.00
0 TAX-MN
Tax-MN
---$0.00 $9.46
0 TAX-WASH
Tax-WASH
---$0.00 $0.69
Subtotal $147.72
Invoice Total $147.72
Credits/Payments Applied $0.00
Balance Due $147.72
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 #W907617
Amount Due $147.72
Amount Paid ______________________
OECS
OECS - 170064 PO Box 9201
Minneapolis, MN 55480
763-417-9599
accounting@oecscomply.com
Invoice 39799
BILL TO
H+U Construction
5555 West 78th Street, Suite A
Minneapolis, MN 55439
DATE
03/15/2023
PLEASE PAY
$3,019.00
DUE DATE
04/29/2023
DATE DESCRIPTION QTY RATE AMOUNT
Monthly Safety Services 1 3,019.00 3,019.00
TOTAL DUE $3,019.00
THANK YOU.
Invoice
Invoice Date 03/22/23
Due Date 04/21/23
110055
Net 30 daysTerms:
Lead Technician:Robert Tallarico
Bill To:
H+U Construction
5555 West 78th Street, Suite A
Minneapolis, MN 55439
H+ U Construction
5555 West 78th Street, Suite A
Minneapolis, MN 55439
Service Location:990468 108124
Work Order: 88978
Scope: 1 Customer PO: Job # LECC
Price Method: Time and Materials
Date of
Service Description Quantity Amount Total
Tax
Price
Unit
Total
Price
Other - Annual Fire Extg Service & Maintenance03/09/23 1.00 $60.00 $60.00 $0.00 $60.00
Other - Maintenance - 2.5lb ABC Stored Pressure03/09/23 1.00 $6.50 $6.50 $0.00 $6.50
Other - Maintenance - 10lb ABC Stored Pressure03/09/23 9.00 $6.50 $58.50 $0.00 $58.50
Other - 6-YR Internal Examination - 2.5lb ABC Stored Pressure03/09/23 1.00 $17.50 $17.50 $0.00 $17.50
Other - Recharge - 10lb ABC Stored Pressure03/09/23 3.00 $29.50 $88.50 $0.00 $88.50
Other - 6-YR Internal Examination - 10lb ABC Stored Pressure03/09/23 4.00 $31.50 $126.00 $0.00 $126.00
Other - Pressure Seal03/09/23 8.00 $3.05 $24.40 $1.84 $26.24
Other - Valve Stem Replacement - Dry Chemical03/09/23 1.00 $12.95 $12.95 $0.97 $13.92
Other - lbs of ABC Dry Chemical03/09/23 6.00 $3.95 $23.70 $1.78 $25.48
Other - Band - Replacement w/ Hose Clip03/09/23 1.00 $12.95 $12.95 $0.97 $13.92
Other - Hazardous Material Handling Charge03/09/23 1.00 $10.00 $10.00 $0.00 $10.00
Scope 1 Subtotal $5.56$441.00 $446.56
Work Description:Jobsite Fire Extinguishers-- Lake Elmo City Center 3880 Laverne Ave N Lake Elmo MN 55042 requested by Gabe Schoer
651-395-0055
Tax
Total
Subtotal $441.00
$5.56
$446.56
Page 1
Remit Payments to: LVC Companies
4200 W 76th St Phone: 952-835-4600
Edina, MN 55435 Fax:952-835-4153
Invoice Date
2/28/2023
Invoice #
368712Customer
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
2/27/2023 30 Yard Container762622 1Each 371.00 371.00
2/27/2023 Solid Waste Management Tax calculated at
$0.60/yard. This ticket includes $18.00 of solid
waste disposal tax.
762622 30Yards 0.60 18.00
$389.00
$389.00
$0.00
Invoice Date
3/8/2023
Invoice #
369165Customer
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
3/3/2023 30 Yard Container762531 1Each 371.00 371.00
3/3/2023 Solid Waste Management Tax calculated at
$0.60/yard. This ticket includes $18.00 of solid
waste disposal tax.
762531 30Yards 0.60 18.00
$389.00
$389.00
$0.00
Invoice Date
3/15/2023
Invoice #
369833Customer
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
3/14/2023 30 Yard Container765829 1Each 371.00 371.00
3/14/2023 Solid Waste Management Tax calculated at
$0.60/yard. This ticket includes $18.00 of solid
waste disposal tax.
765829 30Yards 0.60 18.00
$389.00
$389.00
$0.00
Invoice Date
3/23/2023
Invoice #
370464Customer
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
3/21/2023 30 Yard Container765253 1Each 371.00 371.00
3/21/2023 Solid Waste Management Tax calculated at
$0.60/yard. This ticket includes $18.00 of solid
waste disposal tax.
