4.5 SR 05-18-2020City of
Qk*'
River
Request for Action
To
Item Number
Mayor and City Council
4.5
Agenda Section
Meeting Date
Prepared by
Consent
May 18, 2020
Brandon Wisner, Stormwater Coordinator
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
10-Partial RJM Construction LLC
Amount
$1,898,544.28
A welcoming community with revolutionary and spirited resourcefulness, exceptional,` O� e
service, and community engagement that encourages and inspires pi ospei l_ y INAMIRE1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC C� / _ SZU
Please Remit Payment to: RJM Construction, LLC
830 Boone Ave North
�7Jf�1.t Golden Valley, MN 55427
rV iPP1 ICATI AND CERTIFICATE FOR PAVM NT
CONSTRUCTION
To Owner City of Elk River
Project:19520-0033 Elk River Multi -Purpose Facility and Lion John
Invoice #:
9520003310
Distribution to:
Attn: Justin Femdte
WMAls Street NW
Application No.:
10
= Owner
13065 Orono Parkway
Elk River, MN 55330
® Architect
Elk River, MN 55330
Application Date:
pp
4/3012020
0 Contractor
Architect:
Period From:
4/112020
To:
4/30/2020
CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Contract.
Continuation Sheet is attached.
1.Original Contract Sum ... $25,772,257.00
2. Net Change By Change Order .................... $398,559.40
3. Contract Sum To Date $26,170,816.40
4. Total Completed and Stored To Date ..... $19,673,766.53
5. Retainage:
a. 4.68% of Completed Work $920,129.36
b. 0.00% of Stored Material $0.00
Total Retainage ....... $920,129.36
6. Total Earned Less Retainage ...................... $18,753,637.17
7. Less Previous Certificates For Payments ............ $16,855,092.89
8. Current Payment Due ............... $1,898,544.28
9. Balance To Finish, Plus Retainage . $7,417,179.23
CHANGE ORDER SUMMARY
Additions
Deductions
Total vlousgmon isrr y wrier
$601,520.46
$202,961.06
Total Approved this Month
$24,032.27
$24,032.27
TOTALS
$625,552.73
$226,993.33
Net Changes By Change Order
$398,559.40
The undersigned Contractor certifies that to the best of the Contractor's 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 received from the Owner, and that
current payment shown herein is now due.
CONTRACTOR:
-4*
B • T:-. +eye.,
RJM Construction LLC
State of:
Subscribed and sworn to before me this
Notary Public:
My Commission expires:
5/4/2020
Date:
County of:
day of
In accordance with the Contract Documents, based on on -site observations and the data
comprising the above 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.
ARCHITECT'S CERTIFICATE FOR PAYMENT
AMOUNT CERTIFIED $ 1,898,544.28
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and
on the Continuation Sheet that are changed to conform with the amount certified.)
ARCHITECT:
°awa 5/6/20
Michelle Maier&-Atak ` "" "Q'°'°"°° �°
By �" il « A;.� M .� , 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.
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
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 # : 9520003310
Contract: 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park
Application No.: 10
Application Date: 04/30/20
To: 04/30/20
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
15,637.00
0.00
0.00
15,637.00
37.88%
25,643.00
781.85
2A
Building Demolition
166,199.51
162,199.51
4,000.00
0.00
166,199.51
100.00%
0.00
8,309.98
2B
Selective Demolition
207,918.40
15,482.40
178,713.00
0.00
194,195.40
93.40%
13,723.00
9,709.77
3C
Concrete Floor Finishes
124,022.22
0.00
19,632.22
0.00
19,632.22
15.83%
104,390.00
981.61
4A
Masonry Systems
3,003,739.56
2,756,073.78
44,814.78
0.00
2,800,888.56
93.25%
202,851.00
140,044.43
5A
Structural Material
1,352,108.18
1,035,156.20
170,910.94
0.00
1,206,067.14
89.20%
146,041.04
60,303.36
5B
Structural Labor
445,873.85
309,543.00
41,555.00
0.00
351,098.00
78.74%
94,775.85
17,554.90
6A
Carpentry
1,361,512.73
348,477.65
104,753.65
0.00
453,231.30
33.29%
908,281.43
22,661.56
7A
Waterproofing &WB
38,902.00
30,792.00
0.00
0.00
30,792.00
79.15%
8,110.00
1,539.60
7B
Roofing Systems
1,053,038.00
979,995.19
22,101.00
0.00
1,002,096.19
95.16%
50,941.81
50,104.81
7C
Metal Wall Panel
191,460.00
0.00
23,785.00
0.00
23,785.00
12.42%
167,675.00
1,189.25
8A
Aluminum Entrances/Storefronts
644,100.00
152,608.62
95,728.96
0.00
248,337.58
38.56%
395,762.42
12,416.88
8B
Overhead Coiling and Sectional Doors
53,260.00
0.00
8,575.00
0.00
8,575.00
16.10%
44,685.00
428.75
9A
Gypsum Board
333,850.20
12,231.28
181,723.05
0.00
193,954.33
58.10%
139,895.87
9,697.71
9B
Tiling
138,480.00
0.00
74,138.00
0.00
74,138.00
53.54%
64,342.00
3,706.90
9C
Acoustical Ceilings
134,305.00
2,250.00
38,035.00
0.00
40,285.00
30.00%
94,020.00
2,014.25
9D
Flooring
103,900.00
0.00
0.00
0.00
0.00
0.00%
103,900.00
0.00
9E
Painting
422,750.00
94,000.00
64,363.00
0.00
158,363.00
37.46%
264,387.00
7,918.15
1OA
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
65,773.46
98,534.90
0.00
164,308.36
94.66%
9,266.55
8,215.43
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
1,717,742.00
175,000.00
0.00
1,892,742.00
87.52%
270,000.00
94,637.10
13C
Leg Truss System
125,797.00
125,797.00
0.00
0.00
125,797.00
100.00%
0.00
6,289.85
14A
Elevators
69,875.00
39,750.00
0.00
0.00
39,750.00
56.89%
30,125.00
1,987.50
21A
Fire Protection
268,440.00
210,630.00
11,562.00
0.00
222,192.00
82.77%
46,248.00
11,109.62
22A
Plumbing Systems
1,278,978.00
743,741.00
145,000.00
0.00
888,741.00
69.49%
390,237.00
44,437.05
23A
HVAC
1,834,699.93
1,337,024.18
0.00
0.00
1,337,024.18
72.87%
497,675.75
66,851.21
26A
Electrical Systems
1,776,889.20
988,692.07
313,000.00
0.00
1,301,692.07
73.26%
475,197.13
65,084.60
31A
Multipurpose Earthwork
692,362.30
600,363.34
20,000.00
0.00
620,363.34
89.60%
71,998.96
31,018.17
DocuSign Envelope ID: 18BCC2EB-5C45-4A03-BBDA-FOAFAF992DFC
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 # : 9520003310
Contract: 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park
Application No.: 10
Application Date: 04/30/20
To: 04/30/20
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
518,722.62
471,689.77
1,845.60
0.00
473,535.37
91.29%
45,187.25
23,676.77
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
386,054.93
49,045.58
13,394.00
0.00
62,439.58
16.17%
323,615.35
3,121.98
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
25,986.10
0.00
86,601.85
59.50%
58,941.15
4,330.10
33A
Utilities
619,037.15
603,128.00
15,909.15
0.00
619,037.15
100.00%
0.00
30,951.86
3B.1
Precast Concrete
1,190,000.00
1,130,500.00
0.00
0.00
1,130,500.00
95.00%
59,500.00
56,525.00
3B.2
Precast Concrete
930,000.00
922,537.00
0.00
0.00
922,537.00
99.20%
7,463.00
46,126.85
3B.3
Precast Raker/Plank/Stadia
1,048,025.00
1,048,025.00
0.00
0.00
1,048,025.00
100.00%
0.00
52,401.25
01-00
General Conditions/Requirements
1,231,030.35
874,726.38
69,172.41
0.00
943,898.79
76.68%
287,131.56
0.00
90-50
General Liability Insurance
263,602.38
263,087.56
514.82
0.00
263,602.38
100.00%
0.00
0.00
90-60
Construction Contingency
367,049.25
0.00
0.00
0.00
0.00
0.00%
367,049.25
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
63,678.73
63,518.86
159.87
0.00
63,678.73
100.00%
0.00
0.00
99-99
Contractors Fee
479,734.00
327,916.44
31,884.06
0.00
359,800.50
75.00%
119,933.50
17,990.01
Grand Totals
26,170,816.40
17,678,975.02
1,994,791.51
0.00
19,673,766.53
75.17%
6,497,049.87
920,129.36
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
INVOICE
From: RJM Construction, LLC Invoice: 9520003310
830 Boone Ave North Invoice Date: 04/30/20
Golden Valley, MN 55427 Due Date: 05/30/20
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 Multi -Purpose Facility and Lion John Weicht Park
Building Demolition
SUBCONTRACTS
Rachel Contracting Mass Structure Demoltion Inv# 19520-00333 4,000.00
Total SUBCONTRACTS 4,000.00
Building Demolition Sub -Total: 4,000.00
Selective Demolition
SUBCONTRACTS
Ebert Construction
Demolition
Inv# 19520-00335
178,713.00
Total SUBCONTRACTS
178,713.00
Selective Demolition Sub -Total:
178,713.00
Concrete Floor Finishes
MATERIAL PURCHASES
Brock White Company
Inv# 13885612-00
287.65
Shaw/Stewart Lumber Co.
883936-001
6,884.37
Total MATERIAL PURCHASES
7,172.02
LABOR
Carpenters
Regular Earnings
16.00 HRS @ 83.90
1,342.40
Superintendent
Regular Earnings
6.00 HRS @ 109.90
659.40
Laborer
Regular Earnings
136.00 HRS @ 76.90
10,458.40
Total LABOR
12,460.20
Concrete Floor Finishes Sub -Total:
19,632.22
Masonry Systems
MATERIAL PURCHASES
CenterPointEnergy-Minnegasco
Inv# 20200704
8,653.72
Tioga Air Heaters, LLC
84695
161.06
Total MATERIAL PURCHASES
8,814.78
SUBCONTRACTS
Crosstown Masonry, Inc.
Concrete/Masonry
Inv# 19520-00339
36,000.00
Total SUBCONTRACTS
36,000.00
Masonry Systems Sub -Total:
44,814.78
Structural Material
MATERIAL PURCHASES
Shaw/Stewart Lumber Co.
