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4.4. SR 01-21-2020Request for Action To Item Number Mayor and City Council 4.4 Agenda Section Meeting Date Prepared by Consent January 21, 2020 jenna Fabish P.E., Assistant City Engineer Item Description Reviewed by Pay Estimates Justin Femrite P.E., Public Works Director Reviewed by Cal Portner, City Administrator Action Requested Approve, by motion, the pay estimate detailed below. Background/Discussion The following pay estimate has been reviewed and found to be accurate and in accordance with the approved contracts. Financial Impact PROJECT Multi -purpose Facility & Lions Park Attachments ■ Pay Estimates The Elk River Vision Pay Est. # Contractor 6-Partial RJM Construction LLC Amount $2,837,116.86 A welcoming community with revolutionary and spirited resourcefulness, exceptional,` O� e service, and community engagement that encourages and inspires pi ospei l_ y INAMIRE1 •� V reDocument G70Zm —'1��2 City of Elk River Public Works Director Date Application and Certificate for Payment Code: 420-4-8540-4520 TO OWNER: City of Elk River PROJECT: Elk River Multi Purpose Facility and APPLICATION N0: 006- 9520003306 Distribution to: Attu: Justin Femrite Lion John Weicht Park PERIOD TO: OUVNER: ❑ 13065 Orono Parkway 1000 School StreetNW Elk River, MN 55330 FROM RJM Construction CONTRACTOR: 830 Boone Avenue North Golden Valley, MN 55427 Elk River, MN 55330 VIA 292 Design Group, Inc ARCHITECT: 3533 East Lake Street CONTRACTOR'S APPLICATION FOR PAYMENT Minneapolis, MN 55406 Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Docmnent G703, is attached. 1.ORIGINAL CONTRACT SUN 2. NET CHANGE BY CHANGE ORDERS 3. CONTRACT SUM TO DATE (Line 112) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE 4.50 % of Completed Work (Cohmm D +E on G703) 0 % of stored Material (Column F on G703) $25,771_,257.00 CONTRACT FOR: General Construction CONTRACTOR ❑ CONTRACT DATE: PROJECT NOS: / RJM Construction, RELD: ❑ LLC I OTHER: ❑ The undersigned Contractor certifies that to the best of tho Contractoes knowledge, information and belief the Work covered by this Application for Payment has been 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 T- mived from the Owner, .and that current• payment'shown herein is now due. S398.559.40 CONTRACTOR- S26.170.816.40 By: S9.952.261.99 StateoF/�,r-,r�� S447.815.78 $0.00 Total Retainage (Lines 5a + 5b or Total in Column I of G7M) ____ S447,815.78 6. TOTAL EARNED LESS RETANAGE »_ ..._. ».»._,,..,..» W504.44621 (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT-_-- S6.667.329:35 (Lime 6 from prior certificate) 8. CURRENT PAYMENT DUE .»......»»,»,.»,,.».,.•.,•»,,,,,,,,,,,,,,_.,,.»._ I S2.837.116.86 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Lute 6) this months TOTALS S16.666.370.19 ADDITIONS DEDUCTIONS S410.520. S845.11 S0. $11,115.95 S41Q,520.44 S11.961.06 County of D..M,r del/2/20 Subscribed and sworn to before 4J%AAPJV%AAAAAAAAAAAAAAAAAAAAAAA" me this 14 day°f ^r, JUSTIN M. KING • Notary Publio-Mfmnesota Notary Public: "'r` 1 My Cammissian Envies lac 31.2022 My Commission expires: 114411.L ARCHITECTS CERTIFICATE FOR PAYMENT Ia accordance with the Contract Documents, based on on -site observations and the data comprising this application, -the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT°CERTIFIED. AMOUNTCERTIFIED_._..»»»».S2,837.116.86 (Attach explanation if amow certified duos from the amount appUed Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certifreii) ARC CT: By: Date This Cettiticate is not negotiable. The AMOUNT CERTIFIED is Payable only to the Contractor named herein. lssoance, payment and acceptance ofpayment are without prejudice to any rights of the Owner,or Contractor under this Contract. AIA ao-mw t G7D:i--199L Copyright01953.1963,196S;1971.1978.1983-and 1992 by Thu American Irrs60de of Amh ects. An r19t is rnswvad. WARNING: Thb AW Doeummn Is proleeled by US. C00Hgfi1 Law and Mterrraliomt Treaths. UmunfaHxsQ raprodustloni or:d nlri iftn of Imi Aw, beer rmitsk or any Portion of 1f. may MSdt*ft-% m dull and erhith PWWOes. aAd v►in be prosecute¢ 101ha-ford rime 4401 i Possible uttderlhe Ian This doarmentwas Produced by_AIA saff are at 13:1125 ET on 0IM20M under Order No. 689672WS whkh ezp&es on 08JOMM0, w d is not for resale. User Notes: (389ADASn CONTINUATION SHEET Page 2 of 3 Application and Certification for Payment, containing Contractor's signed certification is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. Invoice # : 9520003306 Contract: 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Application No.: Application Date : 12/31/19 To: 12/31 /19 Architect's Project No.: A B C D E F G H I Item Description of Work Scheduled Work Com leted Materials Total % Balance Retainage From Previous This Period No. Value Presently Completed (G / C) To Finish Application In Place Stored and Stored (C-G) (D+E) To Date Not in D or E D+E+F 1 Elk River Multi -Purpose Facility and 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 Lion John Weicht Park 1A Final Cleaning 80,651.00 0.00 0.00 0.00 0.00 0.00% 80,651.00 0.00 1B Survey 41,280.00 11,309.00 0.00 0.00 11,309.00 27.40% 29,971.00 565.45 2A Building Demolition 169,158.51 162,199.51 0.00 0.00 162,199.51 95.89% 6,959.00 8,109.98 2B Selective Demolition 223,800.00 7,019.00 0.00 0.00 7,019.00 3.14% 216,781.00 350.95 3C Concrete Floor Finishes 104,390.00 0.00 0.00 0.00 0.00 0.00% 104,390.00 0.00 4A Masonry Systems 2,951,395.00 1,149,564.00 300,000.00 0.00 1,449,564.00 49.11% 1,501,831.00 72,478.20 5A Structural Material 1,333,893.51 1,067,301.00 16,888.00 0.00 1,084,189.00 81.28% 249,704.51 54,209.45 5B Structural Labor 433,051.85 177,775.00 37,442.00 0.00 215,217.00 49.70% 217,834.85 10,760.85 6A Carpentry 1,299,267.53 44,567.49 94,786.58 0.00 139,354.07 10.73% 1,159,913.46 6,967.71 7A Waterproofing &WB 39,630.00 12,860.00 7,272.00 0.00 20,132.00 50.80% 19,498.00 1,006.60 7B Roofing Systems 1,022,750.00 33,000.00 440,375.00 0.00 473,375.00 46.28% 549,375.00 23,668.75 7C Metal Wall Panel 191,460.00 0.00 0.00 0.00 0.00 0.00% 191,460.00 0.00 8A Aluminum Entrances/Storefronts 644,100.00 24,168.00 0.00 0.00 24,168.00 3.75% 619,932.00 1,208.40 8B Overhead Coiling and Sectional 56,260.00 0.00 0.00 0.00 0.00 0.00% 56,260.00 0.00 Doors 9A Gypsum Board 332,608.52 6,000.00 0.00 0.00 6,000.00 1.80% 326,608.52 300.00 9B Tiling 138,480.00 0.00 0.00 0.00 0.00 0.00% 138,480.00 0.00 9C Acoustical Ceilings 134,305.00 2,250.00 0.00 0.00 2,250.00 1.68% 132,055.00 112.50 9D Flooring 103,900.00 0.00 0.00 0.00 0.00 0.00% 103,900.00 0.00 9E Painting 416,750.00 5,000.00 0.00 0.00 5,000.00 1.20% 411,750.00 250.00 10A Signage 50,340.00 0.00 0.00 0.00 0.00 0.00% 50,340.00 0.00 11A Athletic Equipment 173,574.91 0.00 0.00 0.00 0.00 0.00% 173,574.91 0.00 11B Concessions 101,740.00 0.00 0.00 0.00 0.00 0.00% 101,740.00 0.00 12A Roller Shades 27,886.00 0.00 0.00 0.00 0.00 0.00% 27,886.00 0.00 13B Ice Rink Systems 2,162,742.00 319,800.00 230,000.00 0.00 549,800.00 25.42% 1,612,942.00 27,490.00 13C Leg Truss System 125,797.00 0.00 125,797.00 0.00 125,797.00 100.00% 0.00 6,289.85 14A Elevators 79,500.00 39,750.00 0.00 0.00 39,750.00 50.00% 39,750.00 1,987.50 21A Fire Protection 268,440.00 39,988.50 64,192.50 0.00 104,181.00 38.81% 164,259.00 5,209.06 22A Plumbing Systems 1,240,156.00 222,733.00 82,000.00 0.00 304,733.00 24.57% 935,423.00 15,236.65 23A HVAC 1,826,464.93 71,736.00 11,000.00 0.00 82,736.00 4.53% 1,743,728.93 4,136.80 26A Electrical Systems 1,754,106.86 195,084.07 48,908.00 0.00 243,992.07 13.91% 1,510,114.79 12,199.60 31A Multipurpose Earthwork 655,833.30 379,479.00 20,000.00 0.00 399,479.00 60.91% 256,354.30 19,973.95 CONTINUATION SHEET Page 3 of 3 Application and Certification for Payment, containing Contractor's signed certification is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. Invoice # : 9520003306 Contract: 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Application No.: Application Date : 12/31/19 To: 12/31 /19 Architect's Project No.: A B C D E F G H I Item Description of Work Scheduled Work Com leted Materials Total % Balance Retainage From Previous This Period No. Value Presently Completed (G / C) To Finish Application In Place Stored and Stored (C-G) (D+E) To Date Not in D or E D+E+F 31B Lions Earthwork 519,672.62 467,480.97 638.80 0.00 468,119.77 90.08% 51,552.85 23,405.99 32A Asphalt Paving 331,364.00 120,225.00 0.00 0.00 120,225.00 36.28% 211,139.00 6,011.25 32B Concrete/Sidewalk/Curb/Gutter 384,854.93 43,758.58 5,287.00 0.00 49,045.58 12.74% 335,809.35 2,452.28 32C Multipurpose Landscaping 39,800.00 0.00 0.00 0.00 0.00 0.00% 39,800.00 0.00 32D Lions Landscaping 96,500.00 0.00 0.00 0.00 0.00 0.00% 96,500.00 0.00 32E Chain Link Fence 145,543.00 60,615.75 0.00 0.00 60,615.75 41.65% 84,927.25 3,030.79 33A Utilities 619,037.15 574,340.00 28,788.00 0.00 603,128.00 97.43% 15,909.15 30,156.40 3B.1 Precast Concrete 1,190,000.00 654,500.00 294,500.00 0.00 949,000.00 79.75% 241,000.00 47,450.00 313.2 Precast Concrete 950,000.00 0.00 438,609.05 0.00 438,609.05 46.17% 511,390.95 21,930.45 313.3 Precast Raker/Plank/Stadia 1,060,925.00 0.00 636,555.00 0.00 636,555.00 60.00% 424,370.00 31,827.75 01-00 General Conditions/Requirements 1,116,107.39 623,334.31 46,522.83 0.00 669,857.14 60.02% 446,250.25 0.00 90-50 General Liability Insurance 262,693.11 262,528.14 164.97 0.00 262,693.11 100.00% 0.00 0.00 90-60 Construction Contingency 729,285.21 0.00 0.00 0.00 0.00 0.00% 729,285.21 0.00 90-70 Value Engineering 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 90-80 Builders Risk Insurance 63,396.38 63,345.15 51.23 0.00 63,396.38 100.00% 0.00 0.00 99-99 Contractors Fee 477,925.69 126,571.67 54,200.89 0.00 180,772.56 37.82% 297,153.13 9,038.62 Grand Totals 26,170,816.40 6,968,283.14 2,983,978.85 0.00 9,952,261.99 38.03% 16,218,554.41 447,815.78 INVOICE From: RJM Construction, LLC Invoice: 9520003306 830 Boone Ave North Invoice Date: 12/31/19 Golden Valley, MN 55427 Due Date: 01/30/20 952-837-8600 Disc Date: To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 55330 Contract : 19520-0033 Elk River MultWurpose Facility and Lion John Weicht Park Masonry Systems SUBCONTRACTS Crosstown Masonry, Inc. Concrete/Masonry Inv# 195200033-05 300,000.00 Total SUBCONTRACTS 300,000.00 Masonry Systems Sub -Total: 300,000.00 Structural Material SUBCONTRACTS Distinctive Iron, LLC Structural Steel Inv# 195200033-04 16,888 00 Total SUBCONTRACTS 16,888.00 Structural Material Sub -Total: 16,888.00 Structural Labor SUBCONTRACTS High Five Erectors II, Inc Structural Steel Erection Inv# 22463 37,442,00 Total SUBCONTRACTS 37,442.00 Structural Labor Sub -Total: 37,442.00 Carpentry MATERIAL PURCHASES Home Depot Credit Services Inv# 20191212 703.99 Brock White Company 13691417-00 63841 Shaw/Stewart Lumber Co. 866169-001 1,18351 Shaw/Stewart Lumber Co. 868576-001 434.19 Shaw/Stewart Lumber Co. 869287-001 865.80 Veit Disposal Systems 573697 275.00 RJM Construction, LLC 201912-11 150.00 United Rentals (North America), Inc 17673888-001 2,479.90 Timothy Ryan EXP 11/27/19 219.60 Total MATERIAL PURCHASES 6,950.40 SUBCONTRACTS Kendell Doors & Hardware, Inc Hollow Metal Doors & Frames Inv# 195200033-01 13,717 63 Ebert Construction Carpentry 195200033-02-61 62,172.39 Total SUBCONTRACTS 75,890.02 LABOR Apprentice Carpenter Regular Earnings 72.00 HRS @ 62.93 4,530.96 Carpenters Regular Earnings 56.00 HRS @ 83.90 4,698.40 Lead Carpenter Regular Earnings 32.00 HRS @ 8490 2,716.80 Total LABOR 11,946.16 Carpentry Sub -Total: 94,786.58 Waterproofing &WB INVOICE From: RJM Construction, LLC Invoice: 9520003306 830 Boone Ave North Invoice Date: 12/31/19 Golden Valley, MN 55427 Due Date: 01/30/20 952-837-8600 Disc Date: To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 55330 Contract : 19520-0033 Elk River MultimPurpose Facility and Lion John Weicht Park Waterproofing &WB SUBCONTRACTS Stevens Insulation, LLC Waterproofing Inv# 195200033-01 7,272,00 Total SUBCONTRACTS 7,272.00 Waterproofing &WB Sub -Total: 7,272.00 Roofing Systems SUBCONTRACTS Top -All Roofing, Inc. Roofing Inv# 195200033-02 440,375.00 Total SUBCONTRACTS 440,375.00 Roofing Systems Sub -Total: 440,375.00 Ice Rink Systems SUBCONTRACTS Rink-Tec International, Inc. Ice Systems Inv# 195200033-05 230,000.00 Total SUBCONTRACTS 230,000.00 Ice Rink Systems Sub -Total: 230,000.00 Leg Truss System SUBCONTRACTS Seating & Athletic Facility Enterprises Leg Truss System Inv# 195200033-01 26,358.00 Leg Truss System 195200033-02 99,439.00 Total SUBCONTRACTS 125,797.00 Leg Truss System Sub -Total: 125,797.00 Fire Protection SUBCONTRACTS Summit Companies Fire Protection Inv# 195200033-04 64,192.50 Total SUBCONTRACTS 64,192.50 Fire Protection Sub -Total: 64,192.50 Plumbing Systems SUBCONTRACTS Weidner Plumbing & Heating Co. Plumbing Inv# 195200033-05 82,000.00 Total SUBCONTRACTS 82,000.00 Plumbing Systems Sub -Total: 82,000.00 HVAC SUBCONTRACTS Sentra-Sota Sheet Metal Inc. HVAC Inv# 195200033-04 11,000.00 Total SUBCONTRACTS 11,000.00 HVAC Sub -Total: 11,000.00 INVOICE From: RJM Construction, LLC Invoice: 9520003306 830 Boone Ave North Invoice Date: 12/31/19 Golden Valley, MN 55427 Due Date: 01/30/20 952-837-8600 Disc Date: To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 55330 Contract : 19520-0033 Elk River MultWurpose Facility and Lion John Weicht Park Electrical Systems SUBCONTRACTS Design Electric, Inc Electrical Inv# 195200033-04 48,908.00 Total SUBCONTRACTS 48,908.00 Electrical Systems Sub -Total: 48,908.00 Multipurpose Earthwork SUBCONTRACTS Minnesota Utilities & Excavating, LLC Multipurpose Earthwork Inv# 195200033-06 20,000.00 Total SUBCONTRACTS 20,000.00 Multipurpose Earthwork Sub -Total: 20,000.00 Lions Earthwork MATERIAL PURCHASES Safety Signs, LLC Inv# 19007844 000 Safety Signs, LLC 19008351 0.00 Safety Signs, LLC 19009309 638.80 Total MATERIAL PURCHASES 638.80 Lions Earthwork Sub -Total: 638.80 Concrete/Sidewa Ik/Cu rb/Gutter MATERIAL PURCHASES RJM Construction, LLC Inv# 201912-11 1,200,00 Total MATERIAL PURCHASES 1,200.00 SUBCONTRACTS Ebert Construction Site Concrete Inv# 195200033-03 4,087.00 Total SUBCONTRACTS 4,087.00 Concrete/Sidewalk/Curb/Gutter Sub -Total: 5,287.00 Utilities SUBCONTRACTS Metro Utilities, Inc Site Utilities Inv# 195200033-04 28,788.00 Total SUBCONTRACTS 28,788.00 Utilities Sub -Total: 28,788.00 Precast Concrete SUBCONTRACTS Fabcon Precast, LLC 0313.1 Precast Wall Panels Inv# 40516 294,500.00 Total SUBCONTRACTS 294,500.00 Precast Concrete Sub -Total: 294,500.00 Precast Concrete SUBCONTRACTS INVOICE Frorrr: RJM Construction, LLC Invoice: 9520003306 830 Boone Ave North Invoice Dare: 12131 /19 Golden Valley, MN 55427 Due Date: 01/30/20 952-837-8600 Disc Date., To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 55330 Contract : 19520-0033 Elk River Mul&Purpose Facility and Lion Jahn Weicht Park Precast Concrete SUBCONTRACTS Wells Concrete Products 0313.2 Precast Wall Panels Inv# 012029 401,609.73 0313.2 Precast Wall Panels 11068 36,999.32 Total SUBCONTRACTS 438,609.05 Precast Concrete Sub -Total: 438,609.05 Precast Raker/Plank/Stadia SUBCONTRACTS Molin Concrete Products Co 0313.3 Precast Plank/Stadia/Raker Beams Inv# 195200033-01 106,092.50 0313.3 Precast Plank/Stadia/Raker Beams 195200033-02 530,462.50 Total SUBCONTRACTS 636,555.00 Precast Raker/Plank/Stadia Sub -Total: 636,555.00 General Conditions/Requirements MATERIAL PURCHASES Spee Dee Delivery Service Inv# 3873574 1786 Spee Dee Delivery Service 3891887 2364 Premium Waters, Inc. 853364-11-19 9.62 Veit Disposal Systems 573326 275.00 Veit Disposal Systems 574026 550.00 RJM Construction, LLC 201912-11 860.00 Biffs Inc. W746369 382.61 Biffs Inc. W746373 123.63 WEX Bank 62994096 474.05 Verizon Wireless 9842675195 153.82 Verizon Wireless 9844751769 157.35 Timothy Ryan EXP 11/27/19 251.72 2020 Holdings, LLC (MLCV) 40006-1 180.00 Jake Fisher EXP 11/18/19A 3306 Tom Druk EXP 12/31/19 751.68 Elk River Municipal Utilities 996 23733 Brett Sillerud EXP 11/30/19 83.52 Total MATERIAL PURCHASES 4,564.89 PICKUP TRUCK 712.00 Total PICKUP TRUCK 712.00 SUBCONTRACTS Action Fence Inc. Temp. Fencing w/ Standard Screening Inv# 19729 450.00 Total SUBCONTRACTS 450.00 LABOR INVOICE From: RJM Construction, LLC Invoice: 952p003306 830 Boone Ave North Invoice Date: 12/31/19 Golden Valley, MN 55427 Due Date: 01/30120 952-837-8600 Disc Date. To: City of Elk River Attn: Justin Fernrite 13065 Orono Parkway Elk River, MN 55330 Contract : 19520.0033 Elk River MultrPurpose Facility and Lion John Weicht Park General Conditions/Requirements LABOR Quality Assurance & Control Regular Earnings 4 00HRS @ 114.90 459.60 Safety Manager Regular Earnings 7 00 HRS @ 106.40 744.80 Superintendent Regular Earnings 172.00HRS @ 109.90 18,902.80 Laborer Regular Earnings 4.00HRS @ 76.90 307.60 Laborer Foreman Regular Earnings 8.00 HRS @ 80.90 647.20 MEP Engineer Regular Earnings 1.00 HRS @ 80.40 80.40 Project Administrator Regular Earnings 12.00HRS @ 56.40 676.80 Project Engineer Regular Earnings 136.00 HRS @ 80.40 10,934.40 Project Executive Regular Earnings 57.00 HRS @ 138.40 7,888.80 Total LABOR 40,642.40 P&P Bond 153.54 General Conditions/Requirements Sub -Total: 46,522.83 General Liability Insurance GENERAL LIABILITY INSURANCE 16497 General Liability Insurance Sub -Total: 164.97 Builders Risk Insurance BUILDERS RISK INSURANCE 51.23 Builders Risk Insurance Sub -Total: 51.23 Contractors Fee CONTRACTORS FEE 54,200.89 Contractors Fee Sub -Total: 54,200.89 INVOICE ISummary ' 4A Masonry Systems 300,000.00 Retainage 2,983,825.31@ 5.00% (15,000.00) 5A Structural Material 16,888.00 Retainage 2,983,825.31@ 5.00% (844.40) 5B Structural Labor 37,442.00 Retainage 2,983,825.31@ 5.00% (1,872.10) 6A Carpentry 94,786.58 Retainage 2,983,825.31@ 5.00% (4,739.33) 7A Waterproofing &WB 7,272.00 Retainage 2,983,825.31@ 5.00% (363.60) 7B Roofing Systems 440,375.00 Retainage 2,983,825.31@ 5.00% (22,018.75) 13B Ice Rink Systems 230,000.00 Retainage 2,983,825.31@ 5.00% (11,500.00) 13C Leg Truss System 125,797.00 Retainage 2,983,825.31@ 5.00% (6,289.85) 21A Fire Protection 64,192.50 Retainage 2,983,825.31@ 5.00% (3,209.63) 22A Plumbing Systems 82,000.00 Retainage 2,983,825.31@ 5.00% (4,100.00) 23A HVAC 11,000.00 Retainage 2,983,825.31@ 5.00% (550.00) 26A Electrical Systems 48,908.00 Retainage 2,983,825.31@ 5.00% (2,445.40) 31A Multipurpose Earthwork 20,000.00 Retainage 2,983,825.31@ 5.00% (1,000.00) 31 B Lions Earthwork 638.80 Retainage 2,983,825.31@ 5.00% (31.94) 32B Concrete/Sidewalk/Curb/Gutter 5,287.00 Retainage 2,983,825.31@ 5.00% (264.35) 33A Utilities 28,788.00 Retainage 2,983,825.31@ 5.00% (1,439.40) 313.1 Precast Concrete 294,500.00 Retainage 2,983,825.31@ 5.00% (14,725.00) 313.2 Precast Concrete 438,609.05 Retainage 2,983,825.31@ 5.00% (21,930.45) 313.3 Precast Raker/Plank/Stadia 636,555.00 Retainage 2,983,825.31@ 5.00% (31,827.75) INVOICE 01-00 General Conditions/Requirements 46,522.83 Retainage 2,983,825.31@ 0.00% 0.00 90-50 General Liability Insurance 164.97 Retainage 2,983,825.31@ 0.00% 0.00 90-80 Builders Risk Insurance 51.23 Retainage 2,983,825.31@ 0.00% 0.00 99-99 Contractors Fee 54,200.69 Retainage 2,983,825.31@ 5.00% (2,710.04) CURRENT DUE: 2,837,116.86 APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 3 SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena & Lion's Park APPLICATION NO: 5 530 Boone Avenue North 1000 School Street NW APPLICATION DATE: 12/1912019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 12/112019 SUBMITTED FROM: Crosstown Masonry, Incorporated ARCHITECT: PERIOD TO: 1213112019 '1322 159th Ave NE PROJECT NO: Ham Lake, MN 55304 CONTRACT DATE -- CONTRACT FOR: Concrete & Masonry CONTRACT NO.: COMMITMENT: YESINO I hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUiV.................................................................. $ 2,935,000.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO. ..... ... ........ .. $ 30,915.00 referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other CONTRACT SUM TO DATE .......................... $ 2,965,915,00 than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this TOTAL COMPLETED AND STORED TO DATE .......................................... $ 1,449,564.00 application. 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 material and labor used in or in connection with the 5 % OF COMPLETED WORK $ 72,478.20 performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Sccial Security laws, Unemployment Compensation Laws and Workman's 5 % OF STORED MATERIAL & Compensation laws insofar as applicable to the performance this contract. TOTAL_ RETAINAGE..........................................................---...........72,478,20 TOTAL EARNED LESS RETAINAGE....................................................... $ 1,377,085.80 OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ $ - PARTIAL WAIVER OF LIENLESS Now therefore, upon receipt of (he payment of the current payment due on this application the LESS PREVIOUS CERTIFICATES FOR PAYMENT—_ ........ ....... $ 1,092,085.80 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE. ...... _._ ...... ................................... ------- $ 285,000.00 for any of the materials andlor labopr therefore Furnished or performed in connection with this project, reserving, however, all lien rights for labor andlor materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE........................................ $ 1,588,829.20 State of: Minnesota The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: Anoka instrument. Subscribed and sworn to before me this Crosstown Masonry, Incorporated 1322 159th Ave NE Ham Lake, MN 55304 SIGNED: 1, 7' ?