765253 30Yards 0.60 18.00
$389.00
$389.00
$0.00
Invoice Date
3/29/2023
Invoice #
370928Customer
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
3/28/2023 30 Yard Container766696 1Each 371.00 371.00
3/28/2023 Solid Waste Management Tax calculated at
$0.60/yard. This ticket includes $18.00 of solid
waste disposal tax.
766696 30Yards 0.60 18.00
$389.00
$389.00
$0.00
Invoice A124718
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
3/16/2023Date
Job Site Shipping Address:
3880 LAVERNE AVE N
LAKE ELMO, MN 55042-9627
Created: 3/16/2023
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 2/16/2023 3/15/2023 28 $421.0000
0 $421.00
Rent $421.00
Subtotal
$452.05
Other tax: (none)$0.00
$31.05
$421.00
Sales tax: MN - LAKE ELMO CITY TAX (7.375%)
Invoice Total
Printed: March 16, 2023 6:50:36 AM Page 1 of 1A124718
Invoice A124936
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
3/23/2023Date
Job Site Shipping Address:
3880 LAVERNE AVE N
LAKE ELMO, MN 55042-9627
Created: 3/23/2023
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 3/16/2023 3/16/2023 1 $421.0000
0 $15.04
Rent $15.04
Non-Rental Items
Number Date Name Description Units No. Units Price/Unit Taxable Total
20-LABOR
RET-360389 3/16/2023 02 -
DISMANTLE Dismantle of Scaffold EA 1 $1,306.00 Yes $1,306.00
30-FREIGHT
RET-360389 3/16/2023 03 -
DELIVER Return Charges EA 1 $100.00 Yes $100.00
Total Additional Charges $1,406.00
Subtotal
$1,525.84
Other tax: (none)$0.00
$104.80
$1,421.04
Sales tax: MN - LAKE ELMO CITY TAX (7.375%)
Invoice Total
Printed: March 23, 2023 2:24:14 PM Page 1 of 1A124936
136451235-0001
661003
3/13/23
1 of 1
SCHOER,GABE 136451235
LAKE ELMO
3 -H +U CONSTRUCTI
ST.PAUL PC782
15125 S ROBERT TRL
ROSEMOUNT,MN 55068 1745
952-229-6696
SUNBELT RENTALS,INC.
PO BOX 409211
ATLANTA,GA 30384-9211
3,656.89
269.69
3,926.58
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
RENTAL RETURN
PO BOX 409211
ATLANTA,GA 30384-9211
1oz -3282 -3341
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 1500-2100LB TRACK SKIDSTEER CAB 419.00 419.00 1287.00 2844.00 2574.00
10377418 Make:BOBCAT Model:T550 Ser #:B57T11185
HR OUT:793.750 HR IN:805.500 TOTAL:11.750
Billed from 2/27/23 thru 3/10/23
#with forks
1.00 PALLET FORKS -LARGE SKID 65.00 65.00 180.00 425.00 360.00
1006234 Make:BRADCO Model:121291/67604 Ser #:472510
1.00 SKIDSTEER LOADER BUCKET N/C
Rental Sub-total:2934.00
SALES ITEMS:
Qty Item number Unit Price
1 DLPKSRCHG EA 90.200 90.20
TRANSPORTATION SURCHARGE
1 ENVIRONMENTAL EA 54.690 54.69
ENVIRONMENTAL/HAZMAT FEE 2133XXX0000
16 DIESEL EA 10.500 168.00
DIESEL 2141XXX0000
DELIVERY CHARGE 205.00
PICKUP CHARGE 205.00
.QTY EQUIPMENT #Min Day Week 4 Week Amount
.
FINAL BILL:2/27/23 11:00 AM THRU 3/10/23 12:00 PM.
132937196-0005
661003
3/16/23
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
RENTAL RETURN
PO BOX 409211
ATLANTA,GA 30384-9211
1oz -3779 -3818
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
Billed from 3/06/23 thru 3/16/23
Rental Sub-total:337.00
SALES ITEMS:
Qty Item number Unit Price
1 ENVIRONMENTAL EA 5.050 5.05
ENVIRONMENTAL/HAZMAT FEE 2133XXX0000
FINAL BILL:3/06/23 08:00 AM THRU 3/16/23 08:00 AM.
137131555-0001
661003
3/31/23
1 of 1
SCHOER,GABE 137131555
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
982.04
72.43
1,054.47
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 -3781 -3854
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 BOX BROOM 116.00 116.00 340.00 776.00 776.00
1032512 Make:BOBCAT Model:6707144 Ser #:714433206
#pick up snow bucket currently on rent
when delivering this.