Inv# 884613-001
8,241.86
United Rentals (North America), Inc.
179992017-002
278.38
Total MATERIAL PURCHASES
8,620.24
SUBCONTRACTS
Sunrise Painting & Wallcovering, Inc.
Prime + Paint Joists
Inv# 19520-00334
30,000.00
Design Electric, Inc
Joist Work - Electrical
19520-00338
15,000.00
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
INVOICE
From: RJM Construction, LLC Invoice: 9520003310
830 Boone Ave North Invoice Date: 04/30/20
Golden Valley, MN 55427 Due Date: 05/30/20
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 Multi -Purpose Facility and Lion John Weicht Park
Structural Material
SUBCONTRACTS
American Sandblasting, Inc.
Joist Sandblasting
Inv# 19520-00331
100,000.00
Total SUBCONTRACTS
146,000.00
LABOR
Carpenters
Regular Earnings
35.00 HRS @
83.90
2,936.50
Superintendent
Regular Earnings
34.00 HRS @
109.90
3,736.60
Laborer
Regular Earnings
120.00 HRS @
76.90
9,228.00
Project Manager
Regular Earnings
14.00 HRS @
106.40
1,489.60
Total LABOR
17,390.70
Structural Material Sub -Total:
170,910.94
Structural Labor
SUBCONTRACTS
High Five Erectors II, Inc
Structural Steel Erection
Inv# 19520-00336
41,555.00
Total
SUBCONTRACTS
41,666.00
Structural Labor Sub -Total:
41,555.00
Carpentry
MATERIAL PURCHASES
Home Depot Credit Services
Inv# 20201004
831.59
Construction Midwest, Inc
67066400
107.57
Construction Midwest, Inc
67087700
150.59
Veit Disposal Systems
578337
1,525.00
Veit Disposal Systems
578680
575.00
Veit Disposal Systems
578988
1,710.00
Veit Disposal Systems
579382
610.00
Total
MATERIAL PURCHASES
6,609.76
SUBCONTRACTS
Kendell Doors & Hardware, Inc
Hollow Metal Doors & Frames
Inv# 19520-00333
21,690.64
Ebert Construction
Carpentry
19520-00336
53,083.36
Total
SUBCONTRACTS
74,774.00
LABOR
Carpenters
Regular Earnings
189.00 HRS @ 83.90
15,857.10
Laborer
Regular Earnings
112.00 HRS @ 76.90
8,612.80
Total
LABOR
24,469.90
Carpentry Sub -Total:
104,753.65
Roofing Systems
SUBCONTRACTS
Top -All Roofing, Inc.
Roofing
Inv# 19520-00336
22,101.00
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
INVOICE
From: RJM Construction, LLC Invoice: 9520003310
830 Boone Ave North Invoice Date: 04/30/20
Golden Valley, MN 55427 Due Date: 05/30/20
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 Multi -Purpose Facility and Lion John Weicht Park
Total SUBCONTRACTS
22,101.00
Roofing Systems Sub -Total:
22,101.00
Metal Wall Panel
SUBCONTRACTS
Schwickert's Tecta America
Metal Wall Panels Inv# 19520-00331
23,785.00
Total SUBCONTRACTS
23,786.00
Metal Wall Panel Sub -Total:
23,785.00
Aluminum Entrances/Storefronts
SUBCONTRACTS
Murphy Window and Door Commerciz
Glass and Glazing Inv# 19520-00333
97,739.06
Glass and Glazing 195200033-02A
-2,010.10
Total SUBCONTRACTS
96,728.96
Aluminum Entrances/Storefronts Sub -Total:
95.728.96
Overhead Coiling and Sectional Doors
SUBCONTRACTS
Skold Specialty Contracting, LLC Overhead Coiling Door Inv# 19520-00331 8,575.00
Total SUBCONTRACTS 8,676.00
Overhead Coiling and Sectional Doors Sub -Total: 8,575.00
Gypsum Board
SUBCONTRACTS
RTL Construction, Inc. Gypsum Inv# 19520-00333 125,633.05
Gypsum 195200055-02A 56,090.00
Total SUBCONTRACTS 181,723.06
Gypsum Board Sub -Total: 181,723.05
Tiling
SUBCONTRACTS
C D Tile & Stone, Inc Tile Inv# 19520-00331 74,138.00
Total SUBCONTRACTS 74,138.00
Tiling Sub -Total: 74,138.00
Acoustical Ceilings
SUBCONTRACTS
Twin City Acoustics Inc Acoustical Ceilings Inv# 19520-00332 38,035.00
Total SUBCONTRACTS 38,036.00
Acoustical Ceilings Sub -Total: 38,035.00
Painting
MATERIAL PURCHASES
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
INVOICE
From: RJM Construction, LLC Invoice: 9520003310
830 Boone Ave North Invoice Date: 04/30/20
Golden Valley, MN 55427 Due Date: 05/30/20
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 Multi -Purpose Facility and Lion John Weicht Park
Painting
MATERIAL PURCHASES
Braun lntertecCorporation
Inv# B209450
1,863.00
Total MATERIAL PURCHASES
1,863.00
SUBCONTRACTS
Sunrise Painting & Wallcovering, Inc.
Painting
Inv# 19520-00334
62,500.00
Total SUBCONTRACTS
62,600.00
Painting Sub -Total:
64,363.00
Athletic Equipment
SUBCONTRACTS
Peterson Companies, Inc.
Athletic Equipment
Inv# 19520-00332
29,154.00
Athletic Equipment
19520-00333
69,380.90
Total SUBCONTRACTS
98,634.90
Athletic Equipment Sub -Total:
98,534.90
Ice Rink Systems
SUBCONTRACTS
Rink-Tec International, Inc.
Ice Systems
Inv# 19520-00339
175,000.00
Total SUBCONTRACTS
176,000.00
Ice Rink Systems Sub -Total:
175,000.00
Fire Protection
SUBCONTRACTS
Summit Companies Fire Protection Inv# 19520-00338 11,562.00
Total SUBCONTRACTS 11,662.00
Fire Protection Sub -Total: 11.562.00
Plumbing Systems
SUBCONTRACTS
Weidner Plumbing & Heating Co. Plumbing Inv# 19520-00339 145,000.00
Total SUBCONTRACTS 146,000.00
Plumbing Systems Sub -Total: 145,000.00
Electrical Systems
SUBCONTRACTS
Design Electric, Inc Electrical Inv# 19520-00338 313,000.00
Total SUBCONTRACTS 313,000.00
Electrical Systems Sub -Total: 313,000.00
Multipurpose Earthwork
SUBCONTRACTS
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
INVOICE
From: RJM Construction, LLC Invoice: 9520003310
830 Boone Ave North Invoice Date: 04/30/20
Golden Valley, MN 55427 Due Date: 05/30/20
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 Multi -Purpose Facility and Lion John Weicht Park
Multipurpose Earthwork
SUBCONTRACTS
Minnesota Utilities & Excavating, LLC Multipurpose Earthwork Inv# 19520-00332 20,000.00
Total SUBCONTRACTS 20,000.00
Multipurpose Earthwork Sub -Total: 20,000.00
Lions Earthwork
LABOR
Laborer
Regular Earnings
24.00 HRS @ 76.90
1,845.60
Total LABOR
1,846.60
Lions Earthwork Sub -Total:
1,845.60
Concrete/Sidewalk/Curb/Gutter
SUBCONTRACTS
Ebert Construction
Site Concrete
Inv# 19520-00334
13,394.00
Total SUBCONTRACTS
13,394.00
Concrete/Sidewalk/Curb/Gutter Sub -Total:
13,394.00
Chain Link Fence
SUBCONTRACTS
Peterson Companies, Inc.
Chain Link Fence
Inv# 19520-00332
25,986.10
Total SUBCONTRACTS
26,986.10
Chain Link Fence Sub -Total:
25,986.10
Utilities
SUBCONTRACTS
Metro Utilities, Inc.
Site Utilities
Inv# 19520-00335
15,909.15
Total SUBCONTRACTS
16,909.16
Utilities Sub -Total:
15,909.15
General Conditions/Requirements
MATERIAL PURCHASES
Construction Midwest, Inc
Inv# 67147700
125.59
Premium Waters, Inc.
853364-03-20
9.62
Priority Courier Experts
1273347
25.61
RJM Construction, LLC
202004-16
408.00
RJM Construction, LLC
202004-48
744.50
RJM Construction, LLC
202004-84
1,398.00
Biffs Inc.
W760033
1,707.24
Biffs Inc.
W760035
705.90
Biffs Inc.