-b !' / ✓t,f; f.' PRINTED, TITLE Tammy Braastad4�Ppesident 19th day of December NOTARY PUB Signed, - My Commission Expires: 1/3112025 20 -19 AMANDACHRWNE BRAW NOTARY PUBLIC MINNESOTA MY 60-1+ilon EVII65 lM. 31.2X 5 AIA Type Document Application and Certification for Payment Page 2 of 3 TO (OWNER): City of Elk River PROJECT: Elk River Ice Arena & Lions Pk APPLICATION NO: 5 DISTRIBUTION 13065 Orono Parkway NW 1000 School Street NW TO: Elk River, MN 55330 Elk River, MN 55330 PERIOD TO: 12/31/2019 _ OWNER _ CONSTRUCTION MANAGER FROM (CONTRACTOR): Crosstown Masonry, Incorporated ARCHITECT'S _ARCHITECT 1322 159th Ave NE PROJECT NO: -CONTRACTOR Ham Lake, MN 55304 VIA CONSTRUCTION MANAGER: RJM Construction CONTRACT FOR: Concrete & Masonry VIA ARCHITECT: CONTRACT DATE: SCHEDULE PREVIOUS COMPLETED STORED COMPLETED ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED o BALANCE RETAINAGE LIONS PARK LIONS PARK 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1 Footings & Foundation Labor 30,000.00 30,000.00 0.00 0.00 30,000.00 100.00 0.00 1,500.00 2 Footings & Foundation Material 8,000.00 8,000.00 0.00 0.00 8,000.00 100.00 0.00 400.00 3 Above Grade CMU Labor 84,000.00 74,000.00 0.00 0.00 74,000.00 88.10 10,000.00 3,700.00 4 Above Grade CMU Material 26,000.00 26,000.00 0.00 0.00 26,000.00 100.00 0.00 1,300.00 5 Slab on Grade Labor 5,300.00 0.00 0.00 0.00 0.00 0.00 5,300.00 0.00 6 Slab on Grade Material 4,200.00 0.00 0.00 0.00 0.00 0.00 4,200.00 0.00 7 Stone Piers Labor 17,000.00 0.00 0.00 0.00 0.00 0.00 17,000.00 0.00 8 Stone Piers Material 10,000.00 0.00 0.00 0.00 0.00 0.00 10,000.00 0.00 g Dug Outs / Batting Cage Labor 41,000.00 15,000.00 0.00 0.00 15,000.00 36.59 26,000.00 750.00 10 Dug Outs / Batting Cage Material 28,000.00 10,000.00 0.00 0.00 10,000.00 35.71 18,000.00 500.00 RINK RINK 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12 Footings & Foundation Labor 415,000.00 410,000.00 0.00 0.00 410,000.00 98.80 5,000.00 20,500.00 13 Footings & Foundation Material 210,000.00 205,000.00 0.00 0.00 205,000.00 97.62 5,000.00 10,250.00 14 Above Grade CMU Labor 812,000.00 195,000.00 160,000.00 0.00 355,000.00 43.72 457,000.00 17,750.00 15 Above Grade CMU Material 348,000.00 105,000.00 140,000.00 0.00 245,000.00 70.40 103,000.00 12,250.00 16 Slab on Grade Labor 236,000.00 0.00 0.00 0.00 0.00 0.00 236,000.00 0.00 17 Slab on Grade Material 210,000.00 0.00 0.00 0.00 0.00 0.00 210,000.00 0.00 18 Slab on Deck Labor 140,000.00 0.00 0.00 0.00 0.00 0.00 140,000.00 0.00 19 Slab on Deck Material 69,000.00 0.00 0.00 0.00 0.00 0.00 69,000.00 0.00 20 Stoops Labor 8,000.00 0.00 0.00 0.00 0.00 0.00 8,000.00 0.00 AIA Type Document Application and Certification for Payment Page 3 of 3 TO (OWNER): City of Elk River PROJECT. Elk River Ice Arena & Lions Pk APPLICATION NO: 5 DISTRIBUTION 13065 Orono Parkway NW 1000 School Street NW TO: Elk River, MN 55330 Elk River, MN 55330 PERIOD TO: 12131/201 9 _ OWNER _ CONSTRUCTION MANAGER FROM (CONTRACTOR): Crosstown Masonry, Incorporated ARCHITECT'S _ARCHITECT 1322 159th Ave NE PROJECT NO: -CONTRACTOR Ham Lake, MN 55304 VIA CONSTRUCTION MANAGER: RJM Construction CONTRACT FOR: Concrete & Masonry VIA ARCHITECT: CONTRACT DATE: SCHEDULE PREVIOUS COMPLETED STORED COMPLETED ITEM -- DESCRIPTION - -- - - - VALUE - APPLICATIONS THIS PERIOD MATERIAL -- - - STORED - - o -0- BALANCE RETAINAGE - ---- 21 Stoops Material 2,000.00 0.00 0.00 0.00 0.00 0.00 2,000.00 0.00 22 Stone at Fireplace Labor 8,000.00 0.00 0.00 0.00 0.00 0.00 8,000.00 0.00 23 Stone at Fireplace Material 2,000.00 0.00 0.00 0.00 0.00 0.00 2,000.00 0.00 24 Concrete Allowance 50,000.00 7,145.00 0.00 0.00 7,145.00 14.29 42,855.00 357.25 25 Masonry Allowance 40,000.00 0.00 0.00 0.00 0.00 0.00 40,000.00 0.00 26 Field House Labor 70,000.00 0.00 0.00 0.00 0.00 0.00 70,000.00 0.00 27 Field House Material 18,000.00 0.00 0.00 0.00 0.00 0.00 18,000.00 0.00 28 Bond 43,500.00 43,500.00 0.00 0.00 43,500.00 100.00 0.00 2,175.00 29 Change Order#1 697.00 697.00 0.00 0.00 697.00 100.00 0.00 34.85 30 Change Order#2 33,996.00 24,000.00 0.00 0.00 24,000.00 70.60 9,996.00 1,200.00 31 Change Order #3 -3,778.00 -3,778.00 0.00 0.00 -3,778.00 100.00 0.00 -188.90 REPORT TOTALS $2,965,915.00 $1,149,564.00 $300,000.00 $0.00 $1,449,564.00 48.87 $1,516,351.00 $72,478.20 APPLICATION AND CERTIFICATE FOR PAYMENT Page / of SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena REVISED NOV APPLICATION NO: 4 830 Boone Avenue North 1000 School St NW APPLICATION DATE: 12-21-2019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 9-1-2019 SUBMITTED FROM: Distinctive Iron, LLC ARCHITECT: 292 Design Group PERIOD TO: 12-30-2019 19128 Industrial Blvd NW 3533 E Lake St PROJECT NO: 19520-0033 Elk River, MN 55330 Minneapolis, MN 55406 CONTRACT DATE: 7-10-2019 CONTRACT FOR: Elk River Ice Arena & Lion John Weicht Park CONTRACT NO.: 19520-0033 COMMITMENT_ YESINO hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUM.................................................................. $ 1,308,353.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO ............................................... $ 25,540.51 referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other CONTRACT SUM TO DATE ............. ................. $ 1,333,893.51 than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this TOTAL COMPLETED AND STORED TO DATE ...................•. application. I also certify that payments, less applicable retention, have been made through the $ 1,084,189.QQ period covered by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for ail material and labor used in or in connection with the 5 % OF COMPLETED WORK $ 54,209.00 performance of this contract I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's 5 % STORED MATERIAL Compensation laws insofar as applicable to the performance this contract. TOTAL RETAINAGE............................................................................. $ 54,209.00 TOTAL EARNED LESS RETAINAGE....................................................... $ 1,029,980.00 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ $ PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICATES FOR PAYMENT......... undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE ......................................... for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE............. $ 1,013,935.90 ............ $ 16.044,10 ........................... $ 303,913.51 State of: The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of. instrument. Subscribed and sworn to before me this #REF! day of 1 l}i r� k Distinctive Iron, LLC 19128 Industrial Blvd.NW i 1 I NOTARY PUBLIC: 0 SIGNED: PRINTED, TITLE Signed: aki My Commission Expires: lmm� 20 1 6-' ALYSA RENEE LADUKF IMARY - .ELjC MINNESOTA My Comm Exp Jan. 31. 2024 From: Cynthia M Hemmer, President Distinctive Iron LLC 19128 Industrial Blvd NW Elk River, MN 55330 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Schedule of Values Invoice No.7 APpl. No.: 1/3/1900 AW. Data: 12/21/19 From: 9-1-2019 To: 12-30-2019 ITEM NO. DESCRIPTION CURRENT CONTRACT 1 CURRENT APPLICATION 1 TOTAL PREVIOUS I WORK IN MATERL. I APPS. APPS. PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 Bond $22,896 $22,896• $22,896 100.00% $0 $1,145 2 Start Up - Shop Drawings $75,000 $75,000. $75,000 100.00% $0 $3,750 3 Steel: Structural $278,353 $278,353 $278,353 100.00% $0 $13,918 4 Steel: Joist and Deck $767,104 $686,5181 1 $686,518 89.49% $80,586 $34.326 5 Steel: Misc. $150,000 1 $0 0.00% $150,000 $0 6 Allowance $15,000 $10,000 $10,000 66.67% $5,DOO $50O 7 $0 0.00% $0 $0 8 $0 0.00% $0 $0 9 Change Order #1 $534 $5341 1 $534 99.93% $0 $27 10 Change Order #2 $18,118 $4,000 $4,D00 22.08% $14,118 $200 11 Change Order #3 $6,888 $6,888 $6,888 0.00% $0 $344 12 $0 0.00% $0 $0 13 $0 0.00% $0 $0 14 $0 0.00% $0 $0 15 I I $0 0.000/0 $0 $0 16 $0 0.00% $0 $0 17 $0 O.DO% $0 $0 18 $0 0.00% $0 $0 19 $0 0.00% $0 $0 20 1 1 $0 0.00% $0 $0 21 ( 1 $0 0.00% $0 $0 22 $0 0.00% $0 $0 23 $0 0.000/0 $0 $0 24 $0 0.000/0 $0 $0 25 $0 0.00°l0 $0 $0 TOTAL 1 $1,333,8941 $1,067,301 $16,888 $0 $1,084,189 81.28% $249,704 $54,209 Page 1 of 1 _a 61STINCTIVE iROlr1 Bill To 19128 Industrial Blvd NW Elk River, MN 55330 RUM Construction 830 Boone Ave N Golden Valley, MN 55427 Ship To ER Ice Arena Invoice Cate Invoice # 12/18/2019 2088 P Q No. Terms Project Elk River Ice Arena l2g§cription Est Amt QtyUIM Rate TgJal o Prior n Curr o Amount 00 Furnish and Deliver: Structural Steel Allowance 6.04% 6.04% 9,356.73T Subtotal $9,356.73 We now accept Mastercard ! Visa! SBE WBE TGB Certified Sales Tax (6.875%) $643.28 Total $10,000.01 Payments/Credits $000 Phone # Fax # E-mail Balance Due $10,000.01 (763)441-8000 (763)441-8056 cindyagd-iron.com kQ=19128 Industrial Blvd NW Ro» Elk River, MN 55330 Bill To RJM Construction 830 Boone Ave N Golden Valley, MN 55427 Ship To ER lee Arena CO 43 - Stairs Invoice Date Invoice # 12iM')()19 2089 P.O. No. Terms Project Net 30 Ell; River Ice Arena Description UIM Amount Furnish: Structural Changes 6,385.3IT Subtotal $6,385.31 Sales Tax (7.875%) $502,84 Total $6 888 15 Phone# Fax# E-mail Payments/Credits $000 (763)441-8000 (763)441-8056 cindy@d-iron.com Balance Due $6,888.15 Bid Pacakge: SA Subcontractor: Distinctive Internal Continency Items COR # Date Description Elk River Multipurpose Facility and Park Internal Contingency Tracking Loy RJM Job # 19520-0033 Dated: 9111119 Updated: 1216119 Original Allowance Valuation $15,000.00 FWO # Cost 1 na na Precast embed plates and channnel na $4,133.00 2 5 10/28/19 ASI#6 R"T'U Changes na $2,565.00 3 7 1.1/21/19 ASI #14 added Stair Detail at Arena-2 na $6,800.46 4 6 11/21/19 ASI #10 Structural Changes na $8,389.69 Remaining = (h6,888.15) (negative means CO owed) Resulting Distinctive CO to offset Allowance Overages (11/22/19) = $6,888.15 Final Net Difference = $0.00 INVOICE No. 22463 DATE: 12/25/19 3005 4th Avenue East • F.U. Box477 • Shakopee, MN 55379. 952-495-4000 • Fax; 953-440-100 #1250 SOLD TO: RJM Construction, LLC JOB. Elk River Ice Arena & Lion John Weicht 830 Boone Avenue N. Golden Valley, WIN 55427 lab ##2598 accauting-mn@rjmconstruction. cam RJM Project # APPLICATION AND CERTIFICATE FOR PAYMENT fAIA DOCUMENT G7021CMa) TO OWNER; PROJECT: APPLICATION NO: TWO (2) Distribution to: City of Elk River Elk {liver Ice Arena & Lion John Weicht Park Facilities OWNER El 13065 Orono Parkway NW 1000 School Street NW PERIOD TO: 12-30-19 Elk River, MN 55330 Elk River, MN 55330 CONSTRUCTION MANAGER El CONTRACT DATE: 07-10-19 VIA CONSTRUCTION MANAGER: ARCHITECT FROM CONTRACTOR: RJM Construction, LLC PROJECT NO-. 0 High Five Erectors II, Inc. CONTRACTOR 3005 4th Avenue East, P.G. Sox 477 VIA ARCHITECT: Shakopee, MN 55379 292 Desi n Group CONTRACT FOR: Install Steel & Misc. Metals L1 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Information and belief the Application is made for payment, as shown below, in connection with the Contract. Work covered by this Application for Payment has been completed in accordance with the Contract Documents, Continuation Sheet, AIA Document G703, is attached. that all amounts have been paid by the Contractor for Work for wich previous Certificates for Payment were 1. ORIGINAL CONTRACT SUM ............................................. $ 435,750.00 issued and payments received from the Owner, and that current payment shown herein is now due. "-1 r 2. Net Change by Change Orders ...................................... $ (2,698.15) CONTRACTOR: e � 3. CONTRACT SUM TO DATE (Line 9 1-2) .................................. $ 433,051.85 By: _4c'�'�Y! vi Date: '"" I 4. TOTAL COMPLETED & STORED TO DATE (column G on 3703).. $ 215,217.00 1. S. RETAINAGE: State af; Minnesota a. 5% of Completed Work County of: Scott (Column D + D on G703) $ 10,760.85 Subscribed and sworn to before b. 0% of Stared Material me this ' `day of Q- 4-u-,— ,r 20_� �� A.STOCK (Column F on G703) $ Notary Pur7llc. , � 4 (� NOTARY PUBLIC - MINNESOTA �� MY COMNSSION EXPIRES 01)31020 Total Retainage (Lines 5a + 5b or Total in Column I of G703) $ 10,760.85 - My Commission expires: 6. TOTAL EARNED LESS RETAINAGE.................................. $ 204,456.15 CERTIFICATE FOR PAYMENT (Line 4 less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data comprising this 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ............... $ 168,886.25 application, the Construction Manager and Architect certify to the Owner that to the best of their knowledge, (Line s from prior Certificate) information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the 8. CURRENT PAYMENT DUE ................... $ 35,569.9[} Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE ................. (Line 3 less Line 3) $ 228,595.70 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total Changes approved in previous months by Owner $ $ Total approved this Mono; 4,490.00 (6,888,15) GO #1 - PR 2 Lease Space CO #2 - Deduct from Allowance TOTALS $ (2,698.15) $ - NET CHANGES by Change Orders $ (2,698.15) AMOUNT CERTIFIED ............................................. $ {Attach explanation if amount certified diners from the amount applied. iniow aii hguies on this Application and on the Continuation Sheet That are changed 10 Cpnrprrn with the BM*trnt Certified. f CONSTRUCTION MANAGER: By: ARCHITECT; Date: By: Date: 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. JOB# 2598 ELK RIVER ICE ARENA RJM CONSTRUCTION CONTINUATION SHEET (AIA DnmjmP_n} C,7n_41 APPLICATION NO: TWO (2) APPLICATION DATE: 12-25-19 PERIOD FROM: 12-01-19 TO: 12-30-19 PROJECT NO: 0 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE FROM PREVIOUS ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED AND % TO 5% NO. VALUE APPLICATIONS THIS PERIOD STORED STORED TO DATE (G + C) FINISH (D + E) (NOT IN D or E) (D+E+F) (C - G) RETAINAGE 1 051200 Structural Steel 129,841.00 51,935.00 25,970.00 - 77,905.00 60% 51,936.00 3,895.25 2 052100 Steel Joists 100,523.00 90,470.00 (0.00) - 90,470.00 90% 10,053.00 4,523.50 3 053100 Steel Decking 45,888.00 22,944.00 11,472.00 - 34,416.00 75% 11,472.00 1,720.80 4 055000 Metal Fabrications 8,508.00 - - - - 0% 8,508.00 - 5 055100 Metal Pan Stairs 43,996.00 - - - - 0% 43,996.00 - 6 055213 Pipe & Tube Railings 71,614.00 - - - - 0% 71,614.00 - 7 Allowance 30,000.00 7,046.00 (0.00) - 7,046.00 23% 22,954.00 352.30 8 Bond 5,380.00 5,380.00 - - 5,380.00 100% - 269.00 9 CO #1 - PR 2 Lease Space 4,190.00 - - - - 0% 4,190.00 - 10 CO #2 - Deduct from Allowance (6,888.15) - - - - 0% (6,888A 5) - TOTALS 433,051.85 177,775.00 37,442.00 - 215,217.00 50% 217,834.85 10,760.85 APPLICATION AND CERTIFICATE FOR PAYMENT Page of SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena & Lion Jahn Weicht Park Facilities APPLICATION NO: 2 830 Boone Avenue North 1000 School Street NW APPLICATION DATE: 12/2512019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 12/1/2019 SUBMITTED FROM: High Five Erectors 11, Inc. ARCHITECT: 292 Resign Group PERIOD TOE 12/30/2019 3005 4th Avenue East PROJECT NO: Shakopee, MN 55379 CONTRACT DATE; 7/10/2019 CONTRACT FOR: 5B Structural & Misc, Steel Installaticn CONTRACT NO,: COMMITMENT: YES1NO I hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUM ........................... represent the actual value of accomplishment under the te•ms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO.......,. referenced project. I further certify that no labor or materials have been supplied urder contracts, agreements, verbal or written, or any other arrangement of any type whatsoever, other CONTRACT SUM TO DATE ...................... . than the contract duly authorized and executed change orders. and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this TOTAL COMPLETED AND STORED TO DATE.. application. 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 5 °la OF COMPLETED WORK 5 (sub -subcontractors) and 2) for all material and labor used in or in connection with the performance of this contract. I further certify that I have complied with Federal, State, and local 5 % OF STORED MATERIAL $ tax laws, including Sac al Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. TOTAL RETAINAGE..................................... PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof for any of the materials andlor labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor andlor materials furnished after said date. The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this instrument. High Five Erectors 11, Inc 3005 4th Avenue East Shakopee, MN 55379 SIGNED. (j PRINTED, TITLE To ra Thompson, President $ 435,750.00 I— ................. $ (2,698.15) $ 433,051.85 .................................... $ 215,217.00 10,760.85 ....... .................. .......--- ... $ 10.760.85 TOTAL EARNED LESS RETAINAGE............................................._..I......1. $ 204,456,15 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ $ - LESS PREVIOUS CERTIFICATES FOR PAYMENT...... $ 168,88625 CURRENT PAYMENT DUE. ............. ................. ...... $ 35,569.90 BALANCE TO FINISH INCLUDING RETAINAGE................................. ....... $ 228.595,70 State of: Minnesota County of: Scott Subscribed and sworn to before me this i day ofj yr NOTARY PUBLIC: i My Commission Commission Expires oI f�` 1 ?_0 20 19 -AIM A. STOCK NOTARY PUBLIC - MINNESOTA CC)MSSICN EXPIRES 01/31320 Remit payment and make checks payable to: INVOICE DETAIL Commercial HOME DEPOT CREDIT SERVICES DEPT. 32 - 2149392668 Revolving Charge PO BOX 9001030 LOUISVILLE, KY 40290-1030 ru 0' tr 02 L-j 02 Invoice #: 1011618 continued PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE SPRAYWAY TRIGGER GLASS 10027411820000400004 1.0000 EA $3.48 $3.48 CLEANER SCOTT 1000 8 10024895480000400022 1.0000 EA $8.48 $8.48 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $65.63 TAX $4.94 TOTAL $70.57 Amount Due: Trans Date: Invoice #: 1020719 $91.53 11 /18/19 PO: 195200033 Store: 2821, ELK RIVER, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 1213 50' RIDGID EXTENSION CORD 00002140120000300003 1.0000 EA $55.97 $55.97 BOUNTY ESSENTIALS 2 GIANT ROLL 10032117390000400022 1.0000 EA $3,00 $3.00 SAS POWERADE ZERO FRUIT PUNCH 10044730770001300005 1.0000 EA $4.97 $497 8PK GORILLA TOUGH & WIDE TAPE 00007854100000500004 1,0000 EA $14.97 $14.97 FEBREZE CAR VENT CLIP LINEN & 00009473320000400025 1.0000 EA $2.97 $2.97 SKY FEBREZE CAR VENT CLIP LINEN & 00009473320000400025 1.0000 EA $2.97 $2.97 SKY BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $84.85 TAX $6.68 I Eel f-A III $91.53 Amount Due: Trans Date: Invoice # 1311383 $11.26 11 /18/19 PO: 19720-7029BC I Store: 2808, PLYMOUTH, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 518"X4'X8' FIRECODE TYPE X 000041910900012000D2 1.0000 EA $10.47 $10.47 DRYWALL BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $10.47 TAX $0.79 I tel t/_1 1111 $11.26 Amount Due: Trans Date: Invoice #: 1626057 $66.29 11 /18/19 PO: 195200110CB Store: 8460, KANSAS CITY, MO PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE DRILLERTOGGLE 1IS- IN X2-IN (25 1004535935000030OD11 1.0000 EA $15.98 $15.98 PCS) DRILLERTOGGLE 1/8-IN X 2-IN (25 10045359350000300011 1.0000 EA $15.98 $15.98 PCS) WASHERS 00005913430000300026 1.0000 EA $4.68 $4.68 EZ TWIST-N-LOCK 75, 50 PK 00004598260000300011 1.0000 EA $12.20 $12.20 continued 2 Page 33 of 126 1-800-685-6691 homedepot.com/mycrc Remit payment and make checks payable to: COmmerClal HOME DEPOT CREDIT SERVICES DEPT, 32 - 2149392668 Revolving Charge PO BOX 9001030 LOUISVILLE, KY 40290-1030 INVOICE DETAIL ru 0^ 0^ w rU t-+ BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 Amount Due: Trans Date: Invoice #: 522790 $17.11 11 /19/19 PO: 195200052DL Store: 2843, INVER GROVE H, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE DEWALT 5 PC MAXIMPACT 10023145410000700009 1.0000 EA $15.97 $15.97 NUTDRIVER SET BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $15.97 TAX $1,14 TOTAL $17.11 Amount Due: Trans Date: Invoice #: 9011030 $41.38 11 /20/19 PO: 195200021 1 Store: 2803, COON RAPIDS, MN PRODUCT SKU * QUANTITY UNIT PRICE TOTAL PRICE 1/2OSB 00007877920000100003 1,0000EA $9.55 $9.55 112OSB 00007877920000100003 1,0000EA M55 $9.55 1/2"X4'X8' R-3 XPS FOAMULAR 150 00004099230000400004 1.0000 EA $9.77 $9.77 1/2"X4'X8' R-3 XPS FOAMULAR 150 00004099230000400004 1,0000 EA $9.77 $9.77 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $38.64 TAX TOTAL $2.74 41.38 Amount Due: Trans Date: Invoice #: 9523285 $22.83 11 /20/19 PO: 19520-0127JMK Store: 3819, COLUMBUS, OH PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE SPRAYWAY GLASS CLEANER 32 OZ 10046643660000400004 1.0000 EA $3.29 $3.29 QUICKIE PRO MICROFIBER TOWEL 10020880550000400020 1.0000 EA $8.98 $8.98 16-PK QUICKIE PRO MICROFIBER TOWEL 10020880550000400020 1.0000 EA $8.98 $8.98 16-PK BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $21.25 TAX $1.58 TOTAL $22.83 Amount Due: Trans Date: Invoice #: 9WO930 $95.54 11 /20/19 PO: 195200033 Store: 2821, ELK RIVER, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 5-1/2' STEEL T-POST 1.25 00009294250001300004 20.0000 EA $4.18 $83.60 POWERADE ZERO FRUIT PUNCH 10044730770001300005 1.0000 EA $4.97 $4.97 SPI< SUBTOTAL $88.57 TAX $6.97 TOTAL $95.54 t Page 39 of 126 1-800-685-6691 homedepot.com/mycrc ru E' Q, DIM C3 T. Remit payment and make checks payable to: HOME DEPOT CREDIT SERVICES Commercial r%70� DEPT. 32 - 2149392663 Revolving Charge PO BOX 9001030 LOUISVILLE,KY 40290-1030 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 INVOICE DETAIL Amount Due: Trans Date: Invoice #: 4021514 $95.35 11 /25/19 PO: 195200033 Store: 2821, ELK RIVER, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 14" NATURAL CABLE TIE 10OPK 00002957150001100005 1.0000 PK $15.43 $15.43 AMES D-HANDLE ALUMINUM SCOOP 10000230380001100003 1.0000 EA $34.98 $34.98 SUNCAST 24 IN. SNOW SHOVEL 00001065560001100005 1.0000 EA $37.98 $37.98 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $88.39 TAX $6.96 TOTAL $95.35 Amount Due: Trans Date: Invoice #: 4201760 -$80.90 11 /25/19 PO: 195200138 Store: 2828, BLAINE, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 3'X5' X 1/4" HARDIE TILE 00001808690001400004 1.0000 EA -$12.48 -$12.48 BACKERBOARD 3'X5' X 1/4" HARDIE TILE 00001808690001400004 1.0000 EA -$12.48 -$12.48 BACKERBOARD 3'X5' X 1/4" HARDIE TILE 00001808690001400004 1.0000 EA -$12.48 -$12.48 BACKERBOARD 3'X5' X 1/4" HARDIE TILE 00001808690001400004 1.0000 EA -$12 48 -$12.48 BACKERBOARD 3'X5' X 1/4" HARDIE TILE 00001808690001400004 1.0000 EA -$12.48 -$12.48 BACKERBOARD 3'X5' X 1/4" HARDIE TILE 00001808690001400004 1 0000 EA -$12.48 -$12.48 BACKERBOARD BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL-$74.88 TAX -$6.02 TOTAL-$80.90 Amount Due: Trans Date: Invoice #: 4640663 $26.94 11 /25/19 PO: 19520-0047TB I Store: 2807, MINNEAPOLIS, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE BOSCH T-SHANK JIGSAW BLADES 00002418450000700005 1.0000 EA $8.97 $8.97 ASST 5PK MIKE 6" 8TP1 BI-M GEN PUR IIPK 00004868250000700003 1.0000 EA $15.97 $15.97 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $24.94 TAX $2.00 TOTAL 94 Amount Due: Trans Date: Invoice #: 4614398 $144.73 11 /25/19 PO: 195200110CB I Store: 3021, KANSAS CITY, MO PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 1/2X3X5DUROCK EDGEGUARD 10029913540001200004 1.0000 EA $9.79 $9.79 CEMENT BOARD continued =�> 1'=�s Page 57 of 126 1-800-685-6691 homedepot.com/mycrc 06 Remit payment and make checks payable to: Mill'` Commercial HOME DEPOT CREDIT SERVICES Revolv �• . g DEPT. 32 - 21492668 PS ,� ing Charge PO BOX 9001030 LOUISVILLE, KY 40290-1030 INVOICE DETAIL ru E' Er (32 Ln C3 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 Amount Due: Trans Date: Invoice #: 50I 0736 $170.23 12/04/19 PO: 19520 Store: 