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APPLICATION FOR PAYMENT NO. 5 <br /> To: City of St. Anthony, Minnesota (OWNER) <br /> From: Forest Lake Contracting, Inc. (CONTRACTOR) <br /> Contract: City of St. Anthony <br /> Project: 1998 Watermai n, Street and Storm Sewer Improvements <br /> OWNER's Contract No. -- ENGINEER'S Project No. 10408.03 <br /> For Work accomplished through the date of: 6/30/99 <br /> 1. Original Contract Price: $ 533,674.45 <br /> 2. Net change by Change Orders and Written Amendments(+or-): $ 0.00 <br /> 3. Current Contract Price(1 plus 2): $ 533,674.45 <br /> 4. Total completed and stored to date: $ 597,664.63 <br /> 5. Retainage(per Agreement): <br /> 2 %of completed Work: $ 11,953.29 <br /> %of stored material: $ <br /> Total Retainage: $ 11,953.29 <br /> 6. Total completed and stored to date less retainage(4 minus 5): $ 585,711.34 <br /> 7. Less previous Application for Payments: $ 545,000.69 <br /> 8.. DUE THIS APPLICATION(6 MINUS 7): $ 40,710.65 <br /> Accompanying Documentation: <br /> CONTRACTOR'S Certification: <br /> The undersigned CONTRACTOR certifies that(1)all previous progress payments received from OWNER on <br /> account of Work done under the Contract referred to above have been applied on account to discharge <br /> CONTRACTOR's legitimate obligations incurred in connection with Work covered by prior Applications for <br /> Payment numbered 1 through 4 inclusive;(2)title of all Work,materials and equipment incorporated in said <br /> Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at time of payment <br /> free and clear of all Liens,security interests and encumbrances(except such as are covered by a Bond acceptable to <br /> OWNER indemnifying OWNER against any such Lien,security interest or encumbrance);and(3)all Work covered <br /> by this Application for Payment is in accordance with the Contract Documents and not defective. <br /> Dated Forest Lake Contracting, Inc. <br /> CONTRACTOR <br /> f����^"� <br /> By: <br /> State of <br /> County of eqt,..s e:r <br /> Subscribed and sworn to before me this <br /> day of J 9cf— <br /> Notafy Public <br /> My Commission expires: <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Dated July 12, 1999 SEH.RCM <br /> EJCDC No. 1910-8-E (1996 Edition) By; <br /> Prepared by the Engineers Joint Contract Documents Committee and endorsed by The Associated General Contractors of America and the Construction Specification <br /> Institute. <br />