W760036
258.64
Verizon Wireless
9853066636
159.69
DocuSign Envelope ID: 18BCC2EB-5C45-4A03-BBDA-FOAFAF992DFC
INVOICE
From: RJM Construction, LLC Invoice: 9520003310
830 Boone Ave North Invoice Date: 04/30/20
Golden Valley, MN 55427 Due Date: 05/30/20
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 Multi -Purpose Facility and Lion John Weicht Park
General Conditions/Requirements
MATERIAL PURCHASES
Midwest Safety
Inv# 60726
368.75
Timothy Ryan
EXP 04/05/20
1,474.36
Brett Sillerud
EXP 04/01/20
64.96
Total MATERIAL PURCHASES
7,460.86
ALLOCATED EXPENSES
O.00HRS @
0.00
992.00
Total ALLOCATED EXPENSES
992.00
LABOR
General Superintendent
Regular Earnings
4.00 HRS @
114.90
459.60
Quality Assurance & Control
Regular Earnings
10.00 HRS @
114.90
1,149.00
Safety
Regular Earnings
31.00 HRS @
114.90
3,561.90
Superintendent
Regular Earnings
160.00 HRS @
109.90
17,584.00
Laborer
Regular Earnings
6.00HRS @
76.90
461.40
Laborer Foreman
Regular Earnings
17.00 HRS @
80.90
1,375.30
BIM Coordinator
Regular Earnings
2.00 HRS @
97.40
194.80
MEP Engineer
Regular Earnings
1.00 HRS @
80.40
80.40
Project Administrator
Regular Earnings
16.00HRS @
56.40
902.40
Project Manager
Regular Earnings
194.00 HRS @
106.40
20,641.60
Project Executive
Regular Earnings
100.00 HRS @
138.40
13,840.00
Total LABOR
60,260.40
P&P Bond
0.00%
479.15
General
Conditions/Requirements Sub -Total:
69,172.41
General Liability Insurance
GENERAL LIABILITY INSURANCE
0.00%
514.82
General Liability Insurance Sub -Total:
514.82
Builders Risk Insurance
BUILDERS RISK INSURANCE
0.00%
159.87
Builders Risk Insurance Sub -Total:
159.87
Contractors Fee
CONTRACTOR'S FEE
0.00%
31,884.06
Contractors Fee Sub -Total:
31,884.06
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
INVOICE
Summary
INVOICE TOTAL: 1,994,791.61
1 Elk River Multi -Purpose Facility and Lion John Weicht Park
Retainage
1,994,312.36@
5.00%
0.00
2A Building Demolition
4,000.00
Retainage
1,994,312.36@
5.00%
(200.00)
2B Selective Demolition
178,713.00
Retainage
1,994,312.36@
5.00%
(8,936.66)
3C Concrete Floor Finishes
19,632.22
Retainage
1,994,312.36@
5.00%
(981.61)
4A Masonry Systems
44,814.78
Retainage
1,994,312.36@
5.00%
(2,240.74)
5A Structural Material
170,910.94
Retainage
1,994,312.36@
5.00%
(8,646.66)
5B Structural Labor
41,666.00
Retainage
1,994,312.36@
5.00%
(2,077.76)
6A Carpentry
104,763.66
Retainage
1,994,312.36@
5.00%
(6,237.68)
7B Roofing Systems
22,101.00
Retainage
1,994,312.36@
5.00%
(1,106.06)
7C Metal Wall Panel
23,786.00
Retainage
1,994,312.36@
5.00%
(1,189.26)
8A Aluminum Entrances/Storefronts
96,728.96
Retainage
1,994,312.36@
5.00%
(4,786.46)
8B Overhead Coiling and Sectional Doors
8,676.00
Retainage
1,994,312.36@
5.00%
(428.76)
9A Gypsum Board
181,723.06
Retainage
1,994,312.36@
5.00%
(9,086.16)
9B Tiling
74,138.00
Retainage
1,994,312.36@
5.00%
(3,706.90)
9C Acoustical Ceilings
38,036.00
Retainage
1,994,312.36@
5.00%
(1,901.76)
9E Painting
64,363.00
Retainage
1,994,312.36@
5.00%
(3,218.16)
11AAthletic Equipment
98,634.90
Retainage
1,994,312.36@
5.00%
(4,926.76)
13B Ice Rink Systems
176,000.00
Retainage
1,994,312.36@
5.00%
(8,760.00)
21A Fire Protection
11,662.00
DocuSign Envelope ID: 18BCC2EB-5C45-4A03-BBDA-FOAFAF992DFC
INVOICE
Retainage
1,994,312.36@
5.00%
(678.10)
22A Plumbing Systems
146,000.00
Retainage
1,994,312.36@
5.00%
(7,260.00)
26A Electrical Systems
313,000.00
Retainage
1,994,312.36@
5.00%
(16,660.00)
31A Multipurpose Earthwork
20,000.00
Retainage
1,994,312.36@
5.00%
(1,000.00)
31 B Lions Earthwork
1,846.60
Retainage
1,994,312.36@
5.00%
(92.28)
32B Concrete/Sidewalk/Curb/Gutter
13,394.00
Retainage
1,994,312.36@
5.00%
(669.70)
32E Chain Link Fence
26,986.10
Retainage
1,994,312.36@
5.00%
(1,299.31)
33A Utilities
16,909.16
Retainage
1,994,312.36@
5.00%
(796.46)
01-00 General Conditions/Requirements
69,172.41
Retainage
1,994,312.36@
0.00%
0.00
90-50 General Liability Insurance
614.82
Retainage
1,994,312.36@
0.00%
0.00
90-80 Builders Risk Insurance
169.87
Retainage
1,994,312.36@
0.00%
0.00
99-99 Contractors Fee
31,884.06
Retainage
1,994,312.36@
5.00%
(1,594.20)
CURRENT DUE :
1,898,644.28
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 3
830 Boone Avenue North John Weicht Park
Golden Valley, MN 55427 Period To: 04/30/20
From: Rachel Contracting, Inc. Application Date: 04/24/20
4125 Napier Court NE Project No.: 19520-0033
Saint Michael, MN 55376
Contract Date: 07/23/19
Contract For: 195200033-024405 - Mass Structure Commitment: 195200033-024405
Demoltion
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
$178,890.00
($9,731.49)
$169,158.51
$166,199.51
$7,842.45
$7,842.45
$158, 357.06
$154, 089.53
$4,267.53
$10,801.45
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$8,255.00
$17,986.49
Total approved this month
$0.00
$0.00
TOTALS
$8,255.00
$17,986.49
NET CHANGES by Change Orders
($9,731.49)
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Jennifer Amenrud Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $4,267.53
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Rachel Contracting, Inc.
APPLICATION NO.: 3
APPLICATION DATE: 04/24/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Building Demolition
$158,890.00
$154,890.00
$4,000.00
$158,890.00
100.00%
$7,944.50
2
Allowance
$20,000.00
$15,000.00
$2,041.00
$17,041.00
85.21%
$2,959.00
1
Mass Structure Demoltion (CO
($945.49)
($945.49)
($945.49)
100.00%
#1)
1
Mass Structure Demoltion (CO
($15,000.00)
($15,000.00)
($15,000.00)
100.00%
#2)
1
Mass Structure Demoltion (CO
$8,255.00
$8,255.00
$8,255.00
100.00%
#3)
1
Mass Structure Demoltion (CO
($2,041.00)
($2,041.00)
($2,041.00)
100.00%
($102.05)
#4)
PAYMENT TOTALS
1 $169,158.51
$162,199.51
1 $4,000.00
$166,199.51
1 98.25%
$2,959.00
$7,842.45
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Ebert Construction
23350 County Road 10
Corcoran, MN 55357
Contract For: 195200033-024105 - Demolition
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$223,800.00
($11,541.60)
$212,258.40
$191,390.40
$9,569.52
$9,569.52
$181,820.88
$12,043.53
$169,777.35
$30,437.52
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$1,324.40
$12,866.00
Total approved this month
$0.00
$0.00
TOTALS
$1,324.40
$12,866.00
NET CHANGES by Change Orders
($11,541.60)
Application No.: 5
Period To:
04/30/20
Application Date:
04/24/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-024105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Caleb Pelkey Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $169,777.35
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Ebert Construction
APPLICATION NO.: 5
APPLICATION DATE: 04/24/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
General Conditions/Bond
$9,888.00
$4,259.00
$2,662.60
$6,921.60
70.00%
$2,966.40
$346.08
2
Selective Demolition
$193,912.00
$8,166.00
$176,050.40
$184,216.40
95.00%
$9,695.60
$9,210.82
3
Allowance
$20,000.00
$2,794.00
$2,794.00
13.97%
$17,206.00
$139.70
1
Demolition (CO #1)
($3,866.00)
($3,866.00)
($3,866.00)
100.00%
($193.30)
1
Demolition (CO #2)
$1,324.40
$1,324.40
$1,324.40
100.00%
$66.22
2
Demolition (CO #3)
($9,000.00)
-
($9,000.00)
-
PAYMENT TOTALS
$212,258.40
$12,677.40
$178,713.00
$191,390.40
90.17%
$20,868.00
$9,569.52
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: CROSSTOWN MASONRY, INCORPORATED
1322 159TH AVE NE
HAM LAKE, MN 55304
Contract For: 195200033-042105 - Concrete/Masonry
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$2,935,000.00
$21,864.00
$2,956,864.00
$2,739,013.00
$136, 950.65
$136, 950.65
$2,602,062.35
$2,567,862.35
$34,200.00
$354,801.65
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$49,351.00
$27,487.00
Total approved this month
$0.00
$0.00
TOTALS
$49,351.00
$27,487.00
NET CHANGES by Change Orders
$21,864.00
Application No.: 9
Period To:
04/30/20
Application Date:
04/22/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-042105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Amanda Brandt Date: 04/23/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $34,200.00
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
CROSSTOWN MASONRY, INCORPORATED
APPLICATION NO.: 9
APPLICATION DATE: 04/22/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Footings & Foundation Labor
$30,000.00
$30,000.00
$30,000.00
100.00%
$1,500.00
2
Footings & Foundation Material
$8,000.00
$8,000.00
$8,000.00
100.00%
$400.00
3
Above Grade CMU Labor
$84,000.00
$74,000.00
$74,000.00
88.10%
$10,000.00
$3,700.00
4
Above Grade CMU Material
$26,000.00
$26,000.00
$26,000.00
100.00%
$1,300.00
5
Slab on Grade Labor
$5,300.00
-
$5,300.00
6
Slab on Grade Material
$4,200.00
$4,200.00
7
Stone Piers Labor
$17,000.00
$17,000.00
8
Stone Piers Material
$10,000.00
-
$10,000.00
9
Dug Outs/Batting Cage Labor
$41,000.00
$35,000.00
$35,000.00
85.37%
$6,000.00
$1,750.00
10
Dug Outs/Batting Cage
$28,000.00
$24,000.00
$24,000.00
85.71%
$4,000.00
$1,200.00
Material
11
Footings & Foundation Labor