2810, WOODBURY, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 5.01VIM4X4 UN DIE RLAYMENT 00004488870000100006 1.0000 EA $11-23 $11.23 5.01VIM 4X4 UNDERLAYMENT 00004488870000100006 1-0000 EA $11-23 $11.23 14/3 100' RIDGID EXTENSION CORD 00002140880000300003 1.0000 EA $59-97 $59.97 4" X 10' PVC40-DWV PE PIPE 00001938790000100002 1.0000 EA $16-51 $16-51 1413 100' RIDGID EXTENSION CORD 00002140880000300003 1.0000 EA $59-97 $59.97 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $158.91 TAX $11.32 TOTAL $170-23 Amount Due: Trans Date: Invoice #: 5363753 $170.23 12/04/19 PO: 195200114 Store: 2810, WOODBURY, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 5.011VIM 4X4 UNDERLAYMENT 00004488870000100006 1.0000 EA $11.23 $11.23 4" X 10' PVC40-DWV PE PIPE 00001938790000100002 1.0000 EA $16.51 $16.51 5.OMM 4X4 UNDERLAYMENT 00004488870000100006 1.0000 EA $11.23 $11.23 14/3 100' RIDGID EXTENSION CORD 00002140880000300003 1.0000 EA $59.97 $59.97 1413 100' RIDGID EXTENSION CORD 00002140880000300003 1.0000 EA $59.97 $59.97 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $158-91 TAX $11.32 TOTAL $170.23 Amount Due: Trans Date: Invoice #: 5363752 -$170.23 12/04/19 PO: 19520 Store: 2810, WOODBURY, MN PRODUCT SKU 4 QUANTITY UNIT PRICE TOTAL PRICE 14/3 100' RIDGID EXTENSION CORD 00002140880000300003 1.0000 EA -$59.97 •$59-97 1413 100' RIDGID EXTENSION CORD 00002140880000300003 1.0000 EA -$59.97 -$59.97 5.0MM 4X4 UNDERLAYMENT 00004488870000100006 1.0000 EA -$11.23 -$11.23 4" X 10' PVC40-DWV PE PIPE 00001938790000100002 1.0000 EA -$16.51 -$16.51 5.0MIV1 4X4 UNDERLAYMENT 00004488870000100006 1.0000 EA -$11.23 -$11.23 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 I�:Lrl�lri�31 ROCKSALT50tt DEWALT #11w1AXFiT PHILPS INSRT BIT BLK DEWALT #1 MAXFIT PHILPS INSRT BIT BILK SUBTOTAL-$158.91 TAX-$11.32 TOTAL-$170.23 Amount Due: Trans Date: Invoice #: 5022326 $38.58 12/04/19 PO: 195200033 Store: 2821, ELK RIVER, MN SKU # QUANTITY UNIT PRICE TOTAL PRICE 00004449010000100009 1.0000 EA $8.97 $8.97 10016738890000700009 1.0000 EA $1.47 $1.47 10016738890000700009 1.0000 EA $1.47 $1.47 continued cz=�> ��'�Ir ! Page 97 of 126 1-800-685-6691 homedepot.com/mycrc r, ru Cr IT 02 Ln L✓ Remit payment and make checks payable to: INVOICE DETAIL ti. Commercial HOME DEPOT CREDIT SERVICES DEPT. 32 - 2149392668 Revolving Charge PO BOX 9001030 LOUISVILLE,KY 40290-1030 Invoice #: 5022326 continued PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE DEWALT#iMAXFIT PHILPS INSRT 10016738890000700009 1.0000 EA $1.47 $1.47 BIT BILK ROCKSALT50# 00004449010000100009 1,0000 EA $8,97 $8.97 DEWALT #1MAXFIT PHILPS INSRT 10016738890000700009 1.0000 EA $1.47 $1.47 BIT BLK DISCOUNT 00000000000000000005 1.0000 EA 40.94 -$0.94 DEWALT #1 MAXFIT PHILPS INSRT 10016738890000700009 1.0000 EA $1.47 $1.47 BIT BILK DEWALT #iMAXFIT PHILPS INSRT 10016738890000700009 1.0000 EA $1.47 $1.47 BIT BLK POWERADE ZERO FRUIT PUNCH 10044730770001300005 1.0000 EA $4.97 $4.97 8PK POWERADE ZERO FRUIT PUNCH 10044730770001300005 1.0000 EA $4,97 $4.97 8PK BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $35.76 TAX $2.82 TOTAL $38.58 Amount Due: Trans Date: 1 Invoice #: 4022414 $382.99 12/05/19 PO: 195200033 Store: 2821, ELK RIVER, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE EMPIRE 1000' YELLOW CAUTION 00004385570000100016 1.0000 EA $8.97 $8.97 TAPE 3/8" X 100 DIAMOND -BRAID POLY 00007060360000300004 1.0000 EA $12.98 $12.98 ROPE 3/8" X 100 DIAMOND -BRAID POLY 00007060360000300004 1.0000 EA $12.98 $12.98 ROPE 36 IN. STANDARD BUNGEE CORD 10017177180000300006 1.0000 EA $1.47 $1.47 36 IN. STANDARD BUNGEE CORD 10017177180000300006 1.0000 EA $1.47 $1.47 36 IN. STANDARD BUNGEE CORD 10017177180000300006 1.0000 EA $1.47 $1.47 ARROW 5/16" T50 STAPLES 5000PK 00001400530000200002 1,0000 EA $10.97 $10.97 DOOR PULL 00002417840000400004 1.0000 EA $4.68 $4.58 DOOR PULL 00002417840000400004 1.0000 EA $4.56 $4,58 HASP, 00002401090000400004 1.0000 EA $3.98 $3.98 SAFETY_DOUBLE H INGE_3°_ZINC DOOR PULL 00002417840000400004 1.0000 EA $4.58 $4.58 HINGE, SPR_ADJ_4.5"_SC 00001632380000400004 1.0000 EA $18.48 $18.48 DOOR PULL 00002417840000400004 1.0000 EA $4.58 $4,58 DOOR PULL 00002417840000400004 1.0000 EA $4.58 $4.58 HINGE, SPR_ADJ_4.5"_SC 00001632380000400004 1.0000 EA $18,48 $16,48 HINGE, SPR_ADJ_4.5"_SC 00001632380000400004 1.0000 EA $18.40 $18.48 DOOR PULL 00002417840000400004 1.0000 EA $4.58 $4.58 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 3/8" X 4" EYE BOLT W/NUT ZP 00001161670000300022 1.0000 EA $0.95 $0.95 HASP, 00002401090000400004 1.0000 EA $3.98 $&98 SAFETY_DOUBLEHINGE_311_ZINC HASP, 00002401090000400004 1.0000 EA $3.98 $3.98 SAFETY_DOUBLEHINGE_3"_ZINC FIXED PULLEY 2 NICKEL 00003671840000300021 1.0000 EA $4.98 $4.98 HINGE, D_ R_4"_SQUARE_SN 00002078040000400004 1.0000 EA $3.28 $3.28 continued lz==�> Page 99 of 126 1-800-685-6691 homedepot.com/mycrc Remit payment and make checks payable to; INVOICE DETAIL Commercial HOME DEPOT CREDIT SERVICES DEPT. 32 - 2149392668 Revolving Charge PO BOX 9001030 Mal` LOUISVILLE,KY 40290-1030 ru I' Q' M tr ru Invoice #: 4022414 continued PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE ROPE CLEAT 4-1/2 CHROME 00001 102360000300021 1.0000 EA $2.35 $2.35 SUPERSTRONG BUNGEE 00007906600000300006 1.0000 PK $5.96 $5.96 CORDS-241N, 4PK HINGE, OR_4'_SQUARE-SN 00002078040000400004 1.0000 EA $3.28 $3.28 DISCOUNT 00000000000000000005 1.0000 EA -$4.85 -$4.85 HINGE, DR_4"_SQUARE_SN 00002078040000400004 1.0000 EA $3.28 $3.28 HINGE, SPR- ADJ_4.5"_SC 00001632380000400004 1.0000 EA $18.48 $18.48 ROPE CLEAT 4-112 CHROME 00001402360000300021 1.0000 EA $2.35 $2.35 HINGE, DR_4"-SQUARE_SN 00002078040000400004 1.0000 EA $3.28 $3,28 HINGE, DR_4"_SQUARE_SN 00002078040000400004 1.0000 EA $3.28 $3.28 HASP, 00002401090000400004 1.0000 EA $3.98 $3.98 SAFETY_DOUBLEHI NGE_3"_ZINC HINGE, DR_4"_SQUARE_SN 00002078040000400004 1.0000 EA $3.28 $3.28 FIXED PULLEY 2 NICKEL 00003671840000300021 1.0000 EA $4.98 $4,98 MILWAUKEE SDS BIT 00005242040000700008 1.0000 EA $6.27 $6.27 5/321 N.X41 NXX61 N MILWAUKEE SDS BIT 00005242040000700008 1.0000 EA $6.27 $6.27 5/321N.X41NXX61N MILWAUKEE SIDS BIT 5/32" X 7" 1/4 00005243740000700008 1.0000 EA $7.47 $7.47 HEX MILWAUKEE SDS BIT 5/32" X 7" 1/4 00005243740000700008 1,0000 EA $7.47 $7.47 HEX HINGE, SPR_ADJ_4.5"_SC 00001632380000400004 1.0000 EA $18.48 $18.48 HINGE, DR_4"_SQUARE_SN 00002078040000400004 1.0000 EA $3.28 $3.28 ROPE CLEAT 4-1/2 CHROME 00001402360000300021 1.0000 EA $2.35 $2.35 ARROW 5/16" T50 STAPLES 5000PK 00001400530000200002 1.0000 EA $10.97 $10.97 FIXED PULLEY 2 NICKEL 00003671840000300021 1.0000 EA $4.98 $4.98 HINGE, SPR_ADJ_4.5"_SC 00001632380000400004 1.0000 EA $18.48 $18.48 DOOR STOP 00005946070000400007 1.0000 EA $4.61 $4.61 DOOR STOP 00005946070000400007 1.0000 EA $4.61 $4.61 DOOR STOP 00005946070000400007 1.0000 EA $4.61 $4.61 DOOR STOP 00005946070000400007 1.0000 EA $4.61 $4.61 ROPE CLEAT 4-1/2 CHROME 00001402360000300021 1.0000 EA $2.35 $2.35 HINGE, DR_4"_SQUARE_SN 00002078040000400004 1,0000 EA $3.28 $3.28 DEWALT HEAVY-DUTY UTILITY 00003948120000100006 1.0000 EA $14.97 $14.97 BLADES 75P MILWAUKEE SIDS BIT 3/161N.X 41N. 00005242060000700008 1.0000 EA $6.47 $6.47 X61 N MILWAUKEE SDS BIT 3/161N.X 41N. 00005242060000700008 1.0000 EA $6.47 $6.47 X61 N MILWAUKEE SDS BIT 3/161N.X 41N. 00005242060000700008 1.0000 EA $6.47 $6.47 X61 N MILWAUKEE SIDS BIT 3/161N.X 41N. 00005242060000700008 1.0000 EA $6.47 $6.47 X61 N MILWAUKEE SDS BIT 3/161N.X 41N. 00005242060000700008 1.0000 EA $6.47 $6.47 X61 N DISCOUNT 00000000000000000005 1.0000 EA -$7.00 -$7.00 DISCOUNT 00000000000000000005 1.0000 EA -$7.00 -$7.00 BILL TO: SHIP TO: Acct: 6035 3221 4939 2668 RJM CONSTRUCTION LLC 830 BOONE AVE N STE 2 MINNEAPOLIS, MN 55427-4589 SUBTOTAL $355.04 TAX $27.95 TOTAL $382.99 Amount Due: Trans Date: Invoice #: 4010M $64.76 12/05/19 PO: HEROJM Store: 2810, WOODBURY, MN PRODUCT SKU # QUANTITY UNIT PRICE TOTAL PRICE 2X3-8 SELECT 00008450000000600005 1.0000 EA $1.98 $1.98 2X3-8 SELECT 00008450000000600005 1.0000 EA $1.98 $1.98 continued =�> !!'ks Page 101 of 126 1-800-685-6691 homedepot.com/mycrc iBROCKWHITE CONSTRUCTION MATERIALS aACONSTRUCfION SUPPLY GROUP COMPANY Brock White Company, LLC 12785 ELK LAKE RD NW ELK RIVER, MN 55330-2439 Page 1 of 1 INVOICE BILL TO: 2854 1 AH 0.412 E0084X 10169 D5598743519 S2 P6975927 0001:0001 I I1I I I I I I I1111-I I I.1-In-11.1.1111-r1111-111111111----I--1I1-1I I I a,JTy'S` RJM CONSTRUCTION -'- 830 BOONE AVE N STE 2 GOLDEN VALLEY MN 55427-4589 PHONE: (763) 441-2004 FAX; (763) 441-1622 TOLL FREE: (800) 859-7077 SHIM TO3 RJM CONSTRUCTION ELK RIVER MUNICIPAL 13069 ORONO PKWY ELK RIVER, MIN 55330 INVOICE NUMBER 13691417-00 INVOICE DATE 12/04/19 PO NUMBER 19520-0033 CUSTOMER NO ORDER NO SHIP VIA DUE DATE TERMS 10496 13691417--00 SLS WILLCALL 01/10/20 10THPROXIMO ORDER DATE SHIP DATE. ORDER BY TAKri,4 BY JOB # JOB NAME 12/03/19 12/04/19 wand ORDER SHIPD QTY I CITY 13KORD QTY UNIT ITEM #! DESCRIPTIs7N PRICE NET PRICE Txhl 5 5 0 ROLL 0332230 $118,3600 $591,80 T' POLY REINF 20' X 100' CLR BLU STRP 52t1 28/PLT Qty Shipped Total 5 Total $591.80 MN SALES TAX $40.69 ELK RIVER $2.96 SHERBU-RNE CO TR $2.96 Invoice Total $638.41 RECEIVED SAVE TIME AND MONEY WITH OUR FREE'E-BILLING INVOICING SERVICEI You can now receive invoices much faster with our emaH or fax hill deliveryt With email delivery, your Invoices are sent once per day in one, easy to open file. You can even download our invoice data directly into your accounting package {such as ' QuickBooks(D). With fax delivery you get all your invoices once per day. Please contact us to sign up for this service. 1� s 1.5% per month interest charged on all overdue accounts. A 20% RESTOCKING FEE APPLIES ON ALL RETURNS NO RETURNS ACCEPTED AFTER 30 DAYS OF INVOICE DATE 0001:0001 U.S. FUNDS REMIT TO Brack White Company LLC C/O CSG PO Box 856458 Minneapolis, MN 55485-6458 645 JOHNSON ST NE Remit To: MINNEAPOLIS, MN 55413- Phone: (612)-378-1520 BILL TO: RJM CONSTRUCTION 830 BOONE AVENUE NORTH GOLDEN VALLEY MN 55427 INVOICE 866169-001 645 JOHNSON ST NE MINNEAPOLIS, MN 55413- Invoice Date: 12/09/19 Phone: (612)-378-1520 Account: 304454 0470 Branch: MSP Phone: (952)-837-8600 Fax: (952)-832-9600 Delivery: 00866169-001 SHIP TO: RJM CONSTRUCTION 1000 SCHOOL ST NW ELK RIVER MULTI PURPOSE 19520-0033 ELK RIVER MN 55330 Page 1 of 1 PO: 19520-0033 REF: JOB: ORDER DATE: 12/04/19 SALES PAUL S. ORDER TYPE: YARD SHIP VIA: DEL 1 ST FRT TERM: SHIP DATE: 12/06/19 AGENTS ORDERED BY: AUTH CHG: QTY QTY CONVERTED ORDERED SHIPPED UOM ITEM/DESCRIPTION QTY PRICE/UOM AMOUNT 1ST BLOCK PAST HIGH SCHOOL TO CONSTRUCTION ENTRANCE 60 60 PC 2X4-8' (1.5"x3.5") **COMMON** #2 & 60.00/PC 2.85/PC 171.00 BTR SPF 24 24 PC 2X4-16' (1.5"x3.5") **COMMON** #2 24.00/PC 8.05/PC 193.20 & BTR SPF 6 6 PC 2X6-16' (1.5"x5.5") **COMMON** #2 6.00/PC 11.00/PC 66.00 & BTR SPF 12 12 PC 4X8-19/32" (5/8) CDX SHEATHING 12.00/PC 22.45/PC 269.40 PLYWOOD - FIR' 100 100 PC 1X2-8' PREMIUM STRIPPING S4S 100.00/PC 2.45/PC 245.00 5 5 BOX 3/16X2-3/4 CONCRETE & MASONRY 5.00/BOX 17.90/BOX 89.50 SCREW PHILLIPS (100)'' 3 3 BOX 1-5/8" (VB400) GRABBER DRYWALL 3.00/BOX 21.00/BOX 63.00 SCREW COARSE 5# (Y) SUBTOTAL 1,097.10 SALES TAX 86.41 PAYMENT TERMS: 2% 15TH OF THE FOLLOWING MONTH NET END OF FOLLOWING MONTH Due Date: 01/30/20 You may deduct 21.94 if paid by 01/15/20 Balance $1,183.51 645 JOHNSON ST NE MINNEAPOLIS, MN 55413- Phone: (612)-378-1520 Remit To: 645 JOHNSON ST NE MINNEAPOLIS, MN 55413- Phone: (612)-378-1520 BILL TO: RJM CONSTRUCTION 830 BOONE AVENUE NORTH GOLDEN VALLEY MN 55427 INVOICE 868576-001 Invoice Date: 12/19/19 Account: 304454 0470 Branch: MSP Phone: (952)-837-8600 Fax: (952)-832-9600 Delivery: 00868576-001 SHIP TO: RJM CONSTRUCTION 1000 SCHOOL ST NW ELK RIVER MULTI PURPOSE 19520-0033 ELK RIVER MN 55330 Page 1 of 1 PO: 19520-0033 REF: JOB: ORDER DATE: 12/18/19 SALES PAUL S. ORDER TYPE: YARD SHIP VIA: XDISP COUR FRT TERM: SHIP DATE: 12/19/19 AGENTS ORDERED BY: AUTH CHG: QTY QTY CONVERTED ORDERED SHIPPED UOM ITEM/DESCRIPTION QTY PRICE/UOM AMOUNT 50 50 PC 2X4-16' (1.5"x3.5") **COMMON** #2 50.00/PC 8.05/PC 402.50 & BTR SPF SUBTOTAL 402.50 SALES TAX 31.69 PAYMENT TERMS: 2% 15TH OF THE FOLLOWING MONTH NET END OF FOLLOWING MONTH Due Date: 01/30/20 You may deduct 8.05 if paid by 01/15/20 Balance $434.19 645 JOHNSON ST NE MINNEAPOLIS, MN 55413- Phone: (612)-378-1520 Remit To: 645 JOHNSON ST NE MINNEAPOLIS, MN 55413- Phone: (612)-378-1520 BILL TO: RJM CONSTRUCTION 830 BOONE AVENUE NORTH GOLDEN VALLEY MN 55427 INVOICE 869287-001 Invoice Date: 12/26/19 Account: 304454 0470 Branch: MSP Phone: (952)-837-8600 Fax: (952)-832-9600 Delivery: 00869287-001 SHIP TO: RJM CONSTRUCTION 1000 SCHOOL ST NW ELK RIVER MULTI PURPOSE 19520-0033 ELK RIVER MN 55330 Page 1 of 1 PO: 19520-0033 REF: JOB: ORDER DATE: 12/23/19 SALES PAUL S. ORDER TYPE: YARD SHIP VIA: DEL AM FRT TERM: SHIP DATE: 12/26/19 AGENTS ORDERED BY: AUTH CHG: QTY QTY CONVERTED ORDERED SHIPPED UOM ITEM/DESCRIPTION QTY PRICEWOM AMOUNT 12 12 PC 4X8-15/32" (1/2) CDX SHEATHING 12.00/PC 16.60/PC 199.20 PLYWOOD - FIR 50 50 PC 2X4-16' (1.5"x3.5") **COMMON** #2 50.00/PC 7.30/PC 365.00 & BTR SPF 12 12 PC 2X6-16' (1.5"x5.5") **COMMON** #2 12.00/PC 10.35/PC 124.20 & BTR SPF 4 4 BDL #2 WOOD LATH (50PC/BDL) 4.00/BDL 12.55/BDL 50.20 1 1 BOX 3" (1100) GRABBER DRYWALL SCREW 1.00/BOX 64.00/BOX 64.00 COARSE2M (Y), SUBTOTAL 802.60 SALES TAX 63.20 PAYMENT TERMS: 2% 15TH OF THE FOLLOWING MONTH NET END OF FOLLOWING MONTH Due Date: 01/30/20 You may deduct 16.05 if paid by 01/15/20 Balance $865.80 Veit Disposal Systems - Metro 14000 Veit Place Rogers, MN 55374 Phone: (763)422-3867 Fax: (763) 428-6779 RJM CONSTRUCTION - NORTH 830 BOONE AVENUE N GOLDEN VALLEY, MN 55427 INVOICE NO. 00005736� PAGE i DATE rlar-1 S-1 f CUSTOMER NO. gRf,R SITE NO. REFERENCE NO. TOTAL INVOICE T $275.00 SERVICE CODE DESCRIPTION REFERENCE QTY. RATE AMOUNT (0444) PO.#19520-0033 RJM - NORTH - ICE ARENA 1000 SCHOOL STREET, ELK RIVER MN Sery #001 Roll Off Service 20.00 13- Dec R1 20.00 Exchange 1.00 $263.00 $263.00 W/O #:669254 19520-0033 13 - Dec C1 Const. Debris - YD 20.00 $0.00 $0.00 Bill of Lading: 58999 Carrier: YBV9637,20 13 - Dec 01 MN Sld Waste Fee-$.60/Yd at $0.60/YD on 20.00YD $12.00 Questions or Inquiries please e-mail customer service @ VDSbilling@VeitUSA.com A service chg of 1.5% per month (18% APR) on any unpaid balances after 30 days CURRENT TOTAL INVOICE $275.00 31 - 60 DAYS 61 - 90 DAYS OVER 90 DAYS 5 083.39 2 085.00 0.00 23 861.00 12/20/2019 RJM Construction 830 Boone Avenue North Golden Valley, MN 55427 EQUIPMENT RENTAL INVOICE Jab Name: Elk River Multi -Purpose Facility and Lion Jot Job Number: 19520-0033 Q Description I From To I Days I ITnt1` 1 1 10x50 OFFICE TRAILER E 11/27/2019 12/20/2019 18 $345.00 2 1 28' LADDER 11/27/2019 12/20/2019 18 $95.00 3 1 AUTO EXT DEFIBRILLATOR 11/27/2019 12/20/2019 18 $60.00 4 2 BATTERY HAMMER DRILL 12/18/2019 12/20/2019 3 $150.00 5 30 FROST BLANKETS 11/27/2019 12/20/2019 18 $1,200.00 6 2 - RETRACT. LANYARD/HARNESS 12/3/2019 12/20/2019 14 $360.00 7 - 8 - --� - 10 - 12 13 - - - -- — - - S 14 15 - - - • - - ----�� - -- - -- - - - - 16- 17 18 19 ---_------ --- a-- ��_- _s.� -.• i 20 21 22 - 23 24 - - --- - _ -- -----_ - 25 - -- - — -- ---- -- - 26 28 CM Approval: ITotal Invoice to Job $ 2.210.00 0United Rentals® BRANCH J20 2340 FERNBROOK LN N PLY74OUTH MN 55447-4727 763-557-1234 763-509-2350 FAX m ELK RIVER REC. FACILITIES •� 1000 SCHOOL ST NW ELK RIVER MN 55330-1337 A F3 Office: 612-305-2120 Cell: 952-292-3903 RJM CONSTRUCTION 830 BOONE AVE N STE 2 GOLDEN VALLEY MN 55427-4589 RENTAL RETURN INVOICE # 176738828-001 Customer # 9154026 Invoice Date 12/17/19 Rental Out 12/04/19 10:00 AM Rental In 12/17/19 08:32 AM UR Job Loc 1000 SCHOOL ST NW, E UR Job # 212 Customer Job ID: P.O. # 19520-0033 Ordered By MIKE MILLESS Reserved By ROGER PETTITT Salesperson ROGER PETTITT Invoice Amount: $2,479.90 Terms: Due Upon Receipt Payment options: Contact our credit office 212-333-6600 Ext. ext: 8 REMIT TO: UNITED RENTALS (NORTH AMERICA),INC. PO BOX 840514 DALLAS TX 75284-0514 RENTAL ITEMS: Qty Equipment Description Minimum Day Week 4 Week Amount 1 10975395 BOOM 37-44' TELESCOPIC 465.00 935.00 1875.00 1,870.00 Make: GENIE Model: S-40 Serial: S40H-27984 Meter out: 100.00 Meter in: 109.70 SALES/MISCELLANEOUS ITEMS: Qty Item 1 ENVIRONMENTAL SERVICE CHARGE 8.60 DYED DIESEL 1 DELIVERY CHARGE 1 PICKUP CHARGE COMMENTS/NOTES: CONTACT: MIKE MILLES CELL#: 952-292-3903 Price [ENV/MCI] 37.400 [DYEDDSL/MCI] 6.900 166.060 166.060 Rental Subtotal: Unit of Measure EACH EACH EACH EACH Sales/Misc Subtotal: Agreement Subtotal: Fuel: Tax: Total: 1,870.00 Extended Amt. 37.40 59.34 166.06 166.06 428.86 2,239.52 59.34 181.04 2.479.90 NOTICE: This invoice is subject to the terms and conditions of the Rental and Service Agreement, which are available at https://www.unitedrentals.com/legal/rental-service-terms-US and which are incorporated herein by reference. A COPY OF THE RENTAL AND SERVICE AGREEMENT TERMS ARE AVAILABLE IN PAPER FORM UPON REQUEST. You Can Now Access Invoice History and Update Purchase Orders Online To Sign Up, contact URControlSupport@ur.com Page. 1 L RJM CONSTRUCTION - EMPLOYEE EXPENSE REPORT Employee - PERIOD NAME: Tim Ryan Market Code: rnVFRFT) TO 1i127l2G79 Expanse Type Meats a atartainment Cell hone Other office (GL of Phase Supplies Code RequiredI 6W 7. f19 1 Ca11.06 21rjf4 42IS W 13.09 219.60 520-00 wf IN REIMBURSEMENT CALCULATION: 7. TOTAL PROJECT COST {Columns 1+2+3+4+5+647' E. Total Project Mlles @ .sa per mile 9. Leas AdvancesN6.fto Allowance @ .33 per Mlle 752.69 288.84 164.34 677. t 9 APPLICATION AND CERTIFICATE FOR PAYMENT SUBMITTED TO: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 SUBMITTED FROM: Kendell Doors & Hardware PO Box 211520 Eagan, MN 55121 CONTRACT FOR: PROJECT: Elk River Ice Arena & Lion John Weicht Park ARCHITECT: CONTRACT NO.: I hereby certify that the work Derformed and the mater a} supplied to date, as shown here. represent the actual value of acromplishment under, the Germs of the contract (and afl authorized chances hereto) between the undersigned and RJM Construction relating to the atxrv. eierertcPo project. I further certiry that no tabor or materials have been supplied under =Ira=, agreetnerifs. verbal or written, or :any other arrangement of any type whatsoever,other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction frorn any claim or liability therefor for the period covered by this application. I also certify that payments, tess applicable retention, have beer: made through the period coveted by previous payments received from she Contractor to 1) all my subcontractors (sub - subcontractors) and 2) for all Material and labor used In or in onnection with the performance of this contracL I further certify that I have complied with Federat, State. and local tax laws, including Social Security laves, Unemployment Compensation Laces and Wiarkman's Compensation lawns insofar as applicable to the perormanoe- this contract. PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the wrrent payment due on thn application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanids liens or other liens against the above real estate or any part thereof for any of the materials and/or labopr therefore iurnshed or performcnJ in connect on with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this instrument. C SIGNED: PRINTED, TITLE ORIGINAL CONTRACT SUM ................................... NET CHANGE BY CHANGE ORDERS TO .................... Page of APPLICATION NO: 1 APPLICATION DATE: 12/19/19 PERIOD FROM: �1 1 /20/19 PERIOD TO: 12/20/19 PROJECT NO: NO PO IN CONTRA( CONTRACT DATE: COMMITMENT: 92,614-00 CONTRACT SUM TO DATE ................................................... 92,614.00 TOTAL COMPLETED AND STORED TO DATE...........................a...... 13,717.63 5 % OF COMPLETED WORK 685.88 % OF STORED MATERIAL TOTAL RETAINAGE........................................................ 685.88 TOTAL EARNED LESS RETAINAGE ............................ 13,031.75 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ..................... LESS PREVIOUS CERTIFICATES FOR PAYMENT..-,,.....„ .............. . CURRENT PAYMENT DUE .................. 13,031.75 BALANCE TO FINISH INCLUDING RETAINAGE...................................... 49.582.25 State of- MN County of: Ramsey Subscribed and sworn to before me this . _ day of e "'xe NOTARY PUBLIC: Signed: "y�� taw; �u�al_l� M��(ISj}�;• _ f My Commission Expires: 4 - gry�r.-"r•^^+� 20 J Y Kendell Doors Hardware, Inc. CONTINUATION SHEET AIA DOCUMENT G703 AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: Contractor's signed certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: PAGE 2 OF 2 12/19/19 12/20/19 RJM Construction - Elk Rier Ice Arena & A B C D I E F G H I WORK COMPLETED ITEM SCHEDULED MATERIALS TOTAL o /o BALANCE TO NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS PRESENTLY STORED COMPLETED AND (G + C) FINISH (C - RETAINAGE (IF APPLICATION (D + THIS PERIOD (NOT IN D OR E) STORED TO DATE G) VARIABLE E) (D + E + F) RATE) Hollow Metal $84,079.00 $13,717.63 $13,717.63 16.32% $70,361.37 Finish Hardware $8,535.00 0.00% $8,535.00 F-1 GRAND TOTALS S92,614.00 $0 00 $13,717.63 $0.00 $13,717.63 14.81% $78,896.37 $0.00 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity AIA DOCUMENT G703 CONTINUATION SHEET FOR G702 1992 EDITION AIAOO O 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N W , WASHINGTON, D C 20006-5232 G703-1992 APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 2 SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Multi Purpose Facility and Lion John Weicht Park APPLICATION NO: 2 830 Boone Avenue North APPLICATION DATE: 12/18/2019 Golden Valley, MN 55427 PERIOD FROM: 12/1/2019 SUBMITTED FROM: Ebert Inc dba Eb ert Construction ARCHITECT: 292 Design Group 23350 County Rd 10 Corcoran, MN 55357 CONTRACT FOR: 6A: Carpentry CONTRACT NO.: I hereby certify that the work performed and the material supplied to date, as shown here, represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above - referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever, other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. 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 material and labor used in or in connection with the performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. PERIOD TO: 12/31/2019 PROJECT NO: 6979 CONTRACT DATE: COMMITMENT: ORIGINAL CONTRACT SUM.................................................................. $ 546,800.00 NET CHANGE BY CHANGE ORDERS TO ................................................ $ - CONTRACT SUM TO DATE................................................................... $ 546,800.00 TOTAL COMPLETED AND STORED TO DATE .......................................... $ 102,137.39 5 % OF COMPLETED WORK $ 5,106.87 5 % OF STORED MATERIAL $ - TOTALRETAINAGE............................................................................. $ 5,106.87 TOTAL EARNED LESS RETAINAGE....................................................... $ 97,030.52 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ $ - LESS PREVIOUS CERTIFICATES FOR PAYMENT .................................... $ 37,966.75 CURRENT PAYMENT DUE.................................................................... $ 59,063.77 BALANCE TO FINISH INCLUDING RETAINAGE........................................ $ 449,769.48 State of: Minnesota The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: Hennepin instrument. Subscribed and sworn to before me this Ebert Inc dba Eb ert Construction 18th day of December 20 19 23350 County Rd 10 Corcoran, MN 55357 NOTARY i=UBLIC: :;'' �' > ��_� CANDACE LEE GREEN SIGNED: Signed: i W_ NOTARY PUBLIC �" = �' TA My Commission Expires Jan. 31, 2022 PRINTED, TITLE Caleb Pelkey - roject Manager My Commission Expires: - -^' From: Ebert Inc dba Ebert Construction 23350 County Rd 10 Corcoran, MN 55357 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Schedule of Values Invoice No. Appl. No.: #2 Appl. Date: 12/18/19 From: Ebert Inc To: RJM Construction CURRENT APPLICATION TOTAL BALANCE RETAIN ITEM CURRENT PREVIOUS I WORK IN MATERL. I APPS. PERCENT TO TO NO. DESCRIPTION CONTRACT APPS. PLACE ON SITE TO DATE I COMPLETE COMPLETE 1 Bonds, Insurance Mobilize 55 000 00 DATE $5,000.00' $5,000.00 100.00% $250.00 2 General Conditions $21,000.00 $1,680.00! $2,520.00 $4 200 00 20.00% $16,800.00 $210.00 3 Allowance $50,000.00 1 $12,882.39 $12882.39 25.76% $37,117.61 $644.12 4 061000 Rough Carpentry M $59,700.00 $14,925.001 $23,880.00 1 $38 805.00 65.00% $20,895.00 $1,940.25 5 D61000 Rough Carpentry L $153,000 00 $18.360.001 $19 890.00 $38,250.00 25.00% $114 750.00 $1.912.50 6 061753 Shop Fam. Wood Trusses $3,000.00 $3.000.00 $3,000 00 100.00% $150.00 7 1064216 Wood Paneling $135,000 00 $135,000.00 8 072119 Foamed -In -Place Insulation $17,000 (10 $17,000.00 9 081113 HM Doors and Frames $81,000.00 $81.000.00 10 097733 FRP $4.500.00 $4,500.00 11 101100 Visual Display Boards $7,800 00 $7,800.00' 12 102600 Wall and Corner Guards $7,000 00 $7,000.00 13 105113 Metal Lockers ,. $2,800.00 14 15 16 17 18 19 20 21 22 I 23 I 24 25 TOTAL $546,800-001 $39,965.00. $62,172.39 $102,137.39 $444,662.61 $5,106.87 EXHIBIT E APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 0f 2 SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena APPLICATION NO: 1 830 Boone Avenue North 1000 School Street NW APPLICATION DATE: 12 / 16 / 19 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 11/25/19 SUBMITTED FROM: ARCHITECT: PERIOD TO: 12/16/19 Stevens Insulation, LLC 15751 Central Avenue NE Ham Lake, MN 55304 CONTRACT FOR: CONTRACT NO.: I hereby certify that the work performed and the material supplied to date, as shown here, represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above -referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, vernal or written, or any other arrangement of any type whatsoever,other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. I also certify that payments, less applicable retention, have been made through the period covered by previous payments received from the contractor to t} all my subcontractors (sub - subcontractors) and 2) for all material and labor used in or in connection with the performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanids liens or rights to claim any and all mechanic's Iiens or other liens against the above real estate or any ,part thereof for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. ORIGINAL CONTRACT SUM__ .................. NET CHANGE BY CHANGE ORDERS TO.--. CONTRACT SUM TO DATE-------- --------------- TOTAL COMPLETED AND STORED TO DATE. 5 % OF COMPLETED WORK 363.60 % OF STORED MATERIAL PROJECT NO: CONTRACT DATE: 12 / 6 / 19 COMMITMENT: ... .... $7, 272. 00 0.00 TOTAL RETAINAGE..... .................................................... TOTAL EARNED LESS RETAINAGE...................................... LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER..--.. LESS PREVIOUS CERTIFICATES FOR PAYMENT --------. CURRENT PAYMENT DUE...... ....... __ -_------------------------ BALANCE TO FINISH INCLUDING RETAINAGE--_-------------- state Of Minnesota The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this Instrument and to bind the undersigned hereto, and does in fact so execute this County of: Anoka instrument. Subscribed and sworn to before me this $7,272.00 ----_ ---- --- $7, 272. 00 --------- 363.60 $6,908.40 0.00 0.00 .$fi_9nR-4n ................ $363.60 16th day of December 1 24 19 _ NOTARY PUBLIC: SIGNED: Signed: Q,.6.,c PRINTED, TITLE Donnie Stevens, President My Commission Expires: 1/31/2020 RACHEL BOBEICA Nofory Public Mate of Minnesota My Commission Expires Januory 3 i , 2020 From: Stevens Insulation, LLC 15751 Central Avenue NE Ham Lake, MN 55304 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Schedule of Values Invoice No. Appl. No.: # 1 Appl. Date: 12 1 1 9 From: 11425 19 To: 12 16 19 2NO, DESCRIPTION CURRENT CONTRACT CURRENT APPLICATION TOTAL PREVIOUS F WORK IN MATERL. I APPS. APPS. PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN Tp DATE 1 Water roofing/weather Harriers 7,272.00 -7,272.00 :7, 272 . 00 100% 0.00 363.60 2 3 I F 4 5 6 _ 7 I I 8 9 10 11 12 I 13 14 15 16 I I 17 18 19 20 I I 21 22 - - 23 24 25 TOTAL 17,272.01 0.00 7,272.00 7 272 001 100% 1 0.00 1 363.60 Page 1 of 1 APPLICATION AND CERTIFICATE FOR PAYMENT SUBMITTED TO: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 SUBMITTED FROM: Top -All Roofing, Inc. 2231 Edgewood Ave. South Minneapolis, MN 55426 CONTRACT FOR: Roofing & Sheet Metal PROJECT: Elk River Ice Arena & Lion John Weicht Facilities 1000 School Street NW Elk River. MN 55330 ARCHITECT: CONTRACT NO.: Page 1 of 2 APPLICATION NO: Two (2) APPLICATION DATE: 12/23/2019 PERIOD FROM: 12/1/2019 PERIOD TO: 12/31/2019 PROJECT NO: 19005.00 CONTRACT DATE: 10/23/2019 COMMITMENT: YES/NO I hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUM ............................ ... .................... $ 1,020,690.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO............ . ............................. referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other than the CONTRACT SUM TO DATE ............................ . . $ 1,020,690.00 contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. I TOTAL COMPLETED AND STORED TO DATE .......... .... .......... $ 473,375.00 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) % OF COMPLETED WORK $ 23,668.75 subcontractors) and 2) for all material and labor used in or in connection with the performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's 5 % OF STORED MATERIAL $ Compensation laws insofar as applicable to the performance this contract. TOTAL RETAINAGE...................... ........ ........ _...... .. $ 23,668 75 TOTAL EARNED LESS RETAINAGE............ _... _ $ 449,706.25 PARTIAL WAIVER OF LIEN LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER.. _ .. $ Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICATES FOR PAYMENT .............. .. .. ..... $ 31,350.00 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE................................................................. $ 418,356.25 for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE................ .. ......... $ 570,983.75 State of: The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: keri (l"i n instrument. Subscribed and sworn to before me this Top -All Roofing, Inc. �1�J'rCi I--, rje l 2231 Edgewood Ave. South Minneapolis, MN 55426 n SIGNED: PRINTED, TITLE Lori Stevens, Project Accountant day of roLIe t-y r 1 , 20 NOTARY PUBLIC: QREW AGEN Signed: u b I i c {6 22 Y Commission Expires My Commission Expires: Januar S 1 . 2024 From: Top -All Roofing, Inc. 2231 Edgewood Ave. South Minneapolis, MN 55426 PLEASE SUBMIT PAYMENT APPLICATIONS TO To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 ACCOUNTING-MN@RJMCONSTRUCTION.COM Schedule of Values Invoice No. 1-19-0033-2 Appl. No.: #2 - (Two) Appl. Date: 12/23/19 From: 12/01/19 To: 12/31/19 ITEM NO. DESCRIPTION CURRENT CONTRACT CURRENT APPLICATION TOTAL PREVIOUS I WORK IN I MATERL. I APPS. APPS. PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 Material Insulation $384,950 $0 $192,475 $192.475 50.00% $192,475 $9,623.75 2 Material Vapor Barrier $50,600 $0. $25,300 $25,300 50.00% $25,300 $1,265.00 3 Material EPDM & Accessories $195.960 $0. $97,980 $97,980 50.00% $97,980 $4,899.00 4 Material Sheet Metal $32,040 $0 $0 $32,040 $0.00 5 Labor Insulation $80,070 $0. $40,035 $40,035 50.00% $40,035 $2,001.75 6 Labor Vapor Barrier $21,110 $0[$10,555 $10,555 50.00% $10,555 $527.75 7 Labor EPDM & Accessories $148,060 $0 $74.030 $74,030 50.00% $74,030 $3,701.50 8 Labor Sheet Metal $29,900 $01 I $0 $29,900 $0.00 9 Allowance for Conditions $45,000 $01 $0 $45,000 $0.00 10 Bonding $33.000 $33,000; $0 $33.000 100.00% $0 $1.650.00 11 12 13 1 14 15 16 17 18 I 19 20 21 22 23 I I 24 25 TOTAL 1 $1,020,6901 $33,0001 $440,375 $0 $473,3751 1 $547.3151 $23.668.75 Page 1 of 1 APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 2 SUBMITTED TO- RJM Construction, LLC PROJECT: Elk River Ice Arena APPLICATION NO: 5 830 Boone Avenue North Lion John Weicht Park Facilities APPLICATION DATE: 12/20/2019 Golden Valley, MN 55427 1000 School Street N.W PERIOD FROM: 12/1/2019 SUBMITTED FROM: Rink-Tec International, Inc. ARCHITECT: 292 Design Group PERIOD TO: 12/31/2019 3485 Willow Lake Blvd. Suite # 500 3533 E. Lake Street PROJECT NO: 19005 Vadnais Heights, MN 55110 Minneapolis, MN CONTRACT DATE: 7f312019 CONTRACT FOR: Elk River Ice Arena CONTRACT NO.: COMMITMENT: YESINO I hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUM .... ................... ............................. ............ $ 2,162,742.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO ................................................ S referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever, other CONTRACT SUM TO DATE................................................................. $ 2,162,742.00 than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liabifity therefor for the period covered by this TOTAL COMPLETED AND STORED TO DATE ........................................ S 549,000.00 application. I also certify that payments, less applicable retention, have been made through the 5 % OF COMPLETED WORK $ 15.990.00 period covered by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for all material and labor used in or in connection with the 5 % OF STORED MATERIAL $ 11,500.00 performance of this contract. I further certify that I have complied with Federal, State: and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's TOTAL RETAI NAG E.. ...........................................................,., ....... S 27,490.00 Compensation laws insofar as applicable to the performance this contract. TOTAL EARNED LESS RETAINAGE..................,,..,....................,.,....,... S 521,510.00 PARTIAL WAIVER OF LIEN LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ....................... $ - Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVJCUS CERTIFICAES FOR PAYMENT ..................................... $ 303,810.00 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE.........................................................,,......... $ 217,700.00 for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE..................................... ... $ 1,641 ,232.00 State of: Mfnnesota The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: Ramsey instrument. Subscribed and sworn to before me this Rink-Tec International, Inc. 20 day of Decem 3485 Willow Lake Blvd. Suite # 500 ! Vadnais Heights, MN 55110 NOTARY PUBU SIGNED: - , - 4vill Signed: t r PRINTED, TITLE Kyle Gillespie - President My Commission Expires: 31•Jan-23 From: Rink -Tee International Inc. 3485 Willow Lake Blvd., Suite #500 Vadnais Heights, MN 55117 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 65427 Schedule of Values Invoice No. Aoor. NO.: # Appl, pate: 12/20/2019 From:: 12/1/2019 To: 12/31 /2019 ITEM NO. DESCRIPTION CURRENT CONTRACT , CURRENT APPLICATION TOTAL PREVIOUS I WORK IN MATERL. I APPS. APPS, PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 Bondi n /Insurance/Permits $60,000 $60,000, $0 1 5 32% $0 $3,000 2 Mobilization $35,000 $35,000- $0 1 5.32% $0 $1,750 3 Reclaim & Demo Equipment Room # 1 $20,000 $20,000, $0 1 5.32Yo $0 $1,000 4 Rink #1 Saw Cutting/Removal $60,000 $60,0001 $0 I 2 $0 $3 000 5 Rink #1 Mains & Insulation $40,000 1 $20,000 5 $20,000 $1,000 6 Rink #1 SubfloorSystem $15,000 $15,000 7 Rink #1 Granular &Fine Grading $30,000 $30,000 8 Rink#1 Floor Insulation $44,000 $44,000 9 Rink #1Chairs/Vapor Barrier/Exansion $35000 I 530,0001 5 $5.000 $1,500 10 Rink#1 Rebar/Mesh $40,000 $20000 $0 1 3 $20,000 $1000 11 Rink #1 Headers & Tubing $100,000 i $30,000' S $70,000 $1,500 12 Rink #1 Concrete Placement /Finishing $90,000 , $90,000 13 Rink #2 Mains & Insulation $40,000 $20 000• 5 $20,000 $1,000 14 Rink #2 Subficor System $15,000 i $15,000 15 Rink #2 Granular & Fine Grading $30,000 $30,000 16 Rink #2 Floor Insulation $44,000 $44,000 17 Rink#21 ChairsNa or Barrier/Expansion $35,000 $30,000, 5 $5000 $11500 18 Rink#2 Rebar/Mesh $40,000 $20,0001 $0 1 3 $20,000 $1,000 19 Rink #2 Headers & Tubing $100,000 1 $30,000 5 $70,000 $1,500 20 Rink #2 Concrete Placement IRnishing $90.000 $90, 000 21 Con ressorlChiller/Rum s/Condenser $349,742 $104,800• $70,000a 4, 5 $244,942 $8 740 22 MCCIEIectrical $120,000 $120,000 23 Microprocessor $85,000 I I 585,000 24 Equipment Room Pi esNalveslTanks and Fittings $100.000 $100,000 25 Equipment Room PiRing Labor $140,000 $140,000 26 Ammonia Pipfng Labor $170,000 $170,000 27 Equipment Room Insulation and Labor $85,000 $85,000 28 Labeling/Painting/Water Treatment $40 000 1 1 $40.000 29 Refrigerants and Fluids $60,000 $60,000 30 Reclaim & Demo Equilpment Room # 2 $20,000 $20,000 31 Removal of Sand Floors stem $30,000 $30,000 32 33 TOTAL $2,162,742 5319,800 $0 $230,000 $41 $0 $1,682,9421 $27,490 Page 1 of 1 s �n a �Cf4LISTS OFF -SITE STORAGE AFFIDAVIT Kyle Gillespie, deposes and says: 1. He is the President/CEO of Rink-Tec International, Inc_ (supplier) (the "Undersigned") doing business at 3495 Willow Fake Blvd, Vadnais Heights, MN 55110, a Subcontractor under a certain Agreement dated the 31 day of July, 2019 in connection with Elk River Ice Arena — Lion John Weicht Park Facilities and that the materials listed in Pay Application #5 with a value of $230,000.00 are now stored at the following location: 6678 3991" Street, North Branch, MN 55056 2. The Undersigned will transfer to Contractor and Owner clear, marketable title to the materials, and they are not subject to any security interest or encumbrance upon delivery to jobsite. 3. The materials are stored in a safe and secure manner so as to preclude damage, theft or vandalism. 4. The materials are available now for inspection by the General Contractor and Owner ortheir representatives and access to the facility is available during normal business flours. S. The materials are now covered by ali risk insurance coverage for in -transit and stored materials. The insurance is in the name of the Contractor and Owner as named insured, as their interest may appear. The insurance is in an amount not less than 100% of the value of the material. The cost of such insurance has been borne by the Undersigned and shall remain in force until the material is transported to the project site upon payment/transfer of title. 6. The materials have been purchased or manufactured for the specific purpose of being used in the construction of the Project, are in accordance with the contract documents, and will be transported to the site at the Undersigned's expense, 7, The materials will remain on the premises until delivery to the above project site, except in an emergency that threatens the materials. 8. The Undersigned makes this affidavit in order to induce owner to pay for such material. 9. The materials are stored at an insured warehouse facility. State of M rp 42..54 1 County of R Signed and sworn to (or affirm ) before me on this -:26 - KATHY MARY F]ARFCN Nalary Public Minnesdla !r%s£ My Commisulan Ezplres N Jan3i,�9f By: Rink-Tec International, Inc Signed, Kyle dillespie, President/C O 3485 Willow Lake Boulevard, Unit 500, Vadnais Heights, MN 55110 651-481-1190 rinktec.com CERTIFICATE OF LIABILITY INSURANCE 7E(MM/DDNYYY) /23/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Matthew Cartier Cartier Agency, Inc. PHONE FAX 2631 W. Superior St A/C No Ext: (218) 727-5992 A/C,No: E-MAIL ADDRESS: ahess@caduluth.com Duluth MN 55816 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:western National 15377 INSURED (651) 481-1190 INSURERB:American Interstate Insurance 31895 Rink-Tec International Inc. INSURER C INSURERD: 3485 Willow Lake Blvd Suite #500 Vadnais Heights MN 55110 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 4808 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE IX I OCCUR CPP0020756 18 02/01/2019 02/01/2020 IREMSESOEaoccurrDence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO - POLICY PRO JECT ❑LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO CPP0020736 18 02/01/2019 02/01/2020 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LAB X OCCUR UMB0011474 18 02/01/2019 02/01/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LAB CLAIMS -MADE DED X RETENTION$ 10,000 Pers/Adv Injury $ 5,000,000 B TION AND EMPLOYERS' LIABILITY ANDEMPWORKERS YERS'LSAILIT Y/N AVWCMN2767402019 02/Ol/2019 02/Ol/2020 X STATUTE OERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE -EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Inland Marine CPP0020756 18 02/01/2019 02/01/2020Rented/Leased Equipment $ 150,000 A Property - Commercial CPP0020756 18 02/01/2019 02/01/2020 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project Name: Elk River Ice Arena and Lion John Weicht Park Facilities Stored Materials: Rink 1 and 2 Mains Piping and Insulation, Rink Chairs, Vapor Barrier and Expansion in total value of $230,000 The following entity's are included as additional insured with a waiver of subrogation in their favor: City of Elk River 13065 Orono Parkway NW Elk River, MN 55330 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RJM Construction 830 Boone Ave North AUTHORIZED REPRESENTATIVE Golden Valley MN 55427 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 2 EXHIBIT E APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 2 SUBMITTED TO: RJM Consiructlon„ LLC PROJECT: Elk River Multi Purpose Facility & APPLICATION NO: 1 B30 Boone Avenue N6rih Dion John Weicht Park APPLICATION DATE: 11-27-19 Golden Valley, MN 55427 PERIOD FROM! 11-1-19 SUBMITTED FROM: ARCHITECT: 292 Design Group PERIOD TO: 11-30-19 Seating And Athletic Facility Enterprises 3533 East Lake Street: PROJECT NO: 19005.00 79554 325th Street Minneapolis, YIN 55406 CONTRACT DATE: 7-11-19 Ellendale, MN 5602€ CONTRACT Fpp CONTRACT NO,. 19520-0033 COMMITMENT: 13' 3417 Leg Truss Bleacher S stem —Section hereby certify that the work performed and the material supplied to data, as shown here, ORIGINAL CONTRACT SUM.................................................................,. 125, 797. 00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Constructlon relating to the above -referenced NET CHANGE BY CHANGE GIRDERS TO ...............„............................... 0 , 00 project. I further certify that no labor or materials have been supplied under condrads, agreements, verbal or written, or any other arrangement of any type whalsoever,other than the CONTRACT SUM TO DATE ........ ..... 125 797' 00 conlract duly authorized and executed change orders, and the undersigned does hereby releases RJ{%l Construction from any claim or riability therefor for the period covered by this applicallun. l TOTAL COMPLETED AND STARED TO iJl'tiTt=........................................... 26,358.00 also cerlIfy 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- subcontracturs) and 2) for all rnaterlal and labor used In or in connection with the performance of °+4 OF COMPLETED WORK this contract. 1 further certify that I have complied with Federal. Slate, and bral tax laws, including Social Security laws, Unemployment Compensation Laws and WorkmaWs Compensation laws % OF STORED MATERIAL insofar as applicable to the performance this contract. TOTALRETAIf+PAGE.................. ............................................................ 1,317.90 TOTAL EARNED LESS RETAINAGE................ ......................................... LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this applicalion the LESS PREVIOUS CERTIFICATES FOR PAYMENT ..................................... undersigned does hereby irrevocably release and waive any and all mechanic`s liens or rights to 25,040.10 clalm any and all mechanic's liens or other Itens against the above real estate or any part Ihereof CURRENT PAYMENT DUE ... ..................... --........ --- .............. ............ for any of the materials andfor labopr therefore furnished or performed In connection with Ihis BALANCE TO FINISH INCLUDING RE7AINAGE.........................................100,756.90 proj.ecl, reserving. however, air rren rights for labor and/or materials furnished after said date. - Slate of. Minnesota The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does In fact so execute this County of. Freeborn instrument. Subscribed and Sworn to before me this SIGNED 27th dayof November NOTARY PUBLIC: Signed: PRINTED, TITLE President My Commission Expires: 20 19 T !C Churct►lil Nkmry Putbllic minnesma 11, 294 From:Seating And Athletic Facility Enterprises, LLC 79554 325th Street Ellendale, MN 56026 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Schedule of Values Invoice No. Appl. No.: # 1 Appl, Date: 11-27-19 From: Seat3.ng Anci AthJe-E-1-C7F—aCxlity Ent. To: ITEM NO. I DESCRIPTION CURRENT CONTRACT CURRENT APPLICATION TOTAL PREVIOUS i WORK IN MATERL. 