Rental Sub-total:776.00
SALES ITEMS:
Qty Item number Unit Price
1 DLPKSRCHG EA 34.400 34.40
TRANSPORTATION SURCHARGE
1 ENVIRONMENTAL EA 11.640 11.64
ENVIRONMENTAL/HAZMAT FEE 2133XXX0000
PICKUP CHARGE 160.00
BILLED FOR FOUR WEEKS 3/16/23 THRU 4/12/23.
$ 9,500.003/27/23
36,490.073/27/23
4,450.273/27/23
29,925.003/27/23
16,026.50
78,450.00
45,349.00
123,799.00
116,259.00
5,812.95
110,446.05
94,419.55
0.00
0.00
116,259.00
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 16,026.50
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: 9 Date: 03/01/23
Period To: 03/31/23
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 Construction
5555 West 78th Street
Suite A
Edina, MN 55439
March 20, 2023
20
March 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
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 10,000.00 0.00 10,000.00 82.75 500.002,085.00
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 14,183.00 4,723.00 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 0.00 2,146.00 0.00 2,146.00 100.00 107.300.00
2,146.00 2,145.00 1.00 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 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 6,870.00 0.00 0.00 6,870.00 100.00 343.500.00
1,360.00 0.00 0.00 0.00 0.00 0.00 0.001,360.00
43,989.00 43,989.00 0.00 0.00 43,989.00 100.00 2,199.450.00
123,799.00 99,389.00 16,870.00 0.00 116,259.00 93.91 5,812.957,540.00
To:H+U Construction
From (Subcontractor):Empirehouse Inc.
Project:Lake Elmo City Center (L)
Application and Certificate For Payment -- page 2
Application No: 9 Date: 03/01/23
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: 03/31/23
Contractor's Job Number: 21152
18,249.50
19,128.34
25,365.003/27/23
3,103.65
4443/27/23
21,433.90
3/27/23
APPLICATION AND CERTIFICATE FOR PAYMENTTO (OWNER): PROJECT:LAKE ELMO CITY HALL, FIRE DEPARTMENT APPLICATION NO: 15Distribution to:City of Lake Elmo & PUBLIC WORKS FACILITIES REMODELXOWNER3880 Laverne Ave N PERIOD TO:3/31/2023Lake 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 $6,313,318.40NumberDate Approved (Column G on G703) 5. RETAINAGE:$0.00$0.00 a. _5_ % of Completed Work$315,665.95 (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)$315,665.95TOTALS$0.00$0.006. TOTAL EARNED LESS RETAINAGE$5,997,652.45Net 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)$5,236,776.73Payment has been completed in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE$760,875.72and that current payments shown herein are now due.9. BALANCE TO FINISH, PLUS RETAINAGE $912,594.55 (Line 3 less Line 6)CONSTRUCTION MANAGER:HOFFMANN + UHLHORN CONSTRUCTION, INC.State of: MINNESOTACounty of:Anoka County Subscribed and sworn to before me this 4/4/2023Notary Public:By:Date:4/4/2023My Commission expires:31-Jan-28ARCHITECT'S CERTIFICATE FOR PAYMENTAMOUNT CERTIFIED$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 SUBSTATION2023-04-05
CITY OF LAKE ELMO - MATERIALAPPLIC. FOR PAYMENT NO.#15H+U CONSTRUCTION EDITION OF AIA DOCUMENT G703PERIOD ENDING 3/31/2023 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 Concrete240,000.0023,922.00263,922.00256,422.000.00256,422.0097%7,500.0012,821.10#0341Strutctural Precast1,422,295.00580.001,422,875.001,422,875.000.001,422,875.00100%0.0071,143.75#0512Steel Supply485,000.0074,767.00559,767.00502,545.8830,398.72532,944.6095%26,822.4026,647.23#0610Carpentry & GC568,000.0021,134.00589,134.0094,134.65240,950.00335,084.6557%254,049.3516,754.23#0750Roofing & Metal Panels498,500.00(28,015.00)470,485.00345,890.000.00345,890.0074%124,595.0017,294.50#0790Caulking & Firestopping18,300.003,221.0021,521.001,580.000.001,580.007%19,941.0079.00#0810Doors, Frames, Hardware - Supply171,697.006,792.00178,489.0074,764.740.0074,764.7442%103,724.263,738.24#0833Coiling & Sectional Doors175,000.00114,530.00289,530.000.00289,530.00289,530.00100%0.0014,476.50#0840Aluminum Storefronts & Curtainwall321,960.0094,127.00416,087.00368,720.0040,775.00409,495.0098%6,592.0020,474.75#0920Drywall & Fireproofing229,410.0018,879.00248,289.00224,304.50403.00224,707.5091%23,581.5011,235.38#0930Tile68,100.000.0068,100.0027,240.0023,840.0051,080.0075%17,020.002,554.00#0950Acoustical Ceilings & Panels75,000.000.0075,000.0045,000.000.0045,000.0060%30,000.002,250.00#0965Resilient Flooring & Carpet90,930.00275.0091,205.0089,940.001,265.0091,205.00100%0.004,560.25#0990Painting and Wallcovering29,531.00112.0029,643.0016,318.006,100.0022,418.0076%7,225.001,120.90#1420Conveying Equipment46,740.000.0046,740.0021,577.000.0021,577.0046%25,163.001,078.85#2100Fire Protection57,520.000.0057,520.0057,520.000.0057,520.00100%0.002,876.00#2200Plumbing & Heating491,000.0016,375.00507,375.00461,508.8125,375.10486,883.9196%20,491.0924,344.20#2300HVAC & Controls662,000.00143,425.00805,425.00744,025.0041,900.00785,925.0098%19,500.0039,296.25#2600Electrical808,100.0053,214.00861,314.00547,365.00100,385.00647,750.0075%213,564.0032,387.50#3100Earthwork & Site Utilities209,390.002,544.00211,934.00197,769.000.00197,769.0093%14,165.009,888.45#3210Asphalt Paving180,634.00(1,549.00)179,085.0012,897.000.0012,897.007%166,188.00644.85#3290Landscaping & Fencing61,140.000.0061,140.000.000.000.000%61,140.000.00TOTAL CONTRACT AMOUNTS6,910,247.000.007,454,580.005,512,396.58800,921.826,313,318.4085%1,141,261.60315,665.95
INVOICE SUMMARY-PAYMENT APPLICATION NO. #15CITY OF LAKE ELMO - MATERIALPERIOD ENDING 3/31/2023ITEM NO# DESCRIPTION VENDORDATENUMBERAMOUNTRETAINAGEDUE#0512Steel SupplyConstruction Systems, Inc.3/31/23Applic #6$30,398.72$1,519.94$28,878.78#0610Carpentry & GCEbert Construction3/31/23Applic #11$240,950.00$12,047.50$228,902.50#0833Coiling & Sectional DoorsQuality Overhead Door3/31/23Applic #1$289,530.00$14,476.50$275,053.50#0840Aluminum Storefronts & CurtainwallEmpirehouse, Inc.3/31/23Applic #10$40,775.00$2,038.75$38,736.25#0920Drywall & FireproofingCommercial Drywall3/31/23Applic #10$403.00$20.15$382.85#0930TileAdvanced Terrazzo & Tile3/31/23Applic #2$23,840.00$1,192.00$22,648.00#0965Resilient Flooring & CarpetCommerical Flooring3/31/23Applic #3$1,265.00$63.25$1,201.75#0990Painting and WallcoveringSteinbrecher Painting Company3/31/23Applic #3$6,100.00$305.00$5,795.00#2200Plumbing & HeatingPeterson Sheet Metal3/31/23Applic #12$25,375.10$1,268.76$24,106.34#2300HVAC & ControlsSt. Cloud Refrigeration3/31/23Applic #9$41,900.00$2,095.00$39,805.00#2600ElectricalVinco, Inc.3/31/23Applic #13$100,385.00$5,019.25$95,365.75SUBTOTAL AMOUNT DUE$800,921.82$40,046.10$760,875.72 TOTAL AMOUNT DUE $760,875.72
28,878.783/27/23
228,902.503/27/23
275,053.503/27/23
38,736.25
321,960.00
94,127.00
416,087.00
409,495.00
19,974.75
389,520.25
350,784.00
0.00
0.00
409,495.00
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 38,736.25
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: 10 Date: 03/01/23
Period To: 03/31/23
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 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: ___________________________________
March 20, 2023
20
March 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
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 23,000.00 34,775.00 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 2,000.00 2,000.00 0.00 4,000.00 66.56 200.002,010.00
6,465.00 0.00 4,000.00 0.00 4,000.00 61.87 200.002,465.00
120.00 0.00 0.00 0.00 0.00 0.00 0.00120.00
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 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
416,087.00 368,720.00 40,775.00 0.00 409,495.00 98.42 19,974.756,592.00
To:H+U Construction
From (Subcontractor):Empirehouse Inc.
Project:Lake Elmo City Center (M)
Application and Certificate For Payment -- page 2
Application No: 10 Date: 03/01/23
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: 03/31/23
Contractor's Job Number: 21153
22,648.00
1,201.75
5,795.003/27/23
3/27/23
39,805.00
3/27/23