$415,000.00
$415,000.00
$415,000.00
100.00%
$20,750.00
12
Footings & Foundation Material
$210,000.00
$210,000.00
$210,000.00
100.00%
$10,500.00
13
Above Grade CMU Labor
$812,000.00
$800,000.00
$12,000.00
$812,000.00
100.00%
$40,600.00
14
Above Grade CMU Material
$348,000.00
$346,000.00
$2,000.00
$348,000.00
100.00%
$17,400.00
15
Slab on Grade Labor
$236,000.00
$231,000.00
$3,000.00
$234,000.00
99.15%
$2,000.00
$11,700.00
16
Slab on Grade Material
$210,000.00
$204,000.00
$5,000.00
$209,000.00
99.52%
$1,000.00
$10,450.00
17
Slab on Deck Labor
$140,000.00
$137,000.00
$3,000.00
$140,000.00
100.00%
$7,000.00
18
Slab on Deck Material
$69,000.00
$67,000.00
$2,000.00
$69,000.00
100.00%
$3,450.00
19
Stoops Labor
$8,000.00
-
$8,000.00
20
Stoops Material
$2,000.00
$2,000.00
21
Stone at Fireplace Labor
$8,000.00
$8,000.00
22
Stone at Fireplace Material
$2,000.00
-
$2,000.00
23
Concrete Allowance
$50,000.00
$25,420.00
$25,420.00
50.84%
$24,580.00
$1,271.00
24
Masonry Allowance
$40,000.00
$5,229.00
$5,229.00
13.07%
$34,771.00
$261.45
25
Field House Labor
$70,000.00
$5,000.00
$5,000.00
7.14%
$65,000.00
$250.00
26
Field House Material
$18,000.00
$4,000.00
$4,000.00
22.22%
$14,000.00
$200.00
27
Bond
$43,500.00
$43,500.00
$43,500.00
100.00%
$2,175.00
PAYMENT TOTALS
$2,956,864.00
$2,703,013.00
$36,000.00
$2,739,013.00
92.63%
$217,851.00
$136,950.65
Page 1 of 2
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
CONTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
CROSSTOWN MASONRY, INCORPORATED
APPLICATION NO.: 9
APPLICATION DATE: 04/22/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Concrete/Masonry (CO #1)
$697.00
$697.00
$697.00
100.00%
$34.85
1
Concrete/Masonry (CO #2)
$33,996.00
$33,996.00
$33,996.00
100.00%
$1,699.80
1
Concrete/Masonry (CO #3)
($3,778.00)
($3,778.00)
($3,778.00)
100.00%
($188.90)
1
Concrete/Masonry (CO #4)
$689.00
$689.00
$689.00
100.00%
$34.45
1
Concrete/Masonry (CO #5)
($15,209.00)
($15,209.00)
($15,209.00)
100.00%
($760.45)
1
Concrete/Masonry (CO #6)
$2,930.00
$2,930.00
$2,930.00
100.00%
$146.50
1
Concrete/Masonry (CO #7)
($8,500.00)
($8,500.00)
($8,500.00)
100.00%
($425.00)
1
Concrete/Masonry (CO #6)
$11,039.00
$11,039.00
$11,039.00
100.00%
$551.95
PAYMENT TOTALS
$2,956,864.00
$2,703,013.00
$36,000.00
$2,739,013.00
92.63%
$217,851.00
$136,950.65
Page 2 of 2
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: SUNRISE PAINTING
805 TOWER DRIVE
MEDINA, MN 55340
Contract For: 195200033-099105 - Painting
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$412, 750.00
$64,800.00
$477, 550.00
$186, 500.00
$9,325.00
$9,325.00
$177,175.00
$89,300.00
$87,875.00
$300,375.00
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$73,800.00
$9,000.00
Total approved this month
$0.00
$0.00
TOTALS
$73,800.00
$9,000.00
NET CHANGES by Change Orders
$64,800.00
Application No.: 4
Period To:
04/30/20
Application Date:
04/20/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-099105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Kim Larson Date: 04/20/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $87,875.00
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
SUNRISE PAINTING
APPLICATION NO.: 4
APPLICATION DATE: 04/20/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
PAINTING
$407,750.00
$89,000.00
$71,500.00
$160,500.00
39.36%
$247,250.00
$8,025.00
2
BOND
$5,000.00
$5,000.00
$5,000.00
100.00%
$250.00
1
Painting (CO#1)
$10,000.00
-
$10,000.00
1
Painting (CO #3)
($9,000.00)
($9,000.00)
($9,000.00)
100.00%
($450.00)
2
Prime + Paint Joists (CO #2)
$63,800.00
$30,000.00
$30,000.00
47.02%
$33,800.00
$1,500.00
PAYMENT TOTALS
$477,550.00
$94,000.00
$92,500.00
$186,500.00
39.05%
$291,050.00
$9,325.00
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Design Electric, Inc
PO Box 1252
St. Cloud, MN 56302
Contract For: 195200033-260105 - Electrical
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$1,786,914.00
$14,536.20
$1,801,450.20
$1,316,692.07
$65,834.60
$65,834.60
$1,250,857.47
$939,257.47
$311,600.00
$550, 592.73
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$59,004.79
$44,468.59
Total approved this month
$0.00
$0.00
TOTALS
$59,004.79
$44,468.59
NET CHANGES by Change Orders
$14,536.20
Application No.: 8
Period To:
04/30/20
Application Date:
04/21/20
Project No.:
19520-0033
Contract Date:
08/01/19
Commitment:
195200033-260105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Ashley Krueger Date: 04/21/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $311,600.00
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Design Electric, Inc
APPLICATION NO.: 8
APPLICATION DATE: 04/21/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
BOND/PERMIT
$35,908.00
$35,908.00
$35,908.00
100.00%
$1,795.40
/MOBILIZATION
2
SITE WORK/UNDERGROUND
$33,158.00
$32,000.00
$32,000.00
96.51%
$1,158.00
$1,600.00
3
DEMOLITION/TEMP WIRING
$64,200.00
$63,800.00
$63,800.00
99.38%
$400.00
$3,190.00
4M
CONDUIT -MATERIAL
$122,167.00
$100,000.00
$100,000.00
81.86%
$22,167.00
$5,000.00
4L
CONDUIT - LABOR
$180,320.00
$89,000.00
$89,000.00
49.36%
$91,320.00
$4,450.00
5M
BOXES/WIRE/DEVICES -
$110,400.00
$95,200.00
$95,200.00
86.23%
$15,200.00
$4,760.00
MATERIAL
5L
BOXES/WIRE/DEVICES -
$67,200.00
$52,500.00
$52,500.00
78.13%
$14,700.00
$2,625.00
LABOR
6M
FIXTURES - MATERIAL
$425,654.00
$100,000.00
$180,000.00
$280,000.00
65.78%
$145,654.00
$14,000.00
6L
FIXTURES - LABOR
$90,400.00
-
$90,400.00
7M
GEAR - MATERIAL
$145,168.00
$119,000.00
$25,000.00
$144,000.00
99.20%
$1,168.00
$7,200.00
7L
GEAR - LABOR
$38,400.00
$25,000.00
$25,000.00
65.10%
$13,400.00
$1,250.00
8M
LOW VOLTAGE ROUGH -IN -
$46,722.00
$35,000.00
$7,000.00
$42,000.00
89.89%
$4,722.00
$2,100.00
MATERIAL
8L
LOW VOLTAGE ROUGH -IN -
$73,120.00
$35,000.00
$25,000.00
$60,000.00
82.06%
$13,120.00
$3,000.00
LABOR
9M
EQUIPMENT CONNECTIONS
$68,400.00
$30,000.00
$30,000.00
43.86%
$38,400.00
$1,500.00
- MATERIAL
9L
EQUIPMENT CONNECTIONS
$12,200.00
$5,000.00
$5,000.00
40.98%
$7,200.00
$250.00
-LABOR
10M
FIRE ALARM - MATERIAL
$84,697.00
$57,798.00
$10,000.00
$67,798.00
80.05%
$16,899.00
$3,389.90
10L
FIRE ALARM - LABOR
$20,000.00
$10,000.00
$4,000.00
$14,000.00
70.00%
$6,000.00
$700.00
11M
SOFTBALL FIELD -
$153,200.00
$153,200.00
$153,200.00
100.00%
$7,660.00
MATERIAL
11L
SOFTBALL FIELD - LABOR
$15,600.00
$8,000.00
$2,000.00
$10,000.00
64.10%
$5,600.00
$500.00
12
-
-
1
Electrical (CO #1)
$945.49
$945.49
$945.49
100.00%
$47.27
PAYMENT TOTALS
$1,801,450.20
$988,692.07
$328,000.00
$1,316,692.07
73.09%
$484,758.13
$65,834.60
Page 1 of 2
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
CONTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Design Electric, Inc
APPLICATION NO.: 8
APPLICATION DATE: 04/21/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Electrical (CO#2)
$1,340.58
$1,340.58
$1,340.58
100.00%
$67.03
1
Electrical (CO#3)
$1,582.00
-
$1,582.00
-
1
Electrical (CO #4)
($24,378.00)
($24,378.00)
1
Electrical (CO #5)
($12,693.73)
($12,693.73)
1
Electrical (CO #6)
$396.52
$396.52
1
Electrical (CO#7)
$2,162.06
$2,162.06
1
Electrical (CO #8)
$7,694.97
$7,694.97
1
Electrical (CO #10)
$5,773.48
-
$5,773.48
-
2
Joist Work - Electrical (CO #9)
$24,561.00
$15,000.00
$15,000.00
61.07%
$9,561.00
$750.00
1
Electrical (CO#7)
$1,035.41
-
$1,035.41
-
1
Electrical (CO #7)
$12,342.68
$12,342.68
1
Electrical (CO#7)
$1,170.60
$1,170.60
1
Electrical (CO #7)
($7,396.86)
-
($7,396.86)
PAYMENT TOTALS
$1,801,450.20
$988,692.07
$328,000.00
$1,316,692.07
73.09%
$484,758.13
$65,834.60
Page 2 of 2
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: American Sandblasting, Inc
9905 Xylite Street NE
Blaine, MN 55449
Contract For: 195200033-054105 - Joist Sandblasting
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$171,000.00
$20,000.00
$191,000.00
$100,000.00
$5,000.00
$5,000.00
$95,000.00
$0.00
$95,000.00
$96,000.00
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$0.00
$0.00
Total approved this month
$20,000.00
$0.00
TOTALS
$20,000.00
$0.00
NET CHANGES by Change Orders
$20,000.00
Application No.: 1
Period To:
04/15/20
Application Date:
03/24/20
Project No.:
19520-0033
Contract Date:
03/24/20
Commitment:
195200033-054105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Ann Wolden Date: 04/30/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $95,000.00
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
American Sandblasting, Inc
APPLICATION NO
APPLICATION DATE: 03/24/20
PERIOD TO: 04/15/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM NUM
DESCRIPTION OF
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
WORK
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
Material Charges
Costs for blasting media,
$81,000.00
$45,000.00
$45,000.00
55.56%
$36,000.00
$2,250.00
lift rental, prep materials,
fuel, etc.
Labor Charges
Cost for labor to blast
$90,000.00
$55,000.00
$55,000.00
61.11 %
$35,000.00
$2,750.00
and clean up area.