1 APPS. APPS. PLACE ON SITE TO DATE PERCENT I COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 Bond 1,258,001,258.00 100 2 concrete 25 100.0 25,100.0 3 Materials Delivered I 1 4 Installation 5 6 7 1 1 8 9 10 11 12 1 13 ' 14 15 16 I i 17 ' 18 19 , 20 1 I 21 22 925 TOTAL Page 1 of 1 F,XHIBIT C APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 2 SUBMITTED TO: RJM Construclion, LLC PROJECT: Elk River Multi Purpose Facility & APPLICATPONNO: 2 830 acone Avenue North Lion John Weicht Park Golden Vafley, MN 55427 SUBMITTED FROM: Seating And Athletic Facility Enterprises 79554 325th Street Ellendale, MN 56026 CONTRACT F{�93417 Section 13 LLeTruss Bleacher System ARCHITECT: 292 Design Group 3533 East Lake Street Minneapolis, M 55406 CONTRACT NO,: 19520-0033 I Hereby certify that the work performed and 1.he material supplied to dare, as shown here, represenl the actual value of amumpflshmenl under the terms of the conlract (and all authorized changes hereto) between the undersigned and RJM Construction felaling to the above-refaranced project. l further certify that no labor or materials have been suppifed under conlracts, agreements, verbal or written, or any other arrangement of any typa whatsoever,other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. arse certify lhat payments, less applicable refenlicm, have been made through the period covered by prevfous payments received from the contractor to 1) all my subconlractors (sub - subcontractors) and 2) for all malerlal and labor used in or in connection with the performance of Ifils -contract. t further certify that I have compiled with Federal. Stale, and local lax fawn, indoding Social Security Paws, Unemployment Compensalion Laws and Workman's Cumpensallon laws insofar as applicable to the performance this contract. PARTIAL WAIVER OF LIEN Now therefore, upon rec;uipt or the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's, liens or other liens agarnst the above real estala or any part lhereof for any of the materials and/or labopr therefore furnished or performed In connection with this project, reserving, ho•,vever. all lien rights for labor andlor materials furnished after said date. The person signing below does hereby ceNty (hat hefshe is fully authorized and empowered to execute this instrument and to bind the undersigned herele, and does in fact so execute this instrument. SIGNED: f .r PRfNTED, TITLE President APPL I6:AT1L}N DAiE. 12 -18 --19 PERIOD FROM: 12 -1-19 PERIOD TO: 12-31-19 PROJECT NO: 19005.00 CONTRACT DATE: 7 -11-19 COMWTNIENT: ORIGJNAL CONTRACTSUM ............ --................................................. 125, 797 . 00 NET CHANGE BY CHANGE ORDERS TO ................................................. 0.010 CONTRACT SUM TO DATE.................................................................... 125, 797. 00 TOTAL COMPLETED AND STORED TO DATE.— ...... ............. 125, 797.00 % OF COMPLETED WORK % OF STORED MATERiAL TOTAL RETAINAGE....................... .............. .......... ......... I ................. ,... 6,289.85 TOTAL EARNED LESS RETAfNAGE......................................................... 119,507.15 LESS OWNER DJRECT PAYMENT BY PURCHASE ORDER ..................,...... LESS I REVIOU5 CERTIFICATES FOR PAYMENT ..................................... 25,040.10 CURRENT PAYMENT DUE,................................................................- 94,467.05 BALANCE TO FINISH INCLUDING RETAINAGE.......... ............................... 6, 289 . 85 Staleof: Minnesota County or: Freeborn Subscribed and swam to before me this 18th day of December 7-bi 9 NOTARY PUBLIC: Signed'. My Commission Expires-. ►+lobar Public Aftnewte ill C mamm E" iarKJ 11. 1, IZD A From: Seating And Athletic Facility Enterprises, LLC 79554 325th Street Schedule of Values Ellendale, MN 56026 Invoice No. Apal. No.: # 2 Appl, data12-IB-19 eating And AthietIc FacIlity Ent. PLEASE SuBMIFPAYMENT APPLICATIONSTO ACCOUNYING.MNQRJMCONSTRUCTION.CCM T®: To; RJIW Consiructlan, LLC 83fl t3oone Avenue North Golden Valley, MN 55427 CURRENT APPLICATION TOTAL BALANCE RETAIN ITEM: CURRENT PREVIOUS I WORK IN fMiATERL.. I APPS. PERCENT TO TO a DESCRIPTION CONTRACT APPS. PLACE ON SITE TO DATE COMPLETE COMPLETE RATE 1 Bond 1, 25 , I,258.40 lDt7 2 Oncre e 251100.0( as,iao.a 3 Materials De ivere I 1 83, 639 . Oil 100 4 Installation 15, 800. OG lU() . A 6 7 I 8 9 10 4 11 , 12 13 , 14 , 15 16 I 1 17 18 , 19 20 I I 21 22 , 23 24 25 TOTAL Page 1 of i APPLICATION AND CERTIFICATE FOR PAYMENT Page of SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena and Lion John Weicht Park Facilities APPLICATION NO: 4 830 Boone Avenue North 1000 School St. NW APPLICATION DATE- 12/16/2019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 12/1/2019 SUBMITTED FROM: Summit Fire Protection ARCHITECT: 292 Design Group PERIOD TO: 12/3112019 575 Minnehaha Avenue West 3533 East Lake Street PROJECT NO: 0 St. Paul, MN 55103 Minneapolis. MN 55406 CONTRACT DATE` 7/11/2019 CONTRACT FOR: Fire Sprinklers CONTRACT NO. 0 COMMITMENT: YESINO hereby certify that the work performed and the me"eriai supplied to date, as shown here, ORIGINAL CONTRACT SUM_ __ --------- ----------------------_ ___ ............. $ 256.485.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJPdi Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO ................. ............... ....... ____ $ 11,955.00 referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other CONTRACT SUM TO DATE.. . ...... ............................... ................ ........ S 268,440.00 than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this TOTAL COMPLETED AND STARED TO DATE......_.... ............................ $ 104,i81.00 application. I also certify that payments, less applicable retention, have been made through the 5 % OF COMPLETED WORK $ 5,209.06 period covered by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for all material and labor used in or in connection with the 5 % OF STORED MATERIAL $ performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, Including Social Security laws, Unemployment Compensation Laws and Workman's TOTAL RETAINAGE.............................................. $ 5.209.06 Compensation laws Insofar as applicable to the performance this contract. TOTAL EARNED LESS RETAiNAGE...__..............°-.,___.._.__.._...._........... S 98.971,94 PARTIAL WAIVER OF LIEN LESS OWNER ❑IRECT'OAYMENT BY PURCHASE ORDER ....................... $ - Now therefore, upon receipt of the ,payment of the current payment due on this application the LESS PREVIOUS CERTIFICAES FOR PAYMENT ...................................... $ 37,989,07 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DJE............ ........................ ................................ S 60,982.87 for any of the materials and/or labopr therefore furnished or performed in connection w'th this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE........................................ $ 169,468.06 State of. Minnesota The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: Ramsey instrument. Subscribed and swom to before me this Summit Fire Protection r ? 1 _ day of _ � c� tM. �� 20 1 575 Minnehaha Avenue St. Paul, MN 55103 NOTARY PUBLIC: q ,, ]nsHua Jaynes Scott SIGNED: Signed: �_ _ 'Notary rub+, - Minnesota $ F. + My Commwsslnii Eapkres 0 113 1I2020 PRINTED, TITLE Il, %Majl��l My Commission Expires: From: Summit Fire Protection 575 Minnehaha Avenue West St Paul. MN 55103 PLEASE SUBMIT PAYMENT APPLICATIONS TO; ACCOUNTING-MN@aRJMCONSTRUCTIC-N.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, Mtn 55427 Sche_d-u_le_of Values Invoice No. A15019563300004 Appl, Date: 12J16119 From; 12/01/19 To: 12/31119 ITEM NO- DESCRIPTION CURRENT CDNTRA IT CURRENT APPLICATION TOTAL PREVIOUS I WORK IN I MATERL. I APPS. APPS. PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 Labor $87.885.00 $8,788.50' $17,577.00 $26,365.50 30-00% $61.519.50 $1,318-28 2 Material $111.200.00 , $33,360.00 $33,360-00 30-00% $77.840.00 $1,668.00 3 Design $31,200.00 $31,200A0 $31,200.00 100.OD% 50.00 $1,560,00 4 Fabrication $20.200.00 1 $6,060.00 I $6.060.00 30,00% 514,140.00 $303,00 5 Bonds $6 000.00 $6 000.00 $6,000.00 100,00% $0.00 $300,00 6 Chan eDrder#1 $11,955.00 $1.195.50 $1,195-50 10,00% $10,759.50 $59.79 7 $0.00 0-000/0 $0.00 $0.00 8 4 $4.00 0,000ti $0.00 $0,00 9 $0.00 0-00% $0.00 $0,00 10 $0.00 0.00% si0.00 $0,00 11 $0,00 0.00% $0.00 50.00 12 $0.00 0.00% $0.00 $0.00 13 I I $0,00 0.00% $0.00 $0.00 14 $0,00 0,00% $0-00 $0.00 15 $0.00 0.00% $0-00 $0.00 16 50.00 0.00% $0.00 $O.OD 17 $0.00 0100% $0.00 SO -OD 18 I [ $0,00 0,00% $0,00 $0-40 19 $0-00 0.00% $0.00 $0.00 20 $0.00 0.00% $0,00 $0.00 21 $0.00 0.009'0 $0.00 $0.00 22 [ I $0,00 0,00% $0,00 $0.00 23 50-00 0.00% $0.00 $0.00 24 $0.00 0,00% $0.00 so.03 25 $0.00 0.00% $0.00 $0.03 TOTAL 1 $268,440,00 $39,988,50, $64,192.50 $0.00r $104,181.ODJ 38.81%1 $164,259.001 $5,209.05 Page . of ' .7 . APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 2 SUBMITTED TO: RJM Construction, U_C PROJECT: ELK RIVER MULTI PURPOSE APPLICATION NO: 5 830 Boone Avenue North ELK RIVER, MN APPLICATION DATE' 12120/2019 Golden Valley, MN 55427 0 PERIOD FROM: SUBMITTED FROM: Weidner Plumbing & Heating Company ARCHITECT: 0 PERIOD TO: PO Box #1087 0 PROJECT NO_ 0 St. Cloud. MN 56302 0 CONTRACT DATE: 7115/2019 CONTRACT FOR: PLUMBING WORK CONTRACT NO.: 0 COMMITMENT: YESINO I hereby certify that the work performed and the material supplied to date, as shown here. ORIGINAL CONTRACT SUM.................................................................. $ 1,206,000.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO ................................................ (474.00) referenced project- I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever, other CONTRACT SUM TO DATE .............. ............................... ,....... ,............. 1,205,526.00 than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor For the period covered by this TOTAL COMPLETED AND STORED TO DATE ............... $ 304,733-00 application. 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 5 % OF COMPLETED WORK $ 15,236.65 (sub -subcontractors) and 2) for all material and labor used in or in connection with the 5 % OF STORED MATERIAL $ - performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's TOTAL RETAINAGE............ ............... ............ ........,,.,.,...,................... $ 15,236.65 Compensation laws insofar as applicable to the performance this contract - PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic"s liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. The person signing below does here'oy verify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this instrument. Weidner Plumbing & Heating Company PO Box #1087 St. Cloud, MN 56302 SIGNED: PRINTED, TITLE PC C1�—_ i a 't� n TOTAL EARNED LESS RETAINAGE--_.,.,................................................ $ 289,496.35 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ....................... $ - LESS PREVIOUS CERTIFICAES FOR PAYMENT. .............................. $ 211.596.25 CURRENT PAYMENT DUE.................................................................... $ 77.900-00 BALANCE TO FINISH INCLUDING RETAINAGE........................................ $ 916,029.65 State of: J-�, 7 County of: �.K7 Subscribed and sworn to before me this day of An E�e_}_� 20 NOTARY PUBLIC: Signed: c 9" �a~, �hl W SCHENK W. Pohtio 7 SW8 W.. Minnesota My Commission Expires: / f (:. 4 lion Expires Rlt;1fV31, 2024 111---AIA Document G703` -1992 Continuation Sheet AIA Document G7021m-I992, Application and Certificate for Payment, or G732T.14-2009, APPLICATION NO: Page a Application and Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION DATE: 5 containing Contractor's signed certification is attached. 12/18j2019 In tabulations below, amounts are in US dollars. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 12/20/2019 A B C D I E F G H I WORK COMPLETED ITEM NO. DESCRIPTION OF WORK SCHEDULED MATERIALS PRESENTLY TOTAL COMPLETED AND % BALANCE TO FINISH RETAINAGE FROM PREVIOUS VALUE APPLICATION THIS PERIOD STORED STORED TO DATE GG � C' ( 1 iC _ Gj (If variable rcrde) (D - E) (Nnt in D or E) PIPING MATERIAL 1 0.105: BOND 10,333.00 10,333.00 0.00 0.00 10,333.00 100 0.00 516.65 2 0.109: ALLOWANCE 7,500.00 0.00 0.00 0.oD 0.00 0 7,500.00 0,00 3 0.115: PIPE & FITTINGS 235,689.00 76,000.00 48,000.00 0.00 124,000.00 53 111,689.00 6,200.00 4 0.119: DRAINS & CARRIERS 47,196.00 25,000.00 0.00 0.00 25,000.00 53 22,196.00 1,250.00 5 0.123: PUMPS & TANKS 5,400.00 0.00 0.00 0.00 0.00 0 5,400.00 0.00 6 0.127: WATER HEATERS 10.139: 82,739.00 0.00 0.00 0.00 0.00 0 82,739.00 0.00 7 0.137. PLBG FIXT & TRIM 79,004.00 1,5D0.00 0.00 0.00 1,500.00 2 77,504.00 75.00 8 MISC PLUMBING 42,488.00 2,200.00 0.00 0.00 2,200.00 5 40,288.00 110.00 510,349.00 115,033.00 48,000.00 0.00 163,033.00 32 347,316.00 8,151.65 PIPING LABOR 9 1.185: LABOR - PLUMBING 560,753.00 103,600.00 21,000.00 0.00 124,600.00 22 436,153.00 6,230.00 560,753.00 103,600.05 21,000.00 0.00 124,600.00 22 436,153.00 9,230.00 SUBCONTRACTS 10 0.300: DIGGING/BACKFILL 37,034.00 0.00 0.00 0.00 D.00 0 37,034.00 0.00 11 0.325: RENTALS 13,000.00 4,100.00 2,000.00 0A0 6,10100 47 6,900.00 305.00 12 0.360: PIPE COVERING 84,864.00 0.00 11,000.00 0.00 11,000.00 13 73,864.00 550.00 134,898.00 4,100.00 13,000.OD 0.00 17,100.00 13 117,798.00 855.00 13 0.300: CH ORDER #3 -2,980.00 0.00 0.04 0.00 0.00 0 -2,980.00 0.00 GRAND TOTAL CAUTION. You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703T1A -1992. Copyright @ 1963, 1966, 1956, 1967, 1970, 1978. 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA" Document is protected by U.S. Copyright Law and international Treaties. Unauthorized reproduction or distribution of this AIA' Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. n 210ACL AIA Document G703'" 1992 Continuation Sheet AIA Document G702T1-1992, Application and Certificate for Payment, or G732TK--2009, APPLICATION NO: Page Application and Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION DATE; 5 containing Contractor's signed eertiiication is attached. 1Z�18f 2(?19 In tabulations below, amounts are in US dollars. PERIOD TO; Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO. 12/20/2019 A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED AND °/a BALANCE TO FINISH RETAINAGE NO VALUE APPLICATION ICAT THIS PERIOD STORED STORED TO DATE ( G + C i (C - G) variable rare (lf ) (D + E) (Not in D or E) (D+E+F) 14 0.400: CH ORDER #4 2,506.00 0.00 0.00 0.00 0.00 0 2,506.00 0.00 GRAND TOTAL CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIR Document G783T" -1992. Copyright 01963, 1965, 1966, 1967, 197Q, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA .' Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AW Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. 101210ACD44 APPLICATION AND CERTIFICATES FOR PAYMENT Page of �� SUBMITTED TO: RJM Construction, LLC PROJECT: L� P—LUb7L Irtpg,f.Lri —Vuw-fwS(- APPLICATION NO: 334 Boone Avenue North VIVO LLoV Jow t&L-ic fr Ptx- -- APPLICATION DATE: 12--1"d-( f Golden Valley, MN 55427 J PERIOD FROM: l _ —1 SUBMITTED FROM: 5044-3117n Shy' r ARCHITECT: a<12— D�-5t610 C1kU) "1A PERIOD To: t2-31—/5 ,7 F` 0 2LV, 40r) PROJECT NO: / � Gi0 WA L M' 119 , .k, 14 r11 Sfo CONTRACT DATE: 7`10 --1 CONTRACT FOR: Z�34 Hv-ml nL Wsr&"ys CONTRACT NO.: COMMITMENT: YES/NO I hereby certify that the work performed and the material supplied to date, as shown here, represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above - referenced project. I further certify that no tabor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Constriction from any claim or liability therefor For the period covered by this application. 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 material and labor used in or in connection with the performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof for any of the materials andlor labopr therefore furnished or performed in connection with this project, reserving, however, ail lien rights for labor andlor materials furnished after said date. The person signing below does hereby verify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this instrument, ORIGINAL CONTRACT SUM_ NET CHANGE BY CHANGE ORDERS TO ................... I, .................. CONTRACT SUM TO DATE ....... ............. ................................... I ......... .., TOTAL COMPLETED AND STORED TO DATE .......................................... 5 % OF COMPLETED WORK $ L4[ % YE) 5 % OF STORED MATERIAL $ zz. TOTAL RETAINAGE............................................................................. $ L4r1J�'-S-T) TOTAL EARNED LESS RETAINAGE ........................ $ 2 S : 2—ir) LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ $ 40 '— LESS PREVIOUS CERTIFICATES FOR PAYMENT..... I Lj CURRENT PAYMENT DUE......—.— ...... ....... --- ................................ 5 uiiF BALANCE TO FINISH INCLUDING RETAfNAGE........................................ $ State of: County of:�✓ Subscribed and swom to before me this CONTINUATION SHEET AIA DOCUMENT" G703 (Instl'Llctitlnti L51h r�vcr,� till t t,��;>? dti r,��,{" AIA Document G702, APPLICATION AND CERTIFICKrE FOR PAYMENT, APPLICATION NO.: 4 cootfilning Cantr,tctor's signcd Ccrtfflc-mlon, I.; mmchccl. PROJECT: 23A-HVACSystems AIII�LiCATION IDNI'E: 12/1812019 III tghtflsulons L1clow, :111jounrs arc atjtcd to the iwni,est dolkii,, Elk River Multi -Purpose Facility and Lion John 1,71001] TO; 12/31/2019 Use Calt.ltlln 1 01) Contracts W11cl,e vitr.IaUle retnlnnge for I111c IwIll'N 11rty apply�Neicht Park ARCHITECT'.S l XQjr:CT NCI,; A Pa C: i7 E f' C1 1-1 1 fTCM SCHEDULED 1'VORK COMPI-LITCf7 hl�i'1'C1ilALti IIRESEN71.Y TOTAL COMPI-FTLD 13ALI INCU ItI"rAIINAL�fi Na OESCRIPTIO,N 01' WC AK VALLIC FROM PRLVtOLtS 'TI•IIS SVOVED AN1) S'1'0I(F1) t0 '. C-1 f1rJltill (lf VARIAM,F) APt'LICiAV10N VER100 (Nal. IN TO DIO'E ItA`i'Ii) (D + I;) C? OR E) (1)+V+V) 1 ICE ARENA $0.00 $0,00 $0.00 $0.00 $0.00 $0.00 $0,00 2 obilization-labor $5,000,00 $1,000.00 $0.00 $0.00 $1,000.00 20% $4,000.00 $50.00 3 obilization-mat'I $2,500.00 $0.00 $0.00 $0.00 $0,00 0% $2,500.00 $0.00 4 11VAC Demo -labor $15,000.00 $0.00 $0.00 $0.00 $0.00 0% $15,000.00 $0.00 5 HVAC Demo -mat') $5,000.00 $0.00 $0.00 $0.00 $0.00 0% $5,000.00 $0.00 8 30593 Test and Balance $22,000.00 $0.00 $0.00 $0.00 $0.00 0% $22,000.00 $0.00 7 30700Insulation $32,000,00 $0.00 $0.00 $0,00 $0.00 0% $32,000.00 $0.00 8 e 32300 Refrigeration Piping $55,000.00 $0.00 $0.00 $0.00 $0.00 0% $55,000.00 $0.00 9 d 50900 Controls $230,000.00 $27,789.00 $0.00 $0.00 $27,789.00 12% $202.211.00 $1,389.45 10 33000 Ductwork -labor $75,000.00 $4,500.00 $0-00 $0.00 $4,500.00 5% $70,500.00 $22&00 11 33000 Ductwork-mat'l $23,300.OD $1,000.00 $0.00 $0.00 $1.000,00 4% $22,300,00 $50.00 12 33000 Misc Round -labor $6,000,00 $0.00 $0.00 $0.00 $0.00 0% $8,00o.00 $0.00 13 33000 Misc Round-rnat'l $4,500.06 $0.00 50,00 $0,00 $0,00 0% $4,500,00 $0.00 14 33000 Spiral Pipe -labor $84,500.00 $0.00 $0.00 $0.00 $0.00 0% $84,500.00 $0.00 t5 330011 Spiral Pipe-mat'i $45,000.Oo $0.00 $0.00 $0.00 $0.00 0% $45,000.00 $0.00 16 33000 Fabric Duct -labor $2,500A0 $0,00 $0.00 $0.00 $0.00 0% $2,500.00 $0.00 17 33000 Fabric Duct -mat'# $4,000.00 $0.00 $0.00 $0.00 $0.00 0% $4,000.00 $0,00 le 33423 Fans/Hoods-labor $10,000.00 $0.00 $0.00 $0.00 $0.00 0% $10,000.00 $0.00 19 33423 Fans/Hoods-mat'i $22,000.00 $0,00 $0.00 $0.00 $0.00 0% $22,000.00 $0.00 20 33616 VAV Boxes -labor $8,000.00 $0.00 $0.00 $0.00 $0,01) 0% $8.000.00 $0,00 21 33616 VAV Boxes-mat'I $24,000.00 $0.00 $0.00 $0-00 $0.00 0% $24,000.00 $0,00 22 33713 G ri lies/Reg isters- labor $17,000,00 $0.00 $0.00 $D,00 $0.00 0% $17,000,00 $0.00 23 33713 GrilleslRegisters-mat'l $30,00b.00 $0.00 $0.00 $0,00 $0.00 0% $30.00D.00 $0.00 24 36213 ACCU -labor $4,000,00 $0.00 $0,00 $0.00 $0.00 0% $4,000,00 $0.00 25 36213 ACCU-mat'I $80,000,00 $0.00 $0.00 $0.00 $0.00 0% $80,000.00 $0,00 26 37400 Rooftop units -labor $44.000,00 $0-00 $5,000.00 $0.00 $5,000,00 11 % $39,000.00 $250.00 27 137400 Rooftop Units-mat'i $445,500.00 $0,00 $0.00 0.00 m 39289A4 3% 1 $1,258,511.0{} $1,964.45 w - A11% WFVV- • rrtc AMU,, 1C:AN Ir0 1T11I1-C L)M AlichH'VCT.; , 17,15 ML,w voitii ` AVI'NUi , fv, l:, 6siifMG7C?N, fi,t. 2000Cr5:t]' • WAiiNfNG; Unlltencad p11010copyln9 Vluiatea U.S. capyrighI laws and will sublecI (he violator to legal prosecution, G703-1992 CAUTION. You ahouid use an original AIA document which has this cautlon printed In red, An vrlglnal assures that changes will not be obscured as ntay occur when caacuments are reproduced. CONTINUATION SHEET AIA DOCUMENT G703 (111Si1'Llt1lW1$ 011 lcvcl'+e SILK) AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYM2NT, AI)PLiCATION NO,; 4 Ct 000ning Concr:lctar's sighed Curtiflcllrlon, is' -mmelicd. PROJECT., 23A-HVAC'Systems AllPLICATION IDNFE; 12/18/2019 In t}lbulatloas below, on)ounoi are Stitetd to the nc*m%:SS clall;ll'. Elk River Multi -Purpose Facility and Lion Jahn 1'EltIOD '1`03 12/3112019 Use C04111111 1 nn Col7t1-acts whet-C v;tr,Iuhlc ret,lln:tge fol' Illlc 1(e1111 jwly :q), lPeichtPark AACI-WCECT'S I'W{ IrC1' NO.; rs t: DWORIC tA CONPLVV12D TOTAL ISnLnNCEldr:'inlNnc IrROM PRevldtl5 eM OESCRIPTION OV' WCIiK ti�ricQUL D VALt}l VR1`,'E1�ln .YI'R1°,tiCNI l.Y Si'C}It�17 i {7M1'i.fiTLl7 AND ?l'lORPI) 1, I'f7 {Ir G'nitlAfSl,ii} l0. API'L]Cn'r'10N 'THIS VERIOD (NOT IN TO C)AI'E} t� A [:) lf�lillrl 1tATE) (D + 1:) t� r.7R t.} +I:T 26 38100 Paackaged AC Units -labor $6,000.00 $0.00 $1,000.00 $0.00 $1.000.00 1 17°% $5,000.00 $50,00 29 38100 Packaged AG Units- rnat'l $25.000.00 $0.00 $0,00 $0.00 $0.00 0°% $25,000.00 $0.00 30 38419 Desiccant Dehumid Units- $40,000.00 $0.00 $5,000.00 $0.00 $5,000.00 13% $35,000,00 $250.00 I ibor 31 38419 Desiccant Dehumid Units- $300,000.00 $0.00 $0.00 $0.00 $0.00 0% $300,000.00 MOO at'I 32 2321100 Hydronic Piping $80,000A0 $17,447-00 $0.00 $0.00 $17,447.00 22% 362,553.00 $872.35 33 t IONS PARK $0.00 $0,00 $0.00 $0.00 $0.00 $0,00 $0.00 34 obilizatiDn-labor $1,OQQ.00 $0.00 $0.00 $0,00 $0.00 0°% $1,000.00 $0.00 36 obilizatlon-mat'I $500.00 $0.00 $0.00 $0.00 $0,00 0°% $500.00 $0.00 36 uctwork-labor $2,500.00 $0,00 $0.00 $0.00 $0.00 0°% $2,500.00 $0.00 37 uctwork-mat'I $500.00 $0.00 $0,00 $0.00 $OAO 0°% $500.00 $0.00 36Grilles/Registers-labor $500,00. $0.00 $0.00 $0.00 $0.00 0% $500.0Q $0.00 39 rules/Registers-mat'I $200.00 $0.00 $0.00 $0.00 $0.00 0% $200.00 $0.00 40 F ans-labor $1,000.00 $0,00 $0.00 $0.00 $0.00 0°% $1,000.00 $0,00 41 F ans-mat'I $1,000.00 $0.00 $0.00 $0.00 $0.00 0% $1,000.00 $0.00 42 Permit $20,000.00 $20,000.00 $0.00 $0.00 $20,000.00 100°% $0,00 $1,000.00 43 Change Order 1 $7,692.93 $0.00 $0.00 $0,00 $0,00 0°% $7,692.93 $0.00 44 Ghange Order 2 $2,751.00 $0.00 $0.00 $0.00 $0.00 0°% $2,751.00 $0.00 45 hange Order 3 $49,9137.00 $0,00 $0.00 $0.00 $0.00 0°% $49,987-00 $0.00 Ata $82,736,00 5%a $1,753,694.93 $4.136.80 �,,, - i1"_ i,�i , li lv - Au"" • 1ry99. 11U AMERICAN INNIT1111T U1+ ARCHITICTN. 