(Before Change Order)
1
Joist Sandblasting (CO
$20,000.00
-
$20,000.00
#1)
PAYMENT TOTALS
1 $191,000.00
1 $100,000.00
$100,000.00
1 52.36%
$91,000.00
$5,000.00
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion
Application No.:
6
830 Boone Avenue North John Weicht Park
Golden Valley, MN 55427
Period To:
04/30/20
From: High Five Erectors II, Inc.
Application Date:
04/24/20
3005 4th Avenue East
Project No.:
19520-0033
P.O. Box 477
Contract Date:
07/23/19
Shakopee, MN 55379
Contract For: 195200033-051210 - Structural Steel Erection
Commitment:
195200033-051210
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
$435,750.00
$10,123.85
$445,873.85
$351,098.00
$17,554.90
$17,554.90
$333,543.10
$294,065.85
$39,477.25
$112,330.75
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$17,012.00
$6,888.15
Total approved this month
$0.00
$0.00
TOTALS
$17,012.00
$6,888.15
NET CHANGES by Change Orders
$10,123.85
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Tara Thompson Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $39,477.25
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
High Five Erectors II, Inc.
APPLICATION NO.: 6
APPLICATION DATE: 04/24/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
051200 Structural Steel
$129,841.00
$129,841.00
$129,841.00
100.00%
$6,492.05
2
052100 Steel Joists
$100,523.00
$100,523.00
$100,523.00
100.00%
$5,026.15
3
053100 Steel Decking
$45,888.00
$45,888.00
$45,888.00
100.00%
$2,294.40
4
055000 Metal Fabrications
$8,508.00
-
$8,508.00
5
055100 Metal Pan Stairs
$43,996.00
$10,999.00
$10,999.00
$21,998.00
50.00%
$21,998.00
$1,099.90
6
055213 Pipe & Tube Railings
$71,614.00
$21,484.00
$21,484.00
30.00%
$50,130.00
$1,074.20
7
Allowance
$30,000.00
$15,438.15
$422.00
$15,860.15
52.87%
$14,139.85
$793.01
8
Bond
$5,380.00
$5,380.00
-
$5,380.00
100.00%
$269.00
1
Structural Steel Erection (CO
$4,190.00
$4,190.00
$4,190.00
100.00%
$209.50
#1)
1
Structural Steel Erection (CO
($6,888.15)
($6,888.15)
($6,888.15)
100.00%
($344.41)
#2)
1
Structural Steel Erection (CO
$500.00
$500.00
$500.00
100.00%
$25.00
#3)
1
Structural Steel Erection (CO
$672.00
$672.00
$672.00
100.00%
$33.60
#4)
1
Structural Steel Erection (CO
$3,000.00
$3,000.00
$3,000.00
100.00%
$150.00
#5)
1
Structural Steel Erection (CO
$8,650.00
$8,650.00
$8,650.00
100.00%
$432.50
#6)
PAYMENT TOTALS
1 $445,873.85
$309,543.00
$41,555.00
1 $351,098.00
1 78.74%
$94,775.85
1 $17,554.90
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 3
830 Boone Avenue North John Weicht Park
Golden Valley, MN 55427 Period To: 04/30/20
From: Kendell Doors & Hardware, Inc. Application Date: 04/24/20
PO Box 211520 Project No.: 19520-0033
Eagan, MN 55121
Contract Date: 11/13/19
Contract For: 195200033-081105 - Hollow Metal Doors & Commitment: 195200033-081105
Frames
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
$92,614.00
$157,787.78
$250,401.78
$47,625.68
$393.69
$393.69
$47,231.99
$25,324.17
$21,907.82
$203,169.79
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$157,787.78
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$157,787.78
$0.00
NET CHANGES by Change Orders
$157,787.78
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Jason Self Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $21,907.82
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Kendell Doors & Hardware, Inc.
APPLICATION NO.: 3
APPLICATION DATE: 04/24/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Hollow Metal
$84,079.00
$25,634.23
$13,816.91
$39,451.14
46.92%
$44,627.86
2
Finish Hardware
$8,535.00
-
-
-
$8,535.00
1
Hollow Metal Doors & Frames
$2,119.32
$300.81
$300.81
14.19%
$1,818.51
(CO #1)
1
Hollow Metal Doors & Frames
$133,389.00
-
$7,873.73
$7,873.73
5.90%
$125,515.27
$393.69
(CO #2)
1
Hollow Metal Doors & Frames
$17,013.00
-
$17,013.00
-
(CO #3)
1
Hollow Metal Doors & Frames
$2,542.87
$2,542.87
(CO #4)
1
Hollow Metal Doors & Frames
$2,723.59
-
$2,723.59
(CO #5)
PAYMENT TOTALS
1 $250,401.78
$25,935.04
$21,690.64
$47,625.68
19.02%
$202,776.10
$393.69
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Ebert Construction
23350 County Road 10
Corcoran, MN 55357
Contract For: 195200033-064015 - Carpentry
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$546,800.00
$416.90
$547,216.90
$267,615.75
$13,380.79
$13,380.79
$254,234.96
$203,805.77
$50,429.19
$292, 981.94
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$416.90
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$416.90
$0.00
NET CHANGES by Change Orders
$416.90
Application No.: 6
Period To:
04/30/20
Application Date:
04/23/20
Project No.:
19520-0033
Contract Date:
11/12/19
Commitment:
195200033-064015
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Caleb Pelkey Date: 04/23/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $50,429.19
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Ebert Construction
APPLICATION NO.: 6
APPLICATION DATE: 04/23/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Bonds, Insurance, Mobilize
$5,000.00
$5,000.00
$5,000.00
100.00%
$250.00
2
General Conditions
$21,000.00
$11,550.00
$1,050.00
$12,600.00
60.00%
$8,400.00
$630.00
3
Allowance
$50,000.00
$12,882.39
$8,473.36
$21,355.75
42.71%
$28,644.25
$1,067.79
4
061000 Rough Carpentry M
$59,700.00
$59,700.00
$59,700.00
100.00%
$2,985.00
5
061000 Rough Carpentry L
$153,000.00
$122,400.00
$10,710.00
$133,110.00
87.00%
$19,890.00
$6,655.50
6
061753 Shop Fam Wood
$3,000.00
$3,000.00
$3,000.00
100.00%
$150.00
Trusses
7
064216 Wood Paneling
$135,000.00
$20,250.00
$20,250.00
15.00%
$114,750.00
$1,012.50
8
072119 Foamed -In -Place
$17,000.00
-
$17,000.00
-
Insulation
9
081113 HM Doors and Frames
$81,000.00
$8,100.00
$8,100.00
10.00%
$72,900.00
$405.00
10
097733 FRP
$4,500.00
$4,500.00
$4,500.00
100.00%
$225.00
11
101100 Visual Display Boards
$7,800.00
-
$7,800.00
-
12
102600 Wall and Corner
$7,000.00
$7,000.00
Guards
13
105113 Metal Lockers
$2,800.00
$2,800.00
1
Carpentry (CO #1)
$416.90
-
$416.90
PAYMENT TOTALS
$547,216.90
$214,532.39
$53,083.36
$267,615.75
48.91%
$279,601.15
$13,380.79
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Top -All Roofing, Inc
2231 Edgewood Ave. So.
Minneapolis, MN 55426
Contract For: 195200033-075305 - Roofing
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
0% of Completed Work
(Columns D + E)
0% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$1,020,690.00
($8,380.00)
$1,012,310.00
$983,001.00
N/A
N/A
$49,150.10
$933,850.90
$932,697.75
$1,153.15
$78,459.10
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$3,620.00
$12,000.00
Total approved this month
$0.00
$0.00
TOTALS
$3,620.00
$12,000.00
NET CHANGES by Change Orders
($8,380.00)
Application No.: 6
Period To:
04/30/20
Application Date:
04/20/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-075305
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Lori Stevens Date: 04/20/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $1,153.15
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Top -All Roofing, Inc
APPLICATION NO.: 6
APPLICATION DATE: 04/20/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Material Insulation
$384,950.00
$384,950.00
$384,950.00
100.00%
$19,247.50
2
Material Vapor Barrier
$50,600.00
$50,600.00
$50,600.00
100.00%
$2,530.00
3
Material EPDM & Accessories
$195,960.00
$195,960.00
$195,960.00
100.00%
$9,798.00
4
Material Sheet Metal
$32,040.00
$20,826.00
$9,612.00
$30,438.00
95.00%
$1,602.00
$1,521.90
5
Labor Insulation
$80,070.00
$76,063.00
$4,006.00
$80,069.00
100.00%
$1.00
$4,003.50
6
Labor Vapor Barrier
$21,110.00
$20,055.00
$1,055.00
$21,110.00
100.00%
-
$1,055.50
7
Labor EPDM & Accessories
$148,060.00
$140,657.00
$7,403.00
$148,060.00
100.00%
$7,403.00
8
Labor Sheet Metal
$29,900.00
$17,940.00
$10,465.00
$28,405.00
95.00%
$1,495.00
$1,420.25
9
Allowance for Conditions
$45,000.00
$18,789.00
$18,789.00
41.75%
$26,211.00
$939.45
10
Bonding
$33,000.00
$33,000.00
$33,000.00
100.00%
$1,650.00
1
Roofing (CO #1)
$2,060.00
$2,060.00
$2,060.00
100.00%
$103.00
1
Roofing (CO #2)
($12,000.00)
($12,000.00)
($12,000.00)
100.00%
($600.00)
1
Roofing (CO #3)
$1,560.00
$1,560.00
$1,560.00
100.00%
$78.00
PAYMENT TOTALS
$1,012,310.00
$960,900.00
$22,101.00
$983,001.00
97.10%
$29,309.00
$49,150.10
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Schwickert's Tecta America, LLC
330 Poplar Street
Mankato, MN 56001
Contract For: 195200033-074205 - Metal Wall Panels
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$202,415.00
($10,955.00)
$191,460.00
$23,785.00
$1,189.25
$1,189.25
$22,595.75
$0.00
$22,595.75
$168, 864.25
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$0.00
$0.00
Total approved this month
$0.00
$10,955.00
TOTALS
$0.00
$10,955.00
NET CHANGES by Change Orders
($10,955.00)
Application No.: 1
Period To:
04/30/20
Application Date:
04/22/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-074205
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Michele Wheeler Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $22,595.75
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Schwickert's Tecta America, LLC
APPLICATION NO
APPLICATION DATE: 04/22/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Insurance/Bonds
$12,574.00
$12,574.00
$12,574.00
100.00%
$628.70
2
Shop Drawings
$11,211.00
$11,211.00
$11,211.00
100.00%
$560.55
3
Mobilzation/Equipment
$11,710.00
-
$11,710.00
-
4
Safety
$9,311.00
$9,311.00
5
Walllnsulation/Z-Furring
$10,888.00
$10,888.00
Materials
6
Wall Insulation/Z-Furring Labor
$9,646.00
$9,646.00
7
Solid Phenolic Rainsceen
$33,465.00
$33,465.00
Panels Materials
8
Solid Phenolic Rainsceen
$11,282.00
$11,282.00
Panels Labor
9
Solid Phenolic Rainscreen
$17,619.00
$17,619.00
Panel Flashing Materials
10
Solid Phenolic Rainscreen
$8,113.00
$8,113.00
Panel Flashing Labor
11
ACM Fabrication Materials
$20,003.00
$20,003.00
12
ACM Fabrication Labor
$17,519.00
$17,519.00
13
ACM Flashing Materials
$5,419.00
$5,419.00
14
ACM Flashing Labor
$4,923.00
$4,923.00
15
ACM Inst. Materials (hat
$7,241.00
$7,241.00
/fasteners/etc.)
16
ACM Inst. Labor
$6,491.00
$6,491.00
17
$5,000 Allowance per Contract
$5,000.00
$5,000.00
1
Metal Wall Panels (CO #1)
($10,955.00)
-
($10,955.00)
PAYMENT TOTALS
1 $191,460.00
$23,785.00
1 $23,785.00
1 12.42%
$167,675.00
$1,189.25
Page 1 of 1
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DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Murphy Window and Door Commercial, Inc
APPLICATION NO.: 3
APPLICATION DATE: 03/23/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
08-900 Curtain Wall &
$147,882.52
$26,691.77
$33,579.38
$60,271.15
40.76%
$87,611.37
$3,013.56
Storefront Metal
2
08-700 Hardware
$89,971.20
-
$89,971.20
3
08-300 Automatic Entrances
$22,578.00
-
$22,578.00
4
08-800 Glazing
$113,807.50
$43,456.85
$30,318.55
$73,775.40
64.82%
$40,032.10
$3,688.77
5
08-950 Brake Metal
$7,100.00
$1,999.33
$1,999.33
28.16%
$5,100.67
$99.97
6
07-900 Joint Sealers
$3,675.73
$1,400.00
$1,400.00
38.09%
$2,275.73
$70.00
7
08-050 Misc Fasteners,
$3,944.65
$1,000.00
$1,000.00
25.35%
$2,944.65
$50.00
Shims, Backer Rod
8
01-542 Man Lifts, Storage, &
$25,560.00
$4,415.40
$8,127.85
$12,543.25
49.07%
$13,016.75
$627.16
Equipment
9
01-750 Bonds & Insurance
$14,200.00
$14,200.00
$14,200.00
100.00%
$710.00
10
01-010 Refundable Allowance
$7,500.00
-
$7,500.00
-
11
08-910 Shop Drawings
$9,958.00
$9,958.00
$9,958.00
100.00%
$497.90
12
08-920 Structural Calcs
$17,569.20
$17,569.20
$17,569.20
100.00%
$878.46
13
08-930 Field Installation Labor
$119,253.20
$11,907.97
$25,713.28
$37,621.25
31.55%
$81,631.95
$1,881.06
14
01-770 Mobilization
$18,000.00
$18,000.00
$18,000.00
100.00%
$900.00
1
Glass and Glazing (CO #1)
$43,100.00
-
$43,100.00
-
PAYMENT TOTALS
$644,100.00
$150,598.52
$97,739.06
$248,337.58
38.56%
$395,762.42
$12,416.88
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: SKOLD SPECIALTY CONTRACTING, LLC
27214 Huck Finn Circle, Ste 3
Harrisburg, SD 57032
Contract For: 195200033-083305 - Overhead Coiling Door
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$61,760.00
($8,500.00)
$53,260.00
$8,575.00
$428.75
$428.75
$8,146.25
$0.00
$8,146.25
$45,113.75
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$0.00
$0.00
Total approved this month
$0.00
$8,500.00
TOTALS
$0.00
$8,500.00
NET CHANGES by Change Orders
($8,500.00)
Application No.: 1
Period To:
04/30/20
Application Date:
04/16/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-083305
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Amanda Fielder-Lembke Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $8,146.25
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
SKOLD SPECIALTY CONTRACTING, LLC
APPLICATION NO
APPLICATION DATE: 04/16/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Material
$46,415.00
$5,325.00
$5,325.00
11.47%
$41,090.00
$266.25
2
Installation
$15,345.00
$3,250.00
$3,250.00
21.18%
$12,095.00
$162.50
1
Overhead Coiling Door (CO #1)
($8,500.00)
-
($8,500.00)
-
PAYMENT TOTALS
$53,260.00
$8,575.00
$8,575.00
r 16.10%
$44,685.00
$428.75
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: RTL Construction, Inc.
290 Sarazin Street
Shakopee, MN 55379
Contract For: 195200033-092905 - Gypsum
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$309,300.00
$24,550.20
$333,850.20
$193,954.33
$9,697.71
$9,697.71
$184, 256.62
$64,905.22
$119, 351.40
$149, 593.58
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$24,550.20
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$24,550.20
$0.00
NET CHANGES by Change Orders
$24,550.20
Application No.: 3
Period To:
04/30/20
Application Date:
04/21/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-092905
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Katie Hislop Date: 04/21/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $119,351.40
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
RTL Construction, Inc.
APPLICATION NO.: 3
APPLICATION DATE: 04/21/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Bonds/Shops
$6,000.00
$6,000.00
$6,000.00
100.00%
$300.00
2
Allowance
$15,000.00
$6,983.05
$6,983.05
46.55%
$8,016.95
$349.15
3
Drywall Assembles
$190,000.00
$38,000.00
$66,500.00
$104,500.00
55.00%
$85,500.00
$5,225.00
4
Insulation
$15,000.00
$10,500.00
$10,500.00
70.00%
$4,500.00
$525.00
5
Materials
$83,300.00
$20,825.00
$41,650.00
$62,475.00
75.00%
$20,825.00
$3,123.75
1
Gypsum (CO #1)
$23,308.52
$3,496.28
$3,496.28
15.00%
$19,812.24
$174.81
1
Gypsum (CO #2)
$1,241.68
-
$1,241.68
-
PAYMENT TOTALS
$333,850.20
$68,321.28
$125,633.05
$193,954.33
58.10%
$139,895.87
$9,697.71
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
Project: Elk River Multi -Purpose Facility and Lion Application No.:
1
830 Boone Avenue North
John Weicht Park
Golden Valley, MN 55427
Period To:
04/30/20
From: CD Tile and Stone, Inc.
Application Date:
04/23/20
3103 103rd Lane NE
Project No.:
19520-0033
Suite 160
Contract Date:
07/23/19
Blaine, MN 55449
Contract For: 195200033-093105 - Tile
Commitment:
195200033-093105
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
$155,980.00
($17,500.00)
$138,480.00
$74,138.00
$2,829.65
$877.25
$3,706.90
$70,431.10
$0.00
$70,431.10
$68,048.90
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$0.00
$0.00
Total approved this month
$0.00
$17,500.00
TOTALS
$0.00
$17,500.00
NET CHANGES by Change Orders
($17,500.00)
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Rita Hamsmith Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $70,431.10
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
CD Tile and Stone, Inc.
APPLICATION NO
APPLICATION DATE: 04/23/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
0
Labor
$85,790.00
$21,448.00
$21,448.00
25.00%
$64,342.00
$1,072.40
0
Materials
$70,190.00
$52,645.00
$17,545.00
$70,190.00
100.00%
$3,509.50
1
Tile (CO #1)
($14,500.00)
($14,500.00)
($14,500.00)
100.00%
($725.00)
1
Tile (CO #2)
($3,000.00)
($3,000.00)
($3,000.00)
100.00%
($150.00)
PAYMENT TOTALS
$138,480.00
$56,593.00
$17,545.00
$74,138.00
53.54%
$64,342.00
$3,706.90
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
C�D
*Tile & Stone mc. 3103103rd Lane NE, Suite 160, Blaine MN 55449.763-746-2290 , Fax: 763-746-2505
April 27, 2020
Attn: Tim Ryan (RJM Construction)
Re: Stored Materials
3103 103rd Lane, Suite 160
Blaine, NIN 55449
This is to certify that CD Tile and Stone has procured all tile materials for the Elk River
Multipurpose Facility, 75% of the materials have been delivered to site and 25% will be
stored at CD Tile's warehouse in Blaine.
1. The materials are stored in a safe and secure manner as to preclude damage, theft
or vandalism.
2. These materials are available now for the inspection by the General Contractor
and Owner or their representatives.
3. The materials are covered by CD Tile's installation floater for 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 materials are shipped to site, at
that time title will be transferred.
4. The materials have been purchased for the specific purpose of being used in the
construction of the project, in accordance with the contract documents.
5. The materials will remain at CD Tile, except in an emergency that threatens the
material.
6. The undersigned makes this affidavit in order to induce owner to pay for such
material.
State of. Minnesota
County of. Anoka
Subscribed and sworn to before me
This �_ of , 2020
Notary Public:
My Commission expires: 1/31/25
LGUq @TA HAPf &WrH public-Minnon mWw sm 31. 2025
rN1M1dVW'/�'
By: CD Tile; acid o ; In .
Signed: >
Name:
Title: ��e�l�� r4-
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Twin City Acoustics, Inc.
9339 Science Center Drive - Ste 100
New Hope, MN 55428
Contract For: 195200033-095105 - Acoustical Ceilings
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$149,410.00
($15,105.00)
$134,305.00
$40,285.00
$2,014.25
$2,014.25
$38,270.75
$2,137.50
$36,133.25
$96,034.25
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$0.00
$15,105.00
Total approved this month
$0.00
$0.00
TOTALS
$0.00
$15,105.00
NET CHANGES by Change Orders
($15,105.00)
Application No.: 2
Period To:
04/30/20
Application Date:
04/20/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-095105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Julie Haupert Date: 04/23/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $36,133.25
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Twin City Acoustics, Inc.