17.15 NLIV YCY N yAVV..NLIC, NW, WAtiliINGTQN, D,C, 00OG-4273 I WAANING; Unil,"e'd pholocopying vlolalas U.S. copyright laws and will sublecl the vinlaSor to leg el proyecvllon. G703-1992 CAUTN3N; You should use an ❑rlgin3l AIA docurrlenl which has this causkan printed In red, An original assures lhTl changes wJ11 not be ooscured as may occur when documents are reproduced. EXHIBIT E APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 3 SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena & John Weicht Park Facilities APPLICATION NO: 4 830 Boone Avenue North 1000 School Street NW APPLICATION DATE: 12/18/2019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 12/01 /2019 SUBMITTED FROM: Design Electric, Inc. ARCHITECT: 292 Design Group PERIOD TO: 12/31 /2019 4807 Heatherwood Road 3533 East Lake Street PROJECT NO: St. Cloud, MN 56301 Minneapolis, MN 55406 CONTRACT DATE: 7/10/2019 CONTRACT FOR: 26 00 00 Electrical CONTRACT NO.: COMMITMENT: I hereby certify that the work performed and the material supplied to date, as shown here, represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above -referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. 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 material and labor used in or in connection with the performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. ORIGINAL CONTRACT SUM................................................................... 1,786,914,00 NET CHANGE BY CHANGE ORDERS TO.................................................-32,807.14 CONTRACT SUM TO DATE.. ...................................... .......... I .............. TOTAL COMPLETED AND STORED TO DATE .................... 5 % OF COMPLETED WORK 12,199.60 % OF STORED MATERIAL 1, 754,106.86 243 992.07 TOTALRETAINAGE.............................................................................. 12,199.60 TOTAL EARNED LESS RETAINAGE........................................................ 231 ,792.47 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ......................... PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICATES FOR PAYMENT.— ................ ........ ....... 185,329.87 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE..................................................................... 46,462.60 for any of the materials andlor labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE......................................... 1,522,314.39_ _ State of: MN .I r.rueger LIC The person signing below does hereby cerify that he/she is fully authorized and empowered to Y t'4J4TA execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: BentonTA instrument. Subscribed and sworn to before me this 18 day of December 20 19 NOTARY PUBLIC: SIGNED: Signed: 155111 PRINTED, TITLE es Schoon, VP My Commission Expires: 1 /31 /2020 From: Design Electric, Inc. 4807 Heatherwood Road St. Cloud, MN 56301 Schedule of Values Invoice No. 05075-4 Amt. No.: # 4 Avvi. Date: 1211812 19 '— PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MNi§RJMCONSTRUCTION.COM Fmm: To: To: RJM Construction, LLC A B C D E F G H I Itcm No,EPa1ue 17 Drxriptian a£VVork CHANGE ORDER GM ASI #7, PGO #17 - CHANGE RTU 3 Scheduled 396.5: Work Completed D&tcnaiz Pres�y Stored 04ot in D or 3) 0.00 Totem %4 Completed and (G i C) Stared to Date (D+E+F) 0.00 0 Ralanec To Finis 396.52 Pre, Taus Application 0.00 -Iis Period 0.00 0 Tows 1 1,754,106.96 195,084.07 49,908.00 0.00 243,992.07 14 1,510,1.14.79 12,199.60 APPLICATION AND CERTIFICATE FOR PAYMENT Page Of SUBMITTED TO: RJM Construction, LLC PROJECT: Elk River Ice Arena APPLICATION NO: 6 830 Boone Avenue North 1000 School Stret NW APPLICATION DATE: 12/20/2019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM: 12/1/2019 SUBMITTED FROM: Minnesota Utilities & Excavating ARCHITECT: 292 Design Group PERIOD TO: 12/31/2019 13932 Lake Drive 3533 East Lake Street PROJECT NO: 0 Forest Lake, MN 55025 Minneapolis, MN 55406 CONTRACT DATE: 1/0/1900 CONTRACT FOR: City of Elk River CONTRACT NO.: 0 COMMITMENT: YES/NO I hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUM................................................................ . $ 572,787.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO........... ..................................... $ 87,954.30 referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other CONTRACT SUM TO DATE ....................................................., $ 660,741.30 than the contract duly authorized and executed change orders, and the undersigned does hereby TOTAL COMPLETED AND STORED TO DATE., .............................,......... $ 399,479.00 releases RJM Construction from any claim or liability therefor for the period covered by this application. I also certify that payments, less applicable retention, have been made through the 5 % OF COMPLETED WORK $ 19,973.95 period covered by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for all material and labor used in or in connection with the 5 % OF STORED MATERIAL $ - performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's TOTAL RETAINAGE............................................................................ $ 19,973.95 Compensation laws insofar as applicable to the performance this contract. TOTAL EARNED LESS RETAINAGE..................... ............................ $ 379,505.05 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER. . . $ PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICAES FOR PAYMENT .................................. $ 360,505.05 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE..............................-............-........................ $ 19,000.00 for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE......... .......................... $ 281,236.25 The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and doss in f liINIto this instrument. _W ix Minnesota Utilities & Excavating 13932 Lake Drive J001 LYNN RUSS NOTARY PUBLIC � MINNESOTA My CoMmwlon EVIres Jan. 31, 2021 Forest Lake, MN 55025rr_cre�o� 1 SIGNED:/,, 0� PRINTED, TITLE I�G�ew.l��L State of: County of: Subscribed and sworn to before me this day of 49L12?,k 20 �! NOTARY PUBLIC: Signed: My Commission Expires: _�/'� �Z From: Minnesota Utilities & Excavating, LLC 13932 Lake Drive Forest Lake, MN 55025 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Schedule of Values Invoice No. Appl. No.: #6 Appl. Date: 12/20/19 From: 12/01 /19 To: 12/31 /19 ITEM NO. DESCRIPTION CURRENT CONTRACT CURRENT APPLICATION TOTAL PREVIOUS I WORK IN MATERL. I APPS. APPS. PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 Earthwork $572,787.00 $324.349.70' $20.000,00 $344,349.70 0.00% $228,437.30 $17,217. 99 2 $0.00 0.00% $0.00 $0.00 3 1 $0.00 0.00% $0.00 $0.00 4 I I $0.00 0.00% $0.00 $0.00 5 $0.00 0.00% $0.00 $0.00 6 CO #1 $43,459.00 $21,730.00' $0.00 $21.730.00 0.00% $21,729.00 $0.00 7 CO #2 $26.672.30 $26,672.30, $0.00 $26.672.30 0.00% $0.00 $0.00 8 CO #3 $3,570.00 $3,570.00F $0.00 I $3.570.00 0.00% $0.00 $0.00 9 CO #4 $3,157.00 $3.157.001 $0.00 I $3.157.00 0.00% $0.00 $0.00 10 CO #5 $11,096.00 $0,00 0.00% $11,096.00 $0.00 11 $0.00 0.00% $0.00 $0.00 12 $0.00 0.00% $0.00 $0.00 13 I I $0.00 0,00% $0.00 $0.00 14 $0.00 0.00% $0.00 $0.00 15 $0.00 0.00% $0.00 $0.00 16 $0.00 0.00% $0.00 $0.00 17 $0 00 0.00% $0.00 $0.00 18 I I $0.00 0.00% $0.00 $0.00 19 $0.00 0.00% $0.00 $0.00 20 $0.00 0.00% $0.00 $0.00 21 $0,00 0.00% $0.00 $0,00 22 I I $0.00 0.00% $0.00 $0.00 23 $0.00 0.00% $0.00 $0.00 24 $0.00 0.00% $0.00 $0.00 25 $0.00 0.00% $0.00 $0.00 TOTAL $660,741.301 $379,479.00. $20,000 00 $0.00, $399,479.00 6046%1 $261,262.301 $0.00 Page 1 of 1 F RJM Construction 830 Boone Ave N Golden Valley, MN 55427 Safety Signs LLC 19784 Kenrick Ave. Lakeville, MN 55044 952-469-6700 Fax 952-469-6689 Job ID: 018824 Lions Park Drive Lions Park Drive Elk River, MN INVOICE Invoice Date Invoice No. 11 /15/9019 19009309 Terms: Net 30 Days Customer Customer Job No. Customer P.O. No. Period Covered Foreman Name / Phone# RJM 19520-0033 10/16/2019 - 10/31/2019 Date For Traffic Control Services From - To Qty Days Units Price Total 10/16/19 Drum 10/16 10/31 10 16 160 $0.90 $144.00 10/16/19 T2 w/ Sidewalk Closed 10/16 10/31 2 16 32 $4.10 $131.20 10/16/19 Type 3 Barricade 10/16 10/31 1 16 16 $3.00 $48.00 10/16/19 T3 w/ Road Closed Plate (48 x 30) 10/16 10/31 1 16 16 $4.10 $65.60 10/31/19 Demobilization 1 1 $100.00 $100.00 10/31/19 Demobilization 1 1 $150.00 $150.00 INVOICE SUBTOTAL $638.80 SALES TAX (incl. if applicable) $0.00 TOTAL CHARGES $638.80 PLEASE PAY THIS AMOUNT $638.80 *** Job Complete *** Page 1 ZRti APPLICATION AND CERTIFICATE FOR PAYMENT SUBMITTED TO: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 SUBMITTED FROM: Ebert Construction 23350 County Road 10 Corcoran, MN 55357 CONTRACT FOR: 3213: Concrete Sidewalks / Curb & Gutter PROJECT: Elk River Ice Arena & Lion John Weicht Park Facilities 1000 School Street NW; Elk River, MN 55330 104 Lions Park Drive: Elk River. MN 55330 nzy:lirrx.�� CONTRACT NO. hereby certify that the work performed and the material supplied to date, as shown here, represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above - referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever, other than the contract duly authorized and executed change orders, and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. 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 material and labor used in or in connection with the performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. 292 Design Group 0 0 Ebert Job #6968 ORIGINAL CONTRACT SUM....... NET CHANGE BY CHANGE ORDERS TO ............. CONTRACT SUM TO DATE ..................................... Page of APPLICATION NO: 39 APPLICATION DATE: PERIOD FROM: PERIOD TO: PROJECT NO: #6968 CONTRACT DATE: 7/10/2019 COMMITMENT: 0 TOTAL COMPLETED AND STORED TO DATE .............................. 5 % OF COMPLETED WORK 5 % OF STORED MATERIAL TOTAL RETAINAGE................... TOTAL EARNED LESS RETAINAGE $ 2,313.70 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ................ PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICAES FOR PAYMENT...... undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE ..................................... for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE......... The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this instrument. Ebert Construction 23350 County Road 10 Corcoran, MN 55357 SIGNED: �AA PRINTED, TITLE :(7L ,�C PI-0 j GC-4— Vn<,cyf $ 387,400.00 ....... $ (4,106.97) ....... $ 383,293.03 $ 46,283.23 ....... $ 2,313.70 ....... $ 43,969.53 ....... $ ....... $ 40,086.85 ....... $ 3,882.68 ....... $ 339,323.50 State of: `jet County of: Subscribed and sworn to Ilefore me this day of 20 NOTARY PUBLIC: Signed: �%_F-� r _ •-•. ,, ef^I`Infi7 ;A My Commission Expires: , 7:Q1 From: Ebert Construction 23350 County Road 10 Corcoran, MN 55357 763-498-7844 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Schedule of Values Invoice No. 3 Appl. No.: # Date: From: ITEM NO, I DESCRIPTION General Conditions _ MPB - Walks - Materials CURRENT CONTRACT I CURRENT APPLICATION TOTAL PREVIOUS I WORK IN MATERL. I APPS. APPS. PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 $14,700.00 $4,769' $2,534.79 $7,303 49.68% $7,397 $365 2 $30,617.00 $744. _ $744 2.43% $29,873 $37 3 MPB - Walks - Labor $44,082.00 $1,071 $1,071 2.43% $43,011 $54 i 4 MPB - Curb - Materials $18,273.00 $2,1801 1 $2,180 11.93% $16,093 $109 5 MPB - Curb - Labor $22,333.00 $2,6641 $2,664 11.93% $19,669 $133 6 Lion - Walks - Materials $83,053.00 $0 o00%1 $83,053 $0 _ 7 Lion - Walks - Labor $123 318.00 $0 0.00% $123,318 $0 8 Lion - Curb - Materials $18,461.00 $13,8461 1 $13,846 75.00%1 $4,615 $692 9 Lion - Curb - Labor $22,563.00 $16,9221 1 $16,922 75.00%1 $5,641 $846 10 Allowance $10,000.00 $5,659 $5,659 56.59% $4,341 $283 11 Chance Order 1 $3,311.40 $3,311.40 $3,311.40 100.00% $0.00 $166 12 Cnan e Order 2 -$1,570.47 -$1,570.47 -$1,570.47 100.00% $0.00 -$79 13 Change Order 3 -$4,286.00 I-$4,286.00 I-$4,286.00 100.00% $0.00 -$214 14 Chance Order 4 -$1,561.90 -$1,561.90 -$1,561.90 100.00% $0.00 -$78 15 $0.00 0.00% $0.00 $0.00 16 _ $0.00 0.00% $0.00 $0.00 17 $0.00 0.00% $0.00 $0.00 18 I I $0.00 0.00% $0.00 $0.00 19 $0.00 0.00% $0.00 $0.00 20 $0.00 0.00% $0.00 $0.00 21 $0.00 0.00% $0.00 $0.00 22 I _r 1 $0.00 0.00% $0.00 $0.00 23 �I $0.00 0.00% $0.00 $0.00 24 $0.00 0.00% $0.00 $0.00 25 $0.00 0.00% $0.00 $0.00 TOTAL 1 $383,293.03 $42,196' $4,087 _ $0. $46,2831 12.08% $337,0101 $2,314 Page 1 of 1 APPLICATION AND CERTIFICATE FOR PAYMENT SUBMITTED TO: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 SUBMITTED FROM: Ebert Construction 23350 County Road 10 Corcoran, MN 55357 CONTRACT FOR: 3213: Concrete Sidewalks / Curb & Gutter PROJECT: Elk River Ice Arena & Lion John Weicht Park Facilities 1000 School Street NW; Elk River, MN 55330 104 Lions Park Drive; Elk River, MN 55330 ARCHITECT: 292 Design Group 0 0 CONTRACT NO.: Ebert Job #6968 I hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUM ......................... represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO.......... referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever, other CONTRACT SUM TO DATE ............................. than the contract duly authorized and executed change orders, and the undersigned does hereby TOTAL COMPLETED AND STORED TO DATE... releases RJM Construction from any claim or liability therefor for the period covered by this application. I also certify that payments, less applicable retention, have been made through the 5 % OF COMPLETED WORK $ period covered by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for all material and labor used in or in connection with the 5 % OF STORED MATERIAL $ performance of this contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's TOTAL RETAINAGE Compensation laws insofar as applicable to the performance this contract. Page of APPLICATION NO: 3 APPLICATION DATE: PERIOD FROM: PERIOD TO: PROJECT NO: #6968 CONTRACT DATE: 7/10/2019 COMMITMENT: 0 .................................... $ 387,400.00 .................................... $ (4,106.97) ...........I......................... $ 383,293.03 .................................... $ 46,283.23 2,314.16 ................ I .............. ..... S 2,314-16 TOTAL EARNED LESS RETAINAGE....................................................... $ 43,969.07 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ..................... $ - PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICAES FOR PAYMENT ..................................... $ 40,086-85 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof CURRENT PAYMENT DUE.................................................................... $ 3,882.22 for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING RETAINAGE...................................... $ 339,323.96 State of: The person signing below does hereby cerify that he/she is fully authorized and empowered to Ll execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: instrument. Subscribed and sworn to before me this 1 Ebert Construction ' O day of`20 I G 23350 County Road 10 Corcoran, MN 55357 NOTARY PUBLIC: SIGNED: Signed: PRINTED, TITLE Davl 5wlagjo+/� ►m�eG^i-/Mana r My Commission Expires: From: Ebert Construction 23350 County Road 10 Corcoran, MN 55357 763-498-7844 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Schedule of Values Invoice No. 3 Appl. No.: # Date: From: To: ITEM NO. _ _ DESCRIPTION _ CURRENT CONTRACT CURRENT APPLICATION TOTAL PREVIOUS I WORK IN MATERL. I APPS. APPS. PLACE ON SITE TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 General Conditions MPB - Walks - Materials MPB - Walks - Labor MPB - Curb - Materials MPB - Curb - Labor $14,700.00 $4,769' $964 $5,733 39.00°/ $8,967 $287 2 $30,617.00 $744. $744 2.43%1 $29,873 $37 3 $44,082.00 $1,07LI $1,071 2.43% $43,011 $54 4 $18,273.00 $2,1801^ I $2,180 11.93% $16,093 $109 $133 5 $22,333.00 $2,664; $2,664 11.93% _ $19,66 6 Lion - Walks - Materials S83.053.00 SO 0.00%1 $83,053 SD 7 Lion - Walks - Labor $123,318.00 $0 0.00% $123,318 $0 8 Lion - Curb - Materials $18,461.00 $13,8461 1 $13,846 75.00% $4,615 $692 9 Lion - Curb - Labor $22,563.00 $16,9221 1 $16,922 75.00% $5,641 $846 10 Allowance $10,000.00 $5,659 $5.659 56.59% $4,341 $283 11 Chanue Order 1 S3,311.40 $3,311.40 $3,311.40 100.00% $0.00 $166 12 Chanrte Order 2 -$1,570.47 $0.00 0.00% -$1,570.47 $0 13 Chance Order 3 -$4,286.00 I -$4 286.00 I-$4,286.00 100.00% $0.00 -$214 14 ChanaeOrder 4 -$1,561.90 -$1,561.90 -S1,561.90 100.00% $0.00 -$78 15 $0.00 0.00% $0.00 $0.00 16 $0.00 0.00% $0.00 $0.00 17 $0.00 0.00% $0.00 $0.00 18 I I $0.00 0.00% $0.00 $0.00 19 $0.00 0.00%1 $0.00 $0.00 20 $0.00 ().00%1 $0.00 $0.00 21 $0.00 0.00% $0.00 $0.00 22 1 1 $0.00 0.00% $0.00 $0.00 23 I 1 S0.00 0.00% so.001 $0.00 24 $0.00 0.00% $0.001 $0.00 25 _ S0.00 _ D.00% $0.00 $0.00 TOTAL S383,293.03 $42,196. $4,087 $0.'� $46,283 12.08% $337,010 $2,314 Page 1 of 1 APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 Of 2 SUBMITTED TO. RJM Constructlon, LLC PROJECT Elk River Ice Arena and Lion John Weicht Park Facilities APPLICATION NO: 4 630 Boone Avenue North 1000 School Street NUJ APPLICATION DATE. 12J2312019 Golden Vatey. MN 55427 Elk River, MN 55330 PERIOD FROM: 12/1/2019 SUBMITTED FROM: METRO UTILITIES, INC. ARCHITECT: 292 Design Group PERIOD TO: 12131 J2019 9656 161st Avenue NW 3533 East Lake Street PROJECT NO: 0 Elk River, MN 55330 Minneapolis MN 55406 CONTRACT DATE: 711112019 CONTRACT FOR. SITE UTILITIES (33A: Utilities) CONTRACT NO_: 4 COMMITMENT: YESJNO I hereby certify that the work performed and the material supplied to date, as shown here, represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above - referenced project. I further certify that no labor or materials have been supplied under contracts, agreements, verbal or written. or any other arrangement of any lype whatsoever, other than the contract duly authorized and executed change orders and the undersigned does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. 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 material and labor used in of in connection with the performance of this contract. I further certify that I have complied with Federal. State, and local tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Campensation laws insofar as applicable to the performance this contract. PARTIAL WAIVER OF LIEN Now therefore, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate of any part thereof for any of the materials andJor labopr therefore furnished or performed in connection with this project. reserving, however, all lien rights for labor andlor materials furnished after said date. ORIGINAL CONTRACT SUM .............. ...............................................,,,. $ 586.000A00 NET CHANGE BY CHANGE ORDERS TO..... .........................,..,.,............ $ 33 037-15 CONTRACT SUM TO DATE .............................. ,,,....,,....................... ...,. S 619,037 15 TOTAL COMPLETED AND STORED TO IOATE...............,,......................... S 603.127.85 5 % Of: COMPLETED WORK S 30,156.39 5 % OF STORED MATERIAL $ - TOTAL RETAIN,AGE............................................... .................. ,,. $ 30.156.39 TOTAL EARNED LESS RETAINAGE....................................................... S 572,971.46 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ........................ $ - LESS PREVIOUS CERTIFICAES FOR PAYMENT. ................ .................... S 545,623.00 CURRENT PAYMENT DUE........ .. . ................................................... S 27.348.46 BALANCE TO FINISH INCLUDING RETAINAGE........................................ $ 46,065.69 State of: Minnesota The person signing below does hereby verify that he.rshe is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of Hennepin instrument. Subscribed and sworn to before ire this METRO UTILITIES, INC. 23rd day of December 9656 161 st Avenue NUJ ElkRiver Mtn 55330 NOTARY PUBLIC: f 1 q SIGNED- i Signed: (PRINTED, TITLE Dale VanNurden !Corp. Secretary My Commission Expires; 1'3V2025 20 19 STEVEN J. +CROSBY _Notaryr Publi*-Minnesota My Cmmftkn Ex*as,m at, 2025 From: METRO UTILITIES, INC. 9656 161st Avenue NW Project: Schedule of Values Elk River, MN 55330 ELK RIVER MULTI -PURPOSE FACILITY & Invoice No. 191847.5 LION JOHN WEICHT PARK Appl. No.: #5 1000 School Street NW. Elk River MN 55330 PLEASE SUBMIT PAYMENT APPLICATIONS TO: ACCOUNTING-MN@RJMCONSTRUCTION.COM To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 Appl. Date: 12/23/19 From: 12/01 /19 To: 12/31 /19 ITEM NO. DESCRIPTION CURRENT CONTRACT ' CURRENT APPLICATION TOTAL PREVIOUS WORK IN MATERL. 'PPS. APPS. I PLACE ON SITE I TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 Mobilization/Bond $24,500 $24,5001 $24,500 100.00% $0 $1,225 2 Watermain $75,800 $72,920' $72,920 96.00% $2,880 $3,646 3 Sanitary Sewer $37,200 $30,400, $30,400 82.00% $6,800 $1,520 4 Storm Sewer $448,500 $446,52OF $446,520 99.60% $1,980 $22,326 5 6 Change Orders/Extra Work: 7 C0#1 $4,249 $0, 0.00% $4,249 $0 8 CO#2 $16,229 $01 $16,229 1 $16,229 100.00% $0 $811 9 CO#3 $12,559 $0 $12,559 $12,559 100.00% $0 $628 10 11 12 I I 13 14 15 16 I I 17 18 19 20 I I 21 22 23 24 25 TOTAL 1 $619,0371 $574,340• $28,788 $0'. $603,1281 98.00%1 $11,6601 $30,156 Page 1 of 1 Invoice Invoice Date 12/ 14/2019 ® Customer No 59396 F Customer Reference I9320-0033 Invoice Address RJM Construcitgon, Inc. 830 Boone Avenue North Gold Valley, MN 55427 Base Contract $ 1,190, 000.00 Change Orders Total Contract $ 1,190,000.00 Total completed to date 80% $ 949,000.00 Retainage 5 % of contract $ 47,450.00 Total completed less Retainage $ 901,550.00 Less Previous Applications for Payment $ 621,775,00 Current Payment Due $ 279,775.00 Invoice No 40516 Revised Fabcon Reference 012813 Delivery Address Elk River Recreational Facilities 1 ODD School Street NW Elk River. MN 55330 Period December, 2019 Payment Terms Due Upon Receipt Interest will be charged on all Past Due amounts in accordance with rates and terms agreed on in the ❑ringal contract. Please pay from this invoice, no statements issued. State sales tax is included in the contract price when applicable. Fabcon Precast, LLC Please Remit To: 12520 Quentin Ave. S., Suite 200 Fabcon Precast, LLC Savage, MN 55378 12520 Quentin Ave. S., Ste. 200 952-890-4444 0 Fax 952-882-7298 Savage, MN 55378 i Zolr_�, APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 2 SUBMITTED TO: RJM Construction, LLC PROJECT; Elk River Ice Arena & APPLICATION NO: 2 830 Boone Avenue North Lion John Weicht Park Facilities APPLICATION. DATE: 12/14/2019 Golden Valley, MN 55427 Elk River, MN 55330 PERIOD FROM- 12/0112019 SUBMITTED FROM: Fabcon Precast, LLC ARCHITECT: 292 Design {Group PERIOD TO: 12l3112019 12520 Quentin Ave. S., Suite 200 3533 E Lake Street PROJECT NO. 012813 Savage, MN 55378 Minneapolis, MN 55406 CONTRACT DATE: 7/100019 CONTRACT FOR: precast concrete panles CONTRACT NO.: 0 COMMITMENT: YES/NO I hereby certify that the work performed and the material supplied to date, as shown here, ORIGINAL CONTRACT SUM ........... ......... ._,_,_........................................ $ 1,190,000.00 represent the actual value of accomplishment under the terms of the contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above- NET CHANGE BY CHANGE ORDERS TO ... ................. ........... .---------- ...,._ S - referenced project. I further certify that no labor or materials have been supplied under CONTRACT SUM TO DATE_ _ ......... 5 1,190,000.00 contracts, agreements, verbal or written, or any other arrangement of any type whatsoever,other than the contract duly authorized and executed change orders, and the undersigned does hereby TOTAL COMPLETED AND STORE€? TO DATE .......................................... S 949,000.00 releases RJM Construction from any claim or liability therefor for the period covered by this application. I also certify that payments, less applicable retention, have been made through the 5 % OF COMPLETED WORK $ 47,450,00 period covered by previous payments received from the contractor to 1) all my subcontractors 5 % OF STORED MATERIAL $ (sub -subcontractors) and 2) for all material and labor used in or in connection with the performance of this contracL I further certify that I have complied with Federal, State,. and local TOTAL RETAINAGE..................... ...................................................._... S 47,450.00 tax laws, including Social Security laws, Unemployment Compensation Laws and Workman's Compensation laws insofar as applicable to the performance this contract. TOTAL EARNED LESS RETAINAGE..............._.„_,,.................................. S 901,550.00 PARTIAL WAIVER OF LIEN LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER ......:................. $ Now therefore, upon receipt of the payment of the current payment due on this application the LESS PREVIOUS CERTIFICAES FOR PAYMENT............ ...............__....._... S 621,775.00 undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other Gens against the above real estate or any part thereof CURRENT PAYMENT DUE..... .... ........................ ........... S 279,775.00 for any of the materials and/or labopr therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. BALANCE TO FINISH INCLUDING REIAINAGE........................................ $ 288,450.00 State of: MINNESOTA The person signing below does hereby cerify that he/she is fully authorized and empowered to execute this instrument and to bind the undersigned hereto, and does in fact so execute this County of: SCOTT instrument. Subscribed and sworn to before me this 12/14/2019 14 day of December 20 19 Fabcon Precast, LLC '" .r � NOTARY PUBLIC: �(/f�� J yaelF_ S1-!AR{3N SIGNED: ram`"" T +.` L Signed: �r 'Z.�. K FA$RY PRINTED, TITLE ! ack Becker !Credit Manager ' My Commission Expires: 1131/2024 PUBLIC. MINNESM _c0AdMMQNE]iPlraDT131!24 From: Fabcon Prccast, LLC 12520 Quentin Ave. S., Suite 200 Savage, MN 55378 952.890-4444 Precast concrete panels PLEASE SUBMIT PAYMENT APPLICATIONS TO: To: RJM Construction, LLC 830 Boone Avenue North Golden Valley, MN 55427 ACCOUNTING-MN@RJMCONSTRUCTION. COM Schedule of Values Invoice No. Appl. No.: #2 - 40516 Revised Appf. Date.. 1211412019 From.• 12J01/2019 Tvr 12131/2019 ITEM NO. DESCRIPTION CURRENT CONTRACT • CURRENT APPLICATION TOTAL PREVIOUS WORK IN MATERL. APPS. APPS. PLACE ON SITE • TO DATE PERCENT COMPLETE BALANCE TO COMPLETE RETAIN TO DATE 1 lEngineering 26,200.00 26,200.00i 0.00 0.00m 26.200.00 100.00% 0.00 1,310.00 2 Manufacturing 628,300.00E 628,300.00E 0.00 0.00E 628.300.00 100.00% 0.00 31,415.00 3 Delivery & Erection 535,500E00 0.00. 294,500.00 0.00E 294.500-00 55.00% 241,000.00 14,725.00 4 5 6 7 8 I I 9 10 a1 12 13 14 15 16 17 18 19 I I 20 21 22 23 24 25 TOTAL 1,190,000-001 654,500,00E 294,50 .001 0001 949,000-001 80,00%1 241,000.00 47,450.00 Page 1 of 1 I ICI V 0 I C E INVOICE DATE: 12/17/19 qdpWELLS INVOICE NO: 012029 PRECAST I INNOVATORS BILLING NO; 2 FOR PERIOD ENDING: 12/31/19 PROJECT DESCRIPTION: ELK RIVER ICE ARENA & PARK FACILITIES PROJECT LOCATION: ELK RIVER MN EMAIL TO: Accounting- MN -Orj mconstruction.com BUYERS SUBCONTRACT NO.: 0 WELLS CONCRETE JOB NO.: 7104 TO: RIM CONSTRUCTION LLC 830 BOONE AVE NORTH GOLDEN VALLEY MN 55427 REMIT TO: WELLS CONCRETE PO BOX 656 ALBANY, MN 56307-0656 SCHEDULED COMPLETE PREVIOUS ITEM DESCRIPTION I TO -DATE VALUE THIS INVOICE UNBILLED VALUE % INVOICES ENGINEERING & DRAFTING $ 36,999.32 100% $ 36,999.32 $ 36,999.32 $ - $0.00 PRODUCTION / MATERIALS $ 610,538.78 66% $ 401,609.73 $ - $ 401,609.73 $209,929.05 FRFCTION $ 277,461.90 0% $ - $ $ - $277,461.90 0 $ 0% $ - $ $ $0.00 RETENTION 5% $ (21,930.45) $ (1,849.97) $ (20,080.491 TOTALS $ 925,000.00 47% $ 416,678.60 $ 35,149.35 $ 381,529.24 $486,390.95 PLEASE PAY THIS AMOUNT UPON RECEIPT OF INVOICE - > $ 381,529.24 Visit us on-line at: www.wellsconcrete.com THANK YOU FOR YOUR BUSINESS. APPLICATION AND CERTIFICATION FOR PAYMENT, Construction Manager as Adviser Edition AL4 DOCUMENT G702 TO OWNER: PROJECT: ELK RIVER ICE ARENA & PARK FACILITIES APPLICATION NO: 2 Distribution to: RIM CONSTRUCTION LLC ELK RIVER MN OWNER 930 BOONE AVE NORTIT PERIOD TO: 12/31/2019 CONSTRUCTION MANAGER GOLDEN VALLEY MN 55427 CONTRACT FOR: RCHITECT ONTRACTOR 5TELD FROM CONTRACTOR: CONTRACT DATE: 7/I0/2019 WELLS CONCRETE VIA CONSTRUCTION PO BOX 656 MANAGER: PROJECT NOS:. ALBANY, MN 56307 VIA ARCHITECT: Contract for Bid Package: CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, iu connection with the Contract. Tbc undersigned Contractor certifies that to the best ofthe Contractor's knowledge, information and belief the Work covered by this Application for Payment has been d` 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 berein is now due. I ORIGINAL CONTRACT SUM S 925.000.00 CONTRACTOR: IC p 2. NET CHANGE BY CHANGE ORDERS 3. CONTRACT SUM TO DATE (Line I ± 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. 5% % of Completed Wark (Column D + E on G703) b. 0% % of Stored Material (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) b. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 nuns Line 6) $ 21,930.45 $0.00 $0.00 S 925,000,00 S 438,609.05 By:%4---- Date State of: MINNESOTA County of STEARNS Subscribed and swo fore we this 17 day of December Notary Public: My Commission expires: 1 j 1 J o a 12/17/19 i C 2019 n Z co � ti M $ 21,930,45 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on an -site observations and the data g $ 416,679,60 comprising the application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, $ 35,149-35 the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. $ 381,529.24 AMOUNT CERTIFIED ..................... $ 381,529.24 $ 508,32140 (Attach explanation if amount certified drffersfrom the amount applied. Initial all figures on this Application and owhe Continuation Sheet that are changed to conform with the amount certifred) CONSTRUCTION MANAGER: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ Total approved this Month TOTALS NET CHANGES by Change Order By: Date: ARCHITECT: (NOTE: If Multiple Prime constrictors are responsible for performing portions of the Project, the Architect's Certification is not required.) By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance ofpayment are without prejudice to any rights of the Owner or Contractor under this Contract. ALA DOCUMENT 3702 - APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION - AIA - 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE, N.W., WASHINGTON, CC 20000-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. CONTINUATION SHEET AIA DOCUMENT G703 In tabulations below, amounts are stated to the nearest dollar. PROJECT NO: 7104 APPLICATION NO: 2 PROJECT NAME: ELK RIVER ICE ARENA & PARK FACILITIES APPLICATION DATE: lV17/19 ELK RIVER MN PERIOD ENDING: 12/31/19 A B C ➢ E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE FROM PREVIOUS THIS PERIOD NO. VALUE PRESENTLY COMPLETED (Cr/q TO FINISH APPLICATION STORED AND STORED (C-G) 5% (D+E) (NOT IN TO DATE D ORE) (D+E+F) ENGINEERING & DRAFTING $36,999.32 S36,999.32 $0.00 $0.00 $36,999.32 100% $0.00 $1,849.97 PRODUCTION MATERIALS $610,539.78 $0,00 $0.00 $401,609.73 $401,609.73 66% $208,929.05 $20,080.49 ERECTION $277,461.90 $0.00 $0.00 $0.00 $0.00 0% $277,4611.90 $0.00 $0.00 $0.00 $0.00 $0.00 S0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 S0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0,00 $0.00 $0.00 $0.00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTALS S925,000.00 $36,999.32 $0.00 S401,609.73 $438,609.05 47% S486,390.95 $2I,930.45 WELLCOM-01 DERSHI `� CERTIFICATE aF LIABILITY INSURANCE D TE( !7 fY l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Heartman insurance 1606 E. Main Street Albert Lea, MN 56007 C TAC7 PAHrCO, No E,, : (507) 373-6446 FAX No :(507) 373-8424 E-MAI info heartman.Corn INSU R S AFFORDING COVERAGE NAiC N INSURER :Travelers 19038 INSURED The Wells Companies, Inc and its subsidiaries PO Box 656 Albany, MN 56307-0656 INSURER a :Charter Oak Fire Insurance Company 25615 INSURER C:Cincinnati Insurance Company 10677 INSURER D : INSURER E : INSURER F - 17PVIQlnkt IUI IMRFR• I,VYCRMUGA v�r",,v THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBRwin Awn. POLICY NUMBER POLICY EFF POLICY BxP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS -MADE F_X] OCCUR X X 630-9F284958 411/2019 4/112020 DAMAGETORENTED ee 100,000 MED EXP (Any oneperson) 5,000 PERSONAL&ADV INJURY 1,000,600 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ® jFe7 n LOG GENERAL AGGREGATE S 2,000,000 PRODUCTS -CCMPIOPAGG 2,0001000 A OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a 1,000,000 S BODILY INJURY Per a son X ANY AUTO X X 810-80563318 411/2019 41112020 BODILYINJURYPeraccldenl AUQSONLY AUTOSLILED IRECH DULI�p X AUTOS ONLY rxA11T05 ONLY Pe0accltlenl AMAGE A X UMBRELLA LIAR EXCESSLIAs X OCCUR CLAIMS -MADE CUP-1J604373 41112019 411/2020 EACH OCCURRENCE $ ,000,000 AGGREGATE 6 ,OOD,000 DED I X I RETENTIONS 10,000 B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIErORIPARTNERIEXECLrTIVE OFFICERIMEMBI;IEXCLUDED? a (Mandatory in hIH] Ives, describe under SCRIPTIONOFOPERATIONSbelow Leased Rented Equip N!A UB3K310176 660.8A136732 411/2019 411/2019 41112020 4/112020 PER OTH- �( A LIFT ER E.L. EACH ACCIDENT 600,000 E.L. DISEASE - EA EMPLOYE 500,000 E.L. DISEASE -POLICY LIMIT Leased Rented Equip 600,000 S 1,500,000 C Excess Umbrella EXS 0379319 41112019 41112020 Excess Umbrella 6,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule maybe attached IF more • ce in required), WC Job# 7104. Project- Elk River New Cammunity Center. RJM Construction, LL6, City of Elk River, 292 Design Group and all other parties per written contract are named as additional Insured on a primary & non-contributory basis with respects to the General Liability. Waiver of subrogation applies to the General Liability. Automatic additional insured & Waiver of subrogation an the Auto Liability coverage. Umbrella follows form. Should the insurance company cancel the above insurance for any other reason than non-payment of premium 30 day notice will be mailed. The Work Comp coverage is for the following states Iowa, South Dakota, Colorado, and Wisconsin. Minnesota is self- insured. Stored materials in the amount of $401.609.73. t+AKIPCI I ATIAhF ucrcr rri%om r nv, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RJM Construction THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 830 Boone Ave N Golden Valley, MN 55427 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) Oa 198E-2015 AGpRU L;[ kpCjKA i iON. Aii ngnis reserves. The ACORD name and logo are registered marks of ACORD OFF -SITE STORAGE AFFIDAVIT John M Kloos , deposes and says: 1. He is the Controller of WELLS CONCRETE PRODUCTS (supplier) (the "Undersigned") doing business at 210 INSPIRATION LANE, ALBANY, MN 56307 a Subcontractor under a certain Agreement dated th@10th day of July, 2019 In connection with Elk River Ice Arena - Lion Weicht Park Facilities and that the materials listed in Pay Application #2 - with a value of 401,609.73 are now Stored at the following location: 210 inspiration Lane, Albany, MN 56307 2. The Undersigned will transfer to Contractor and Owner clear, marketable title to the materials, and they are not subject to any security interest or.encumbrance upon delivery to jobsite. 3. The materials are stored in a safe and secure manner so as to preclude damage, theft or vandalism. 4. The materials are available now for inspection by the General Contractor and Owner or their representatives and access to the facility is available during normal business hours; S. The materials are now covered by all risk insurance coverage for in -transit and stored materials, The insurance is in the name of the Contractor and Owner as named insured, as their interest may appear, The insurance is in an amount not less than 100% of the value of the material. The cost of such Insurance has been borne by the Undersigned and shall remain in force until the material is transported to the project site upon payment/transfer of title. 6. The materials have been purchased or manufactured for the specific purpose of being used in the construction of the Project, are in accordance with the contract documents, and will be transported to the site at the. Undersigned's expense, 7, The materials will remain on the premises until delivery to the above project site, except in an emergency that threatens the materials, S, The Undersigned makes this affidavit in order to induce Owner to pay for such material. 9. The materials are stored at an insured warehouse facility. By: WELLS CONCRETE PRODUCTS Signed: State of County of fy Signed and sworn to (or affirm�) before me on this 2—Lp (day), DmQA �R L_. % D l c-'4uA�.. - 4 Signature of not My Commission Expires: T ZZO 23 ff STACY MARIE SCHWANTZNOTARY PUBLiC•fViINNE8 TAy Comm, Exp. Jan. 31, 2023 IIIr - WELLS I i�i V D I C INVOICE DATE:. 11/25/19 INVOICE NO: 011068 BILLING NO: 1 FOR PERIOD ENDING; 11/30/19 PROJECT DESCRIPTION: ELK RIVER ICE ARENA & PARK FACILITIES PROJECT LOCATION: ELK RIVER MN EMAIL TO: BUYERS SUBCONTRACT NO.: 0 WELLS CONCRETE JOB NO.: 7104 TO: RIM CONSTRUCTION LLC 930 BOONE AVE NORTH GOLDEN VALLEY MN 55427 REMIT TO: WELLS CONCRETE PO BOX 656 ALBANY, MN 56307-0656 ITEM DESCRIPTION SCHEDULED COMPLETE TO -DATE VALUE PREVIOUS THIS INVOICE UNBILLED VALUE % INVOICES ENGINEERING & DRAFTING $ 36,999.32 100% $ 36,999,32 $ $ 36,999.32 $0.00 PRODUCTION / MATERIALS $ 610,538.78 0% $ $ $ - $610,53&78 ERECTION $ 277,461.90 0% $ $ $ $277,461,90 0 $ - 0% $ $ $ $O.DO RETENTION 5% $ (1,849,97) TOTALS $ 925,000-00 4% $ 35,149.35 $ PLEASE PAY THIS AMOUNT UPON RECEIPT OF INVOICE Visit us on-line at; www.wellsconcrete.com $ (1,849.97) $ 35,149.35 $888,000.68 $ 35,149.35 THANK YOU FOR YOUR BUSINESS.. RECEIVED FjJM Construct'On APPLICATION AND CERTIFICATION FOR PAYMENT, Construction Manager as Adviser Edition TOOWNER: PROJECT. ELK RIVER ICE ARENA& PARKtACILITIES A11111 It kHONNO* I R3M CONSTRUCTION LLC ELK RIVER MN 930 BOON'E AVE NORTH PERIOD TO: GOLDEN VALLEY MN 55427 CONTRACT FOR: FROM CONTRACTOR- CONTRACT DATE: WELLS CONCRETE VIA CONSTRUCTION PO BOX 656 MANAGER: PROJECT NOS- ALTIANY. MN 56307 VIA ARCHITECT: t uulreru Cur Hid PIICIuty;C:' CONTRACTOR'S APPLICATION FOR PAYMENT Appiiestiosi is made for payment, as shown Wow. in connection vti i:,. ; :. ; :,tract. Continuation Sheet, AIA Document 6703, is attached. I. ORIGINAL CONTRACT SLIM z. NET CHANGE 8V CHANGE ORDERS 3. CONTRACT SUM TO DATE (Line 1 i 7) a- TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5, RETAINAGE: a. 5% %ofCompleied Work (Coliorin D I E on G703) b. 0% % of Stored Mine7rial (Colttmn F on G703) Total Reminage (Lines 5a + % or Total in Column I ol`Ci703) k TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7, LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE. 9. BALANCE TO FINISH, INCLUDING RETAINAGE S ILine 3 minus Line 6) m.•l I rOt'UMENT G702 Distribution toy HOWNER 11130/2019 CONSTRUCTION MANAGI-R ARCHITECT CONTRACTOR 7110/2019 HFIELD The undersigned Contractor certiles that to the beau of the Contractor's knowledgC. information and lrelief the Work covered by this Application for Payment has becn compteted 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 die Owner, acid that cw=ir payinent shown herein is now due. S 925,400.00 CONTRAC"70R. cn tin ] %L J,VVV.InI S 36,999.32 S 1,84997 S6 tk) By:71 _ Date: Statcof: MINN TA County or STL•ARNS Suhscxibcd d s po V et r}de iW ,4 /1 25 day of November Not c_ / f My Comm) n expires: y� i 11/25/19 2019 s 1.1W9.97 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site obsmnarions acid the data S 35.149,35 comprising the application, the architect certifies to the Owner that to the best of the .Architect's knowledge, mrionnation and hdiof the Work has progressed as indicated, 5 the quality ofthe Work Is in accordm= with the Contract Documentn_ acid the Contractor is entitled to payment of die AMOUNT CERTIFIED. S 35.I49,35 AMOUNT CERTIFIED . . ......... ... .. $ 35,149.35 S 889.950.65 {Attach explaaanon +f aroom' lerrfrfied dif irx.fram the amount appherl Initial alffignrxr ua 110s Appheation and anthe CouraivanwF :freer that are changred in conform with the antnunt certtird) CONSTRUCTION MANAGER: CHANGE ORDER SUMMARY ADDITIONS DEDUMONS Total changes approved in previous months by Owner 5 - S - Tmal approved this Montt 5 5 TOTALS S S NET CHANGES by Chat,ge Order 5 By: Pate: ARCHITECT: ( NOTE If Multiple Prime consiractors are responsible for performing poniour, ofulie Project, Ilie Architect's Ceitificarion is not required.) I3y: Date: This Certificate is not netrotiabtc. The AN40UNT CERTIFIED is payable- only to die Contractor named harem. issuance, M7nrnt and acceptance of poymcm are without prejudice to any rights of the Owner or Contractor under this Contract AIA OOI'UMENr arOT APPPTION m40 CERTinCATIoN FOR PAYMENT 1942 U,7 0t. A'A m -99: TKy , A pERIC„M M I I I UTE or ARIZWTECT5. 1735 NEW YORK AVE N'W W. WASHINGTON. DC "OO&5292 Users may obtain valldation of this document by requesting a completed MA Document D401 - Certification of Document's Authenticity from the Licensee, CONTINUATION SHEET AIA DOCLIML-NT6703 In labulalions below, amounts we stated to the nearest dollar PROJECT NO: 7104 APPLICATION NO PROJECT NAME: ELK RIVER ICE ARENA& PARK FACILITIES APPLICATION DATE` 111,25/19 ELK RIVER MN PERIOD ENDING, 1 Imfl9 N � B C 17 1 - _ F 0 H I DESCRIPTION OF WORK SC14EDULED -E _ WORK COMPLETED MATERIALS TGrAL. % BALANCE RETAINAGE FROM PREVIOUS THIS PERIOD VALUE PRESENTLY COMPLETED 'G/C) TO FINISH APPLICATION STORED AND STORED (C-0) 5% (134E) SNOT IN TO DATE D OR E) (D+E+F) ENGINEERING & DRAFTING $36,999.32 $0.00 $36,()99.32 $0.00 $36.9".32 100% $0.00 S 1 _849 97 PRODUCTION 1 MATERIALS $610338.78 S0,00 $0.00 $0.00 $000 0% S610,538.78 $000 ERECTION $277,461.90 $0.00 $000 $0.0 $0.00 0% S277,46190 So()() $0.00 $0,00 $000 $0.00 $0.00 S0-00 50,00 S0.01) S().O() $0,00 $0.00 $0.00 $0.00 $0.00 S000 S000 $0,00 $0.00 $0.00 s0-00 $0.00 S0.00 $000 $0,00 S000 $0.0 $0-0() $0.00 S000 $0.00 $0.00 S()()() $0.00 $0.00 S0.00 sow $0.00 $0.00 $000 $0.00 5000 $000 S() DO $0.00 S0.00 $0.00 $0.00 $000 S0.00 $000 $0.00 $0.00 $().no $0.00 $000 $0.00 50.00 $0.00 50.00 S000 $0.00 so-00 $0,00 $0.00 S0.00 $0.00 $0,00 $0.00 $0.00 $0,00 $0.00 50.00 50.00 S0,00 $0.00 s0-00 $0.00 $000 $0.00 50.00 $000 $0 60 $0-00 $0,00 TOTALS - I $925,000,00 N0A) $36,999.32 $0.00 S36,999.32 4% $888,000.68 S1,849.97 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER: PROJECT. BFXS9211E-0 RIM CONST J ELK RIVER ICE ARENA APPLICATION NO.: 018Qsltribution to: 830 BOONE AVE N 1000 SCHOOL ST NW PERIOD TO: 11/30/2019 ❑ OWNER ELK RIVER MN J El ARCHITECT GOLDEN VALLEY, MN 55427 PROJECT NOS.: FROM CONTRACTOR: Molin Concrete Products Co VIA ARCHITECT: /19/2019 El CONTRACTOR 415 Lilac Street CONTRACT DATL ❑ Lino Lakes, NfN 55014-1005 19-9211 ❑ CONTRACT FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- 1. ORIGINAL CONTRACT SUM ... 1,013,283.00 ments received from the Owner, and that current payment shown herein is now due. 2 . Net change by Change Orders ............... $ 47,642.00 CONT fACTOR: Molin Concrete Products Co 3 CONTRACT SUM TO DATE (Line 1 t 2) ........ $ 4. TOTAL COMPLETED & STORED TO DATE ...... $ (Column G on G703) 5. RETAINAGE: a• —fig4% of Completed Work (Columns D + E on G703) b. % of Stored Material (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) ....... 1,060,925.00 106,092.50 5,304.64 $ 5 304.64 6. TOTAL EARNED LESS RETAINAGE , , ........ 