APPLICATION NO.: 2
APPLICATION DATE: 04/20/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
095100 - Material
$97,380.00
$48,690.00
$48,690.00
50.00%
$48,690.00
$2,434.50
2
095100 - Labor
$44,500.00
$4,450.00
$4,450.00
10.00%
$40,050.00
$222.50
3
098430 - Material
$3,450.00
-
$3,450.00
-
4
098430 - Labor
$1,830.00
-
$1,830.00
-
5
Bonds
$2,250.00
$2,250.00
$2,250.00
100.00%
$112.50
1
Acoustical Ceilings (CO #1)
($15,105.00)
($15,105.00)
($15,105.00)
100.00%
($755.25)
PAYMENT TOTALS
$134,305.00
$2,250.00
$38,035.00
$40,285.00
30.00%
$94,020.00
$2,014.25
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Peterson Companies, Inc
8326 Wyoming Trail
Chisago City, MN 55013
Contract For: 195200033-323105 - Chain Link Fence
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$126, 918.00
$17,600.00
$144, 518.00
$115, 755.85
$5,787.80
$5,787.80
$109,968.05
$57,584.96
$52,383.09
$34,549.95
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$17,600.00
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$17,600.00
$0.00
NET CHANGES by Change Orders
$17,600.00
Application No.: 2
Period To:
04/30/20
Application Date:
04/29/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-323105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Nate Schwaab Date: 04/29/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $52,383.09
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Peterson Companies, Inc
APPLICATION NO.: 2
APPLICATION DATE: 04/29/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Survey and Layout
$2,875.00
$2,875.00
$2,875.00
100.00%
$143.75
2
Concrete Maintenance Strip
$23,272.50
$20,945.25
$20,945.25
90.00%
$2,327.25
$1,047.26
3
Chain Link Fences and Gates
$47,698.50
$23,849.25
$4,769.85
$28,619.10
60.00%
$19,079.40
$1,430.96
- Labor
4
Chain Link Fences and Gates
$53,072.00
$26,536.00
$26,536.00
$53,072.00
100.00%
$2,653.60
- Materials
1
Chain Link Fence (CO#4)
$17,600.00
$7,355.50
$2,889.00
$10,244.50
58.21%
$7,355.50
$512.23
PAYMENT TOTALS
$144,518.00
$60,615.75
$55,140.10
$115,755.85
80.10%
$28,762.15
$5,787.80
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Rink-Tec International Inc.
3485 WILLOW LAKE BLVD., SUITE # 500
VADNAIS HEIGHTS, MN 55110
Contract For: 195200033-131805 - Ice Systems
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$2,162,742.00
$0.00
$2,162,742.00
$1,892,742.00
$94,637.10
$94,637.10
$1,798,104.90
$1,633,854.90
$164, 250.00
$364,637.10
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$0.00
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$0.00
$0.00
NET CHANGES by Change Orders
$0.00
Application No.: 9
Period To:
04/30/20
Application Date:
04/21/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-131805
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Kathy Barton Date: 04/21/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $164,250.00
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Rink-Tec International Inc.
APPLICATION NO.: 9
APPLICATION DATE: 04/21/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Bonding/Insurance/Permits
$60,000.00
$60,000.00
$60,000.00
100.00%
$3,000.00
2
Mobilization
$35,000.00
$35,000.00
$35,000.00
100.00%
$1,750.00
3
Reclaim & Demo Equipment
$20,000.00
$20,000.00
$20,000.00
100.00%
$1,000.00
Room #1
4
Rink #1 Saw Cutting/Removal
$60,000.00
$60,000.00
$60,000.00
100.00%
$3,000.00
5
Rink #1 Mains & Insulation
$40,000.00
$40,000.00
$40,000.00
100.00%
$2,000.00
6
Rink #1 Subfloor System
$15,000.00
$15,000.00
$15,000.00
100.00%
$750.00
7
Rink #1 Granular & Fine
$30,000.00
$30,000.00
$30,000.00
100.00%
$1,500.00
Grading
8
Rink #1 Floor Insulation
$44,000.00
$44,000.00
$44,000.00
100.00%
$2,200.00
9
Rink #1 Chairs/Vapor Barrier
$35,000.00
$35,000.00
$35,000.00
100.00%
$1,750.00
/Expansion
10
Rink #1 Rebar/Mesh
$40,000.00
$40,000.00
$40,000.00
100.00%
$2,000.00
11
Rink #1 Headers & Tubing
$100,000.00
$100,000.00
$100,000.00
100.00%
$5,000.00
12
Rink #1 Concrete Placement
$90,000.00
$90,000.00
$90,000.00
100.00%
$4,500.00
/Finishing
13
Rink #2 Mains & Insulation
$40,000.00
$40,000.00
$40,000.00
100.00%
$2,000.00
14
Rink #2 Subfloor System
$15,000.00
$15,000.00
$15,000.00
100.00%
$750.00
15
Rink #2 Granular & Fine
$30,000.00
$30,000.00
$30,000.00
100.00%
$1,500.00
Grading
16
Rink #2 Floor Insulation
$44,000.00
$44,000.00
$44,000.00
100.00%
$2,200.00
17
Rink #2 Chairs/Vapor Barrier
$35,000.00
$35,000.00
$35,000.00
100.00%
$1,750.00
/Expansion
18
Rink #2 Rebar/Mesh
$40,000.00
$40,000.00
$40,000.00
100.00%
$2,000.00
19
Rink #2 Headers & Tubing
$100,000.00
$100,000.00
$100,000.00
100.00%
$5,000.00
20
Rink #2 Concrete Placement
$90,000.00
$90,000.00
$90,000.00
100.00%
$4,500.00
/Finishing
21
Compressor/Chiller/Pumps
$349,742.00
$349,742.00
$349,742.00
100.00%
$17,487.10
/Condenser
22
MCC/Electrical
$120,000.00
$95,000.00
$25,000.00
$120,000.00
100.00%
$6,000.00
PAYMENT TOTALS
$2,162,742.00
$1,717,742.00
$175,000.00
$1,892,742.00
87.52%
$270,000.00
$94,637.10
Page 1 of 2
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
CONTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Rink-Tec International Inc.
APPLICATION NO.: 9
APPLICATION DATE: 04/21/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
23
Microprocessor
$85,000.00
-
$85,000.00
24
Equipment Room Pipes/Valves
$100,000.00
$100,000.00
$100,000.00
100.00%
$5,000.00
/Tanks and Fittings
25
Equipment Room Piping Labor
$140,000.00
$140,000.00
$140,000.00
100.00%
$7,000.00
26
Ammonia Piping Labor
$170,000.00
$70,000.00
$100,000.00
$170,000.00
100.00%
$8,500.00
27
Equipment Room Insulation
$85,000.00
-
$85,000.00
and Labor
28
Labeling/Painting/Water
$40,000.00
$40,000.00
Treatment
29
Refrigerants and Fluids
$60,000.00
-
$60,000.00
30
Reclaim & Demo Equipment
$20,000.00
$20,000.00
$20,000.00
100.00%
$1,000.00
Room #2
31
1 Removal of Sand Floor System
$30,000.00
1
$30,000.00
1
$30,000.00
1 100.00%1
1 $1,500.00
PAYMENT TOTALS
$2,162,742.00
$1,717,742.00
$175,000.00
$1,892,742.00
1 87.52%
$270,000.00
1 $94,637.10
Page 2 of 2
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Summit Companies
575 Minnehaha Avenue West
St Paul, MN 55103
Contract For: 195200033-211005 - Fire Protection
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
0% of Completed Work
(Columns D + E)
0% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$256,485.00
$11,955.00
$268,440.00
$222,192.00
N/A
N/A
$11,109.62
$211,082.38
$200,098.48
$10,983.90
$57,357.62
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$11,955.00
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$11,955.00
$0.00
NET CHANGES by Change Orders
$11,955.00
Application No.: 8
Period To:
04/30/20
Application Date:
04/27/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-211005
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Josh Scott Date: 04/27/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $10,983.90
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Summit Companies
APPLICATION NO.: 8
APPLICATION DATE: 04/27/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Labor
$87,885.00
$65,913.75
$4,394.25
$70,308.00
80.00%
$17,577.00
$3,515.41
2
Material
$111,200.00
$83,400.00
$5,560.00
$88,960.00
80.00%
$22,240.00
$4,448.00
3
Design
$31,200.00
$31,200.00
$31,200.00
100.00%
$1,560.00
4
Fabrication
$20,200.00
$15,150.00
$1,010.00
$16,160.00
80.00%
$4,040.00
$808.00
5
Bonds
$6,000.00
$6,000.00
-
$6,000.00
100.00%
$300.00
1
Fire Protection (CO#1)
$11,955.00
$8,966.25
$597.75
$9,564.00
80.00%
$2,391.00
$478.21
PAYMENT TOTALS
$268,440.00
$210,630.00
$11,562.00
$222,192.00
82.77%
$46,248.00
$11,109.62
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 9
830 Boone Avenue North John Weicht Park
Golden Valley, MN 55427 Period To: 04/30/20
From: WEIDNER MECHANICAL Application Date: 04/21/20
29 WILSON AVENUE NE Project No.: 19520-0033
PO BOX 1087
ST CLOUD, MN 56304 Contract Date: 08/23/19
Contract For: 195200033-220105 - Plumbing Commitment: 195200033-220105
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
$1,206,000.00
$72,978.00
$1,278,978.00
$888,741.00
$44,437.05
$44,437.05
$844,303.95
$706, 553.95
$137,750.00
$434,674.05
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$78,161.00
$5,183.00
Total approved this month
$0.00
$0.00
TOTALS
$78,161.00
$5,183.00
NET CHANGES by Change Orders
$72,978.00
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Karen Schenk Date: 04/21/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $137,750.00
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
WEIDNER MECHANICAL
APPLICATION NO.: 9
APPLICATION DATE: 04/21/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
10.105 Bond
$10,333.00
$10,333.00
$10,333.00
100.00%
$516.65
2
10.109 Allowance
$7,500.00
-
$7,500.00
-
3
10.115 Pipe & Fittings
$235,689.00