8 Inn 787.86 (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) $ 0.00 8. CURRENT PAYMENT DUE ...... , .. , . $ 100,787.86 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $_ 960,137.14 CHANGE ORDER SUMMARY_ ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 47,642.00 Total approved this Month 47,642.00 TOTALS 47.642.00 NET CHANGES by Change Ordert By: Date: I aW l q State of: MINNESOTA County of: ANOKA Subscribed and sworn to before me this day of Notary Public: My Commission expires: ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ............:.................. $ (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) ARCHITECT: By: — Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor 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 - APPLICATION AND CERTIFICATE FOR PAYMENT - 1992 EDITION - AIA° - ©1992 - THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006-5292 - WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution, G702-1992 r_ CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents am rpnrnrlurrul rM iAlA Document G703 _ 1992 Continuation Sheet AIA Document G702Tk-1992, Application and Certificate for Payment, or G732T"L2009111E-00001 Application and Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION I`lO: 11/30/2019 containing Contractor's signed certification is attached. APPLICATION DATE: 11/30/2019 In tabulations below, amounts are in US dollars. Use Column I an Contracts where variable retains g Yapply. a for line items may PERIOD TO: 19-9211 ARCHITECT'S PROJECT NO: — E F G H I -� WORK COMPLETED 1 1O N" DESCHEDULEDSCRIPTION OF WORK NO. VALUE FROMPREVIOUS APPLICATION THIS PERIOD (D + E) 7100 Precast Plank 7200 Precast Beams 7500 Precast Stadia 8100 Labor - Plank 8200 Labor - Beams 8400 Labor - Stadia 8600 Misc/Trucking Totals GRAND TOTAL 7,838.00 347, 040.00 117,851.00 1,964.00 94,282.00 175, 631.00 783.80 34, 704.00 11,785.10 196.40 9,428.20 17, 563.10 MATERIALS TOTAL PRESENTLY COMPLETED AND STORED STORED TO DATE (Not in D or E) (D+E+F) 783.80 34,704.00 11,785.10 196.40 9,428.20 17,563.10 % (G=C) 10.00 10.00 10.00 10.00 10.00 10.00 BALANCE TO FINISH (C - G) 284Xd7-1 -- 7,054.20 312,336.00 106,065.90 1,767.60 84,853.80 158, 067.90 RETAINAGE (If variable rate) 1,581.60 39.19 1,735.20 589.26 9.82 471.41 878.16 304.64 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures thatchanges hh nges will not be obscured. AIA Document G703T07 —1992. Copyright ©1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA' Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA°'Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, a -mail The American Institute of Architects' legal counsel, copyright@aia.org. ia�s�oncoao APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER: RIM CONST PROJECT: ELK RIVER ICE ARENA APPLICATION NO.: BFXS9211E-000,gAtribution to: 830 BOONE AVE N 1000 SCHOOL STNW PERIOD TO: 12/31/2019 ❑ OWNER GOLDEN VALLEY, MN 55427 ELK RIVER MN PROJECT NOS.: ❑ ARCHITECT FROM CONTRACTOR: Molin Concrete Products Co VIA ARCHITECT: CONTRACT DATA/19/2019 El CONTRACTOR 415 Lilac Street ❑ Lino Lakes, NIN 55014-1005 19-9211 ❑ CONTRACT FOR: C®NTRAC'T®1�'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- L ORIGINAL CONTRACT SUM .................. $ 1,013,283.00 ments received from the Owner, and that current payment shown herein is now due. 2. Net change by Change Orders .. ..... $ 47,642.00 CONTRACTOR: Molin Concrete Products Co 3. CONTRACT SUM TO DATE (Line 1 t 2) .... , ... $ 1,060,925.00 4. TOTAL COMPLETED & STORED TO DATE .. , ... $ 636,555.00 (Column G on G703) 5. RETAINAGE: a. egg_% of Completed Work (Columns D + E on G703) b• % Of Stored Material (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) ... $ 31,827.78 21 R77 7R 6. TOTAL EARNED LESS RETAINAGE........ $ 604,727.22 (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) ................. $ 100,787.86 8. CURRENT PAYMENT DUE ................. $ 503,939.36 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 456,197.78 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in 47,642.00 previous months by Owner Total approved this Month 47.642.00 TOTALS 47.642.00 NET CHANGES by Change Order By: Date: ��On State of: MINNESOTA County of: ANOKA Subscribed and sworn to before me this day of Notary Public: My Commission expires: ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ............................... $ (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) ARCHITECT: By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor 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 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA® • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G702-1992 so®i CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reorodur.Pd_ 7" _ Docuent G703TM ®1997 Continuation Sheet AIA Document 13702TM-1992, Application and Certificate for Payment, or G732T"4-2009, Application and Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION NO. 12/18/2019 containing Contractor's signed certification is attached. APPLICATION DATE: 12/31/2019 In tabulations below, amounts are in US dollars. PERIOD TO: Use Column I an Contracts where variable retainage for line items may apply. 19-9211 A yARCHITECT'S PROJECT NO: B C D E F G H I WORK COMPLETED ITEM NO. DESCRIPTION OF WORK SCHEDULED DULED FROM PREVIOUS MATERIALS PRESENTLY TOTAL COMPLETED AND ' % BALANCE TO VALUE APPLICATION THIS PERIOD STORED STORED TO DATE (G C) FINISH RETAINAGE (If variable rate) (D + E) (Not in D or E) (D+E+F) (C _ G ) 7100 Precast Plank 316,319. _ —9 489.58 7200 Precast Beams 7,838.00 783.80 3,919.00 4,702.80 60.00 3,135.20 235.14 7500 Precast Stadia 347,040.00 34,704.00 173,520.00 208,224.00 .00 138,816.00 10,411.20 8100 Labor- Plank 117,851.00 11,785.10 58,925.50 70,710.60 0.00 47,140.40 3,535.54 8200 Labor- Beams 1,964.00 196.40 982.00 1,178.40 0.00 785.60 58.92 8400 Labor -Stadia 94,282.00 9,428.20 47,141.00 56,569.20 0.00 37,712.80 2,828.46 8600 Misc/Trucking 175,631.00 17,563.10 1 87,815.50 105,378.60 0.00 70,252.40 5,268.94 Totals GRAND TOTAL 06 , CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TA' —1992. Copyright m 1963, 1966, 1966. 1967, 1970. 1978, 1983 and'1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA'Document is protected by U.S. Copyright Law and International Trey 1jn' -.ns or distribution of this Ale Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. 101210AC044 B A I D L D L R I B N S G S S A H D I D F R P E I s N S G INVOICE RE('FIVED RJM CONSTRUCTIO*� `J +M 1.440 B30 BOONE AVE N LC r)Stru ctio"1 GOLDEN VALLEY MN 55427 ]��Y�.1�i�;P►iti:lttYliL�IiI►R�i1lt��'i[��I:�L' ►�d�►11 RJM CONSTRUCTION 630 BOONE AVE N GOLDEN VALLEY MN 16520-0138 Toti 8.93 18520-0034 Toti 17.86 18520-0125 Toti 9.73 18520-0131 Tot: 10.36 19520-0021 Toti 26.78 19520-0033 Tots 17.86 19520-0113 Tots 47.00 19520-0148 Tot: 8,93 19520-0180 Tote 17.86 6204-20-90-100 8.93 Grand Total 174.23 55427 - ► . SPEE•DEE Delivery Service Inc. PO Box 1417 St Cloud MN 56302-1417 (320) 251-6697 FAX:251-1846 SHIPPER NUMBER 06217 INVOICE NUMBER 3873574 AMOUNT DUE 1.74 . 23 INVOICE DATE 11/04/2019 AMOUNT PAID PAYABLE IN U.S. DOLLARS INVOICE R SHIPPER NUMBER 06217 INVOICE NUMBER 3.873574 AMOUNT DUE 174.23 INVOICE DATE 11/04/2019 Job Number Amount 19520-0003 Total 11.82 19520-0033 Total 23.64 19520-0072 Total 11.82 19520-0075 Total 13.35 19520-0113 Total 23.64 19520-0163 Total 11.82 Grand Total 96.08 IVUNIHLY INVVIUL/bIAIGIV=41 Premium Waters. In�� t— r t t a. ct vw .E t u rJ�-- PO BOX 9128 MINNEAPOLIS MN 55480-9128 (612) 379-4141 Fax: (512)-379-3543 RETURN SERVICE REQUESTED Website: www.premiumwaters.com � , i � � • . i' r]C_Y.T.��Isl�ll�:lr�i�1�^i.Y:IyI[�lll_ CARP NUMBER VERIFICATION NUM. i Elm SIGNATURE EXP. DATE CAROHOLQEFI NAME (Please Print) AMOUNT 853364 11/30/2019 853364-11-19 s � ■• s RJM CONSTRUCTION ##1952 12/31/2019 S19.24 Mr1 fI 1 1 AB II•'A-01-11P3N-AIIM•t13215-46 pII 9{ 4 f +FIf IIIIIII III�IIIf II�III�IIi IIIIlllllfllllll/111711111'IIEAIXEIIIIII II IIIIIII III I4III (IIIIIII (III IIIIIII IIIIIIIIIIII IIIIf IIIlIIII�III RJM CONSTRUCTION 91952-0033 111 1 7 PREMIUM WATERS INC I $30 BOONE AVE IN PO BOX 9128 GOLDEN VALLEY MN 55427-4568 MINNEAF'OLIS MN 55480 9128 DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT DATE INVOICE NO. DESCRIPTION QTY/UN1T $ TAX INV.TOTAL PAYMENT I BALANCE RECEIVED 2 PAST DUE ACCOUNTS AMOUNT Constru BALANCE FORWARD 9.62 Stoplt 1 RJM CONSTRICTION 0952-0033 1000 SCHOOL 5T 11130/2019 317237179 Monthly Dec 1 � 9.00 18.52 1113012419 317237179 Tax 0.82 19• dBliverie5. Tue-Dec 17 Fri -Jan 17 Tue - Feb 18 NAME Tue-Mar 17 In preparation of winter, here are a couple tips to ensure you will continue to receive tap quality products from Premium Waters: Stare all fatties inside to protect them from the frigid weather. " Please empty all partial battles. Partial bottles may freeze, causing them to crack. PREMIUM WATERS INC PO BOX 912$ MINNEAPC7'L1S MN 554$0-912$ (612) 379-4141 Fax: (612)-379-3543 � CUSTOMER Fil ..,'30/2019 853364 RJM CONSTRUCTION #1952-0033 Veit Disposal Systems - Metro 14000 Veit Place Rogers, MN 55374 Phone: (763)422-3867 Fax: (763) 428-6779 RJM CONSTRUCTION - NORTH 830 BOONE AVENUE N GOLDEN VALLEY, MN 55427 INVOICE INVOICE NO. 00005733� PAGE 1 DATE nA�_nsz_i c CUSTOMER NO. 9Rf,R SITE NO. 0 REFERENCE NO. TOTAL INVOICE T $275.00 SERVICE CODE DESCRIPTION REFERENCE QTY. RATE AMOUNT (0444) PO.#19520-0033 RJM - NORTH - ICE ARENA 1000 SCHOOL STREET, ELK RIVER MN Sery #001 Roll Off Service 20.00 03- Dec R1 20.00 Exchange 1.00 $263.00 $263.00 W/O #:668350 03 - Dec CN Const Debris Tons/Yds 20.00 $0.00 $0.00 Bill of Lading: 58628 Carrier: YBP4020,20 03 - Dec 01 MN Sld Waste Fee-$.60/Yd at $0.60/YD on 20.00YD $12.00 Questions or Inquiries please e-mail customer service @ VDSbilling@VeitUSA.com A service chg of 1.5% per month (18% APR) on any unpaid balances after 30 days CURRENT TOTAL INVOICE $275.00 31 - 60 DAYS 61 - 90 DAYS OVER 90 DAYS 15 130.30 4 420.00 275.00 23 586.00 Veit Disposal Systems - Metro 14000 Veit Place Rogers, MN 55374 Phone: (763)422-3867 Fax: (763) 428-6779 RJM CONSTRUCTION - NORTH 830 BOONE AVENUE N GOLDEN VALLEY, MN 55427 INVOICE NO. _ PAGE DATE CUSTOMER NO. SITE NO. REFERENCE NO. TOTAL INVOICE $550.00 SERVICE CODE DESCRIPTION REFERENCE QTY. RATE AMOUNT (0444) PO.#19520-0033 RJM - NORTH - ICE ARENA 1000 SCHOOL STREET, ELK RIVER MN Sery #001 Roll Off Service 20.00 17 - Dec R1 20.00 Delivery 1.00 $0.00 $0.00 W/O #:669537 17- Dec R1 20.00 Exchange 1.00 $263.00 $263.00 W/O #:669544 17 - Dec CN Const Debris Tons/Yds 20.00 $0.00 $0.00 Bill of Lading: 59112 Carrier: YBN0729,20 17 - Dec 01 MN Sld Waste Fee-$.60/Yd at $0.60/YD on 20.00YD $12.00 19 - Dec R1 20.00 Pick Up 1.00 $263.00 $263.00 W/O #:669720 19 - Dec CN Const Debris Tons/Yds 20.00 $0.00 $0.00 Bill of Lading: 59220 Carrier: YBR1003,20 19 - Dec 01 MN Sld Waste Fee-$.60/Yd at $0.60/YD on 20.00YD $12.00 20 - Dec R1 20.00 Delivery 1.00 $0.00 $0.00 W/O #:669822 Sery #002 Roll Off Service 30.00 19 - Dec R1 30.00 Delivery 1.00 $0.00 $0.00 W/O #:669719 Questions or Inquiries please e-mail customer service @ VDSbilling@VeitUSA.com A service chg of 1.5% per month (18% APR) on any unpaid balances after 30 days CURRENT TOTAL INVOICE $550.00 31 - 60 DAYS 61 - 90 DAYS OVER 90 DAYS 12 046.29 2 957.10 305.00 23 861.00 8610 Hansen Ave Shakopee, MN 55379 (952) 403-1221 info@biffsinc.com Bill To RJM Construction, LLC 830 Boone Ave N Golden Valley MN 55427 United States Invoice Page 1 of 2 Date 12/4/2019 Invoice # W746369 Customer ID C642570 Terms Net 28 Due Date 1/1/2020 Memo PO # 19520-0033 Location # L116854 Sales Order 333108 Ship To Elk River Arena 19520-0033 1000 School St NW Elk River MN 55330 United States Quantity 1 Rental Regular Unit Nov 06-Dec 03 4.00 4.00 1 SERVICE Service Nov 06-Dec 03 55.00 55.00 1 SERVICE ClimateSvc Nov 06 to Dec 03 34.00 34.00 1 Rental HandSani Nov 06-Dec 03 0.00 0.00 1 Rental ContainmentPan Nov 06-Dec 03 20.00 20.00 1 Rental Regular Unit Nov 06-Dec 03 4.00 4.00 1 SERVICE Service Nov 06-Dec 03 55.00 55.00 1 SERVICE ClimateSvc Nov 06 to Dec 03 34.00 34.00 1 Rental HandSani Nov 06-Dec 03 0.00 0.00 1 Rental ContainmentPan Nov 06-Dec 03 20.00 20.00 1 Rental MiniLift Nov 06-Dec 03 4.00 4.00 1 SERVICE Service Nov 06-Dec 03 64.00 64.00 1 SERVICE ClimateSvc Nov 06 to Dec 03 34.00 34.00 1 Rental HandSani Nov 06-Dec 03 0.00 0.00 1 Rental ContainmentPan Nov 06-Dec 03 20.00 20.00 2 Rental Heater Nov 06-Dec 03 5.00 10.00 0 TAX -MN Tax -MN 0.00 24.61 8610 Hansen Ave Shakopee, MN 55379 (952) 403-1221 info@biffsinc.com Biffs Inc. Make Checks Payable To Biffs Inc. 8610 Hansen Ave Shakopee, MN 55379 Please return this portion with your payment. Remittance Slip Customer Invoice # Amount Due Amount Paid Visa, Mastercard, Discover and American Express accepted. Invoice Page 2 of 2 Date 12/4/2019 Invoice # W746369 Total 382.61 Amount Due $382.61 L116854 Elk River Arena 19520-0033 W746369 $382.61 8610 Hansen Ave Shakopee, MN 55379 (952) 403-1221 info@biffsinc.com Bill To RJM Construction, LLC 830 Boone Ave N Golden Valley MN 55427 United States Invoice Date 12/4/2019 Invoice # W746373 Customer ID C642570 Terms Net 28 Due Date 1/1/2020 Memo PO # 19520-0033 Location # L117359 Sales Order 334584 Ship To Lions Park 19520-0033 1104 Lions Park Dr Elk River MN 55330 United States Quantity 1 Rental Regular Unit Nov 06-Dec 03 4.00 4.00 1 SERVICE Service Nov 06-Dec 03 55.00 55.00 1 SERVICE ClimateSvc Nov 06 to Dec 03 34.00 34.00 1 Rental HandSani Nov 06-Dec 03 0.00 0.00 1 Rental ContainmentPan Nov 06-Dec 03 20.00 20.00 1 DELIVERY Delivery Nov 19 0.00 0.00 1 Rental Heater Nov 19-Dec 03 5.00 2.68 0 TAX -MN Tax -MN 0.00 7.95 Biffs Inc. Make Checks Payable To Biffs Inc. 8610 Hansen Ave Shakopee, MN 55379 Please return this portion with your payment. Remittance Slip Customer Invoice # Amount Due Amount Paid Visa, Mastercard, Discover and American Express accepted. Total 123.63 Amount Due $123.63 L117359 Lions Park 19520-0033 W746373 $123.63 16520-0138 Total 494.66 18520-0034 Total 432.83 18520-0054 Total 146.85 18520-0090 Total 386.45 18520-0118 Total 443.13 19520-0021 Total 443.13 19520-0033 Total 474.05 19520-0047 Total 252.48 19520-0052 Total 499.81 19520-0067 Total 533.30 19520-0070 Total 278.25 19520-0072 Total 1,066.61 19520-0096 Total 466.32 19520-0110 Total 437.98 19520-0113 Total 458.59 19520-0114 Total 407.06 19520-0132 Total 512.69 19520-0138 Total 466.32 19520-0145 Total 213.84 19520-0149 Total 244.75 19520-0166 Total 208.68 19520-0169 Total 139.12 19520-0178 Total 149.43 19520-0181 Total 244.75 19520-0186 Total 128.82 Grand Total 9,529.90 16520-0138 Total 168.17 17520-0086 Total 96.90 18520-0034 Total 178.75 18520-0042 Total 40.45 18520-0054 Total 140.65 18520-0090 Total 380.55 18520-0118 Total 321.28 19520-0005 Total 206.98 19520-0021 Total 108.19 19520-0030 Total 127.95 19520-0033 Total 153.82 19520-0047 Total 60.68 19520-0051 Total 74.56 19520-0052 Total 217.80 19520-0055 Total 141.83 19520-0059 Total 24.46 19520-0060 Total 71.97 19520-0061 Total 2M4 19520-0063 Total 36.22 19520-0067 Total 159.23 19520-0068 Total 177.81 19520-0070 Total 185.81 19520-0072 Total 770-05 19520-0075 Total 71.97 19520-0078 Total 62.56 19520-0086 Total 26.34 19520-0094 Total 39.04 19520-0095 Total 60.45 19520-0096 Total 176.87 19520-0110 Total 111.01 19520-0113 Total 77.62 19520-0114 Total 61.15 19520-0115 Total 83.73 19520-0127 Total 238.02 19520-0131 Total 73.85 19520-0132 Total 100.67 19520-0133 Total 25.40 19520-0138 Total 267.66 19520-0143 Total 183.46 19520-0145 Total 109.37 19520-0148 Total 66.80 19520-0149 Total 68.21 19520-0151 Total 52.68 19520-0163 Total 51.27 19520-0166 Total 301.53 19520-0169 Total 248.84 19520-0181 Total 128.89 19520-0196 Total 24.46 19520-0201 Total 53.16 19520-0209 Total 46.57 19720-7038 Total 24.93 Grand Total 6710.27 16520-0138 Total 184.71 18520-0034 Total 220-63 18520-0090 Total 177.02 18520-0118 Total 257A0 19520-0021 Total 155.64 19520-0033 Total 157.35 19520-0047 Total 91.50 19520-0052 Total 174.45 19520-0055 Total 112-88 19520-0067 Total 436.98 19520-0070 Total 94.07 19520-0072 Total 622.55 19520-0094 Total 72.69 19520-0095 Total 59.01 19520-0096 Total 158.20 19520-0110 Total 199.25 19520-0113 Total 150.51 19520-0115 Total 88.94 19520-0121 Total 122.29 19520-0127 Total 200.96 19520-0132 Total 180.44 19520-0138 Total 274.50 19520-0145 Total 80.38 19520-0148 Total 69.27 19520-0149 Total 128.27 19520-0166 Total 65.85 19520-0169 Total 172.74 19520-0178 Total 46.18 19520-0181 Total 104.33 19520-0186 Total 42.76 Grand Total 4,901-75 INVOICE .oi BRAND SOLUTIONS.. INVOICE TO RJM Construction Brenda Tresco 830 Boone Ave N. Golden Valley MN 55427 SHIP TO RJM Construction Amy Halasz 830 Boone Ave N. Golden Valley MN 55427 Number 40006-1 Date 12/23/2019 Client ID 148282 Rep Alysson Gebauer Ship Via FOB Customer Order No. Terms Tax Number Our Discretion Factory Net 30 Days Qty Shipped Description Unit Price Extension ANSI Hi -Viz Yellow/Black Insulated XTREME-FLEXTM Jacket Color: Yellow -Black 1 Size: L $130.00 $130.00 Decorating Method : Screen Printing 1 Setup Charge : Screen (1-color, NO underbase) $0.00 $0.00 1 Run Charge : 1-color Flat Rate (Qty <12) $50.00 $50.00 Decorating Location : Left Bicep Decorating Size : 4" W Design Name : RJM Outline 1-color PMS : Black Terms & Conditions Artwork $0.00 2% service charge per month (24% per annum) on overdue accounts. All claims for S & H $0.00 shortages or damaged goods must be made in writing within seven days of receipt of Sub -Total $180.00 goods or invoice.Thank you for your business! Tax $0.00 TOTAL $180.00 Deposit $0.00 Balance Due $180.00 2020 BRAND SOLUTIONS, 135 Grand Ave. East, South St. Paul, MN, United States 55075 Tel : (651) 451-3850 Fax : (651) 455-8507 Toll Free: (800) 229-3850 Website : 2020collection.com Email : info@2020brands.com RJM CONSTRUCTION - EMPLOYEE EXPENSE REPORT Employee PERIOD NAME: Jake Fisher Market Code: COVERED: 11/17/2019 TO 11/18/2019 Expense Type Date Item Description Name all Involved Parties and Business Purpose JOB #I GL Code Phase Code I Market Code Mileage Mileage Charge Parking Meals & Entertainment Cellphone Office Supplies Other (GL or Phase Code Required) 11/14/2019 Lean Coffee 6400 20-40-100 17.00 9.86 11/15/2019 Elk River Drone 19520-0033 01-32-36 57.00 33.06 11/15/2019 U of MN Institute of Childcare - Drone Site Visit 19520-0196 01-32-36 26.00 15.08 2.50 33.27 11/17/2019 Uber Home to MSP 6405 20-40-100 21.21 11/17/2019 Uber LAS to Hotel 6405 20-40-100 23.71 11/17/2019 Coffee at Airport 6400 20-40-100 3.28 11/17/2019 Soda for flight 6400 20-40-100 3.42 11/17/2019 Dinner First Night 6400 20-40-100 11.85 11/18/2019 Coffee 6400 20-40-100 5.41 11/18/2019 Coffee 6400 20-40-100 4.71 11/18/2019 Food for Hotel Room 6400 20-40-100 23.83 11/22/2019 Hotel 6405 20-40-100 994.35 11/17/2019 Checked Bag 6405 20-40-100 30.00 11/21/2019 Checked Bag 6405 20-40-100 30.00 TOTALS BY CATEGORY: 100.00 58.00 2.50 130.69 `See description for proper expense coding Employee Signature Approved (1) (2) (3) REIMBURSEMENT CALCULATION: 7. TOTAL PROJECT COST (Columns 1+2+3+4+5+6+7) 8. Total Project Miles @ .58 per mile 9. Less Advances/Auto Allowance @ .33 per mile 10. Total Due Employee (4) (6) 1,187.54 58.00 33.00 1,212.54 RJM CONSTRUCTION - EMPLOYEE EXPENSE REPORT Employee PERIOD NAME: Tom Druk Market Code: COVERED: 10/31/2019 TO 12/31/2019 Expense Type Date Item Description Name all Involved Parties and Business Purpose JOB #/GL Code Phase Code / Market Code Mileage Mileage Charge Parking Meals 8 Entertainment Cellphone Office Supplies Other (GL or Phase Code Required) 10/31/19 19520-0033 54.00 31.32 11/05/19 19520-0033 54.00 31.32 11/07/19 19520-0033 54.00 31.32 11/08/19 19520-0033 54.00 31.32 11/12/19 19520-0033 54.00 31.32 11/13/19 19520-0033 54.00 31.32 11/15/19 19520-0033 54.00 31.32 11/19/19 19520-0033 54.00 31.32 11 /20119 19520-0033 54.00 31.32 11/21/19 19520-0033 54.00 31.32 11/25/19 19520-0033 54.00 31.32 11/26/19 19520-0033 54.00 31.32 12/03/19 19520-0033 54.00 31.32 12/04/19 19520-0033 54.00 31.32 12/06/19 19520-0033 54.00 31.32 12/09/19 19520-0033 54.00 31.32 12/11/19 19520-0033 54.00 31.32 12/12/19 19520-0033 54.00 31.32 12/17/19 19520-0033 54.00 31.32 12/18/19 19520-0033 54.00 31.32 12/20/19 19520-0033 54.00 31.32 12/27/19 19520-0033 54.00 31.32 12/30/19 19520-0033 54.00 31.32 12/31/19 1 19520-0033 54.00 31.32 TOTALS BY CATEGORY: 1 1,296.00 751.68 - - - - - 'See description for proper expense coding Tom Druk 12/27/19 Employee Signature 0) (2) (3) REIMBURSEMENT CALCULATION: 7. TOTAL PROJECT COST (Columns 1+2+3+4+5+6+7) 8. Total Project Miles @ .58 per mile 9. Less Advances/Auto Allowance @ .33 per mile (4) (6) 0.00 751.68 427.68 Elk River Municipal Utilities 13066Cran0 ps*wAy I PC 90. s39 .1 PW1 MN553394430 1 70A41.2020 RJM CONSTRUCTION 830 BOONE AVENUE NORTH GOLDEN VALLEY MN 55427 INVOICE: 99+6 Invoice Date: 12/19/2019 Terms: Net 30 Due Date: 01/18/2020 Amount Due: $ 237.33 Account: 242` �-- Description: Hydrant Rental & Usage for Elk River Lions Park Page 1 of 1 Instructions: DESCRIPTION QUANTITY UOMJ UNIT PRICE AMOUNT TAX' CATALOG ITEM: BULK WATER SALES Water Usage by Volume (Hydrant Rental) 55.000 EA 4.0000 Z ' 1-GO Hydrant Water Sales - Units (per 1000 gallons) MESSAGES Subtotal: $ 220.00 Tax: $ 17.33 Total; $ 237.33 Please remit payment at your earliest convenience. Amount Paid: $ 0.00 Amount Due: $ 237.33 Electronic payment can be made online by visiting our website at www.elkriverutilitles.corn Elk River Municipal Utilities %M9Qvv'w**ay I K60�'39 M PJ1W MN 55339-0430 , 7b3."1.N2O RJM CONSTRUCTION 830 BOONE AVENUE NORTH GOLDEN VALLEY MN 55427 Account: 242 Invoice: 996 Due Date: 01/18/2020 Amount Due: $ 237.33 Amount Of Payment: Remit To: ELK RIVER MUNICIPAL UTILITIES 130b9 ORONO PARKWAY P.O. BOX 430 ELK RIVER MN 55330 RJM CONSTRUCTION - EMPLOYEE EXPENSE REPORT Employee PERIOD NAME: Brett Sillerud Market Code: COVERED: 11.01.2019 TO 12.01.2019 Expense Type Date Item Description Name all Involved Parties and Business Purpose JOB #I GL Code Phase Code / Market Code Mileage Mileage Charge Parking Meals & Entertainment Cellphone Office Supplies Other (GL or Phase Code Required) 11.01.2019 Methodist 4th Floor 18520-0090 01-59-45 98.00 56.84 11.01.2019 U of M Main Energy Chiller Replacement 19520-0224 01-59-45 16.00 9.28 11.01.2019 1PNHS Lakeville 18520-0118 01-59-45 168.00 97.44 11.01.2019 PNHS Burnsville MOB 19520-0018 01-59-45 92.00 53.36 11.01.2019 St. Louis Park Westwood Hills Nature Center 18520-0034 01-59-45 8.00 4.64 11.01.2019 Parking 6507 20-40-100 4.25 11.01.2019 Elk River Ice Arena 19520-0033 01-59-45 144.00 83.52 11.06.2019 Drone Micro SO Card 6200 20-30-100 17.13 11.15.19 Duffey Lofts 19520-0131 01-59-45 13.00 7.54 11.17.19 Wayzata City Hall 19520-0189 01-59-45 24.00 13.92 11.20.19 South Lake Pediatrics 19520-0219 01-59-45 10.00 5.80 TOTALS BY CATEGORY: 573.00 332.34 4.25 - - - 17.13 `See description for proper expense coding Employee Signature Approved (1) (2) (3) REIMBURSEMENT CALCULATION: 7. TOTAL PROJECT COST (Columns 1+2+3+4+5+6+7) 8. Total Project Miles @ .58 per mile 9. Less Advances/Auto Allowance @ .33 per mile 10. Total Due Employee (4) (6) 21.38 332.34 189.09 164.63 Only Section Office Row Labels Mileage Charge PARKING Amt M&E AMT Cellphone Amt Supplies Amt Other Milage/Park/M&E/Cell 332.34 4.25 18520-0034 4.64 18520-0090 56.84 18520-0118 97.44 19520-0018 53.36 19520-0033 83.52 19520-0131 7.54 19520-0189 13.92 19520-0219 5.80 19520-0224 9.28 6507 4.25 General Ledger 17.13 6200-20-30-100 17.13 Grand Total 332.34 4.25 17.13 Action Fence, Inc P.O. Box 1065 Burnsville, MN 55337 Voice: (952)432-9737 Fax: (952)432-4132 Bill To RJM Construction 830 Boone Ave N Golden Valley, MN 55427 INVOICE Invoice Number: 19729 Invoice Date: Dec 3, 2019 Page: 1 Ship to: Elk River Muti-Purpose Facility 19520-0033 Elk River, MN Customer ID Customer PO Payment Terms R06 Net 45 Days Sales Rep ID Shipping Method Ship Date Due Date Airborne 1/17/20 Quantity Item Description Unit Price Amount 1.00 Extra Work Authorization - 11/26/19: Relocate 36' of 6' high free-standing panelized construction fence "Pricing includes any applicable sales tax 450.00 450.00 Check/Credit Memo No: Subtotal 450.00 Sales Tax Total Invoice Amount 450.00 Payment/CreditApplied TOTAL 450.00 LJ Date: 1t- 2k- !i Job Name: 64k ?,tutr, ?,tutJob Code: <-y Work Description: 4f ! n C L o c A; a t" (rr ' P N C L S Equipment Needed: Crew & Hours Worked: , N" r r 4 Contractor PO #: 1 �� - CC, 3-3 Contractor: I Action Fence: Name: � �/ ' f!'{!'! Name: --e %A.; C Signature: Signature 11 okt,-? Af 18999k513