$191,000.00
$15,000.00
$206,000.00
87.40%
$29,689.00
$10,300.00
4
10.119 Drains & Carriers
$47,196.00
$47,000.00
$47,000.00
99.58%
$196.00
$2,350.00
5
10.123 Pumps & Tanks
$5,400.00
$5,400.00
$5,400.00
100.00%
-
$270.00
6
10.127 Water Heaters
$82,739.00
-
$82,739.00
-
7
10.137 Plumbing Fixtures &
$79,004.00
$17,500.00
$15,000.00
$32,500.00
41.14%
$46,504.00
$1,625.00
Trim
8
10.139 Misc Plumbing
$42,488.00
$13,700.00
$15,000.00
$28,700.00
67.55%
$13,788.00
$1,435.00
9
11.185 Labor - Plumbing
$560,753.00
$325,600.00
$80,000.00
$405,600.00
72.33%
$155,153.00
$20,280.00
10
30.300 Digging/Backfill
$37,034.00
$37,034.00
$37,034.00
100.00%
-
$1,851.70
11
30.325 Rentals
$13,000.00
$12,600.00
$12,600.00
96.92%
$400.00
$630.00
12
30.360 Pipe Covering
$84,864.00
$52,000.00
$20,000.00
$72,000.00
84.84%
$12,864.00
$3,600.00
1
Plumbing (CO #1)
$7,430.00
$3,379.00
$3,379.00
45.48%
$4,051.00
$168.95
1
Plumbing (CO #2)
($2,203.00)
-
($2,203.00)
-
1
Plumbing (CO #3)
($2,980.00)
($2,980.00)
($2,980.00)
100.00%
($149.00)
1
Plumbing (CO #4)
$2,506.00
$2,506.00
$2,506.00
100.00%
$125.30
1
Plumbing (CO #5)
$10,815.00
$10,815.00
$10,815.00
100.00%
$540.75
1
Plumbing (CO #6)
$1,338.00
-
$1,338.00
-
1
Plumbing (CO #7)
$15,209.00
$15,209.00
$15,209.00
100.00%
$760.45
1
Plumbing (CO #8)
$2,645.00
$2,645.00
$2,645.00
100.00%
$132.25
1
Plumbing (CO #9)
$10,615.00
-
$10,615.00
-
1
Plumbing (CO #10)
$25,562.00
$25,562.00
1
Plumbing (CO #6)
$2,041.00
$2,041.00
PAYMENT TOTALS
$1,278,978.00
1 $743,741.00
$145,000.00
$888,741.00
69.49%
$390,237.00
1 $44,437.05
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Minnesota Utilities & Excavating, LLC
13932 Lake Drive
Forest Lake, MN 55025
Contract For: 195200033-312205 - Multipurpose Earthwork
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
5.00% of Completed Work
(Columns D + E)
5.00% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$572,787.00
$119,498.30
$692,285.30
$623,933.34
$26,308.20
$26,308.20
$597,625.14
$573,736.67
$23,888.47
$94,660.16
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$120,836.30
$1,338.00
Total approved this month
$0.00
$0.00
TOTALS
$120,836.30
$1,338.00
NET CHANGES by Change Orders
$119,498.30
Application No.: 2
Period To:
04/30/20
Application Date:
04/24/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-312205
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Jodi Russ Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $23,888.47
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Minnesota Utilities & Excavating, LLC
APPLICATION NO.: 2
APPLICATION DATE: 04/24/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Earthwork
$572,787.00
$506,164.04
$20,000.00
$526,164.04
91.86%
$46,622.96
$26,308.20
1
Multipurpose Earthwork (CO
$43,459.00
$21,730.00
$21,730.00
50.00%
$21,729.00
#1)
1
Multipurpose Earthwork (CO
$26,672.30
$26,672.30
$26,672.30
100.00%
#2)
1
Multipurpose Earthwork (CO
$3,157.00
$3,157.00
$3,157.00
100.00%
#4)
1
Multipurpose Earthwork (CO
$11,096.00
$11,096.00
$11,096.00
100.00%
#5)
1
Multipurpose Earthwork (CO
($1,338.00)
($1,338.00)
($1,338.00)
100.00%
#6)
2
Geogrid (CO #3)
$3,570.00
$3,570.00
$3,570.00
100.00%
1
Multipurpose Earthwork (CO
$2,338.00
$2,338.00
$2,338.00
100.00%
#7)
1
Multipurpose Earthwork (CO
$26,310.00
$26,310.00
$26,310.00
100.00%
#8)
1
Multipurpose Earthwork (CO
$4,234.00
$4,234.00
$4,234.00
100.00%
#8)
PAYMENT TOTALS
$692,285.30
$603,933.34
$20,000.00
$623,933.34
1 90.13%
$68,351.96
1 $26,308.20
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Ebert Construction
23350 County Road 10
Corcoran, MN 55357
Contract For: 195200033-321305 - Site Concrete
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
0% of Completed Work
(Columns D + E)
0% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$387,400.00
($4,106.97)
$383,293.03
$59,677.68
N/A
N/A
$2,982.39
$56,695.29
$43,969.50
$12,725.79
$326, 597.74
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$3,311.40
$7,418.37
Total approved this month
$0.00
$0.00
TOTALS
$3,311.40
$7,418.37
NET CHANGES by Change Orders
($4,106.97)
Application No.: 4
Period To:
04/30/20
Application Date:
04/01/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-321305
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Caleb Pelkey Date: 04/24/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $12,725.79
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
CONTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Ebert Construction
APPLICATION NO.: 4
APPLICATION DATE: 04/01/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G _ C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
General Conditions
$14,700.00
$7,303.47
$5,410.00
$12,713.47
86.49%
$1,986.53
$635.41
2
MPB - Walks - Materials
$30,617.00
$744.00
$4,752.00
$5,496.00
17.95%
$25,121.00
$273.32
3
MPB - Walks - Labor
$44,082.00
$1,071.18
$1,071.18
2.43%
$43,010.82
$54.01
4
MPB - Curb - Materials
$18,273.00
$2,180.00
$2,180.00
11.93%
$16,093.00
$109.00
5
MPB - Curb - Labor
$22,333.00
$2,664.00
$2,664.00
11.93%
$19,669.00
$133.00
6
Lion - Walks - Materials
$83,053.00
$3,232.00
$3,232.00
3.89%
$79,821.00
$161.60
7
Lion - Walks - Labor
$123,318.00
-
$123,318.00
-
8
Lion - Curb - Materials
$18,461.00
$13,846.75
$13,846.75
75.01 %
$4,614.25
$692.04
9
Lion - Curb - Labor
$22,563.00
$16,922.25
$16,922.25
75.00%
$5,640.75
$846.01
10
Allowance
$10,000.00
$5,659.00
$5,659.00
56.59%
$4,341.00
$283.00
1
Site Concrete (CO #1)
$3,311.40
$3,311.40
$3,311.40
100.00%
$166.00
1
Site Concrete (CO#2)
($1,570.47)
($1,570.47)
($1,570.47)
100.00%
($79.00)
1
Site Concrete (CO #3)
($4,286.00)
($4,286.00)
($4,286.00)
100.00%
($214.00)
1
Site Concrete (CO #4)
($1,561.90)
($1,561.90)
($1,561.90)
100.00%
($78.00)
PAYMENT TOTALS
$383,293.03
$46,283.68
$5,410.00
$7,984.00
$59,677.68
15.57%
$323,615.35
$2,982.39
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Peterson Companies, Inc
8326 Wyoming Trail
Chisago City, MN 55013
Contract For: 195200033-116705 - Athletic Equipment
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
0% of Completed Work
(Columns D + E)
0% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$133,955.00
$39,619.91
$173,574.91
$135,154.36
N/A
N/A
$6,757.74
$128, 396.62
$62,484.78
$65,911.84
$45,178.29
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$39,619.91
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$39,619.91
$0.00
NET CHANGES by Change Orders
$39,619.91
Application No.: 3
Period To:
04/30/20
Application Date:
04/29/20
Project No.:
19520-0033
Contract Date:
07/23/19
Commitment:
195200033-116705
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Nate Schwaab Date: 04/29/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $65,911.84
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Peterson Companies, Inc
APPLICATION NO.: 3
APPLICATION DATE: 04/29/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Survey and Layout
$4,310.00
$4,310.00
$4,310.00
100.00%
$215.51
2
Athletic Equipment - Labor
$27,489.00
$6,872.25
$1,374.45
$8,246.70
30.00%
$19,242.30
$412.34
3
Athletic Equipment - Materials
$68,608.00
$17,152.00
$51,456.00
$68,608.00
100.00%
$3,430.40
4
Scoreboard - Labor
$11,420.00
$5,710.00
$5,710.00
50.00%
$5,710.00
$285.50
5
Scoreboard - Materials
$22,128.00
$22,128.00
$22,128.00
100.00%
$1,106.40
1
Athletic Equipment (CO #1)
$29,154.00
$7,943.25
$14,892.50
$22,835.75
78.33%
$6,318.25
$1,141.79
1
Athletic Equipment (CO #2)
$7,150.00
-
$7,150.00
-
1
Athletic Equipment (CO #3)
$3,315.91
$1,657.96
$1,657.95
$3,315.91
100.00%
$165.80
PAYMENT TOTALS
$173,574.91
$65,773.46
$69,380.90
$135,154.36
77.86%
$38,420.55
$6,757.74
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
APPLICATION FOR PAYMENT
To: RJM Construction, LLC.
830 Boone Avenue North
Golden Valley, MN 55427
From: Metro Utilities, Inc
9656 161st Avenue NW
Elk River, MN 55330
Contract For: 195200033-330105 - Site Utilities
1. ORIGINAL CONTRACT AMOUNT
2. NET CHANGE BY CHANGE ORDERS
3. CONTRACT SUM TO DATE
4. TOTAL COMPLETED AND STORED TO DATE
(Column G)
5. RETAINAGE
0% of Completed Work
(Columns D + E)
0% of Stored Materials
(Columns F)
Total Retainage
(Line 5a + Line 5b OR Sum of Column 1)
6. TOTAL EARNED LESS RETAINAGE
(Line 4 less Line 5 Total)
7. LESS PRIOR CERTIFICATES FOR PAYMENT
(Line 6 from prior Certificate)
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6)
Project: Elk River Multi -Purpose Facility and Lion
John Weicht Park
$586,000.00
$33,037.15
$619,037.15
$619,037.15
N/A
N/A
$30,951.88
$588,085.27
$572, 971.60
$15,113.67
$30,951.88
CHANGE ORDER SUMMARY
ADDITIONS
DEDUCTIONS
Total changes approved in previous months
$33,037.15
$0.00
Total approved this month
$0.00
$0.00
TOTALS
$33,037.15
$0.00
NET CHANGES by Change Orders
$33,037.15
Application No.: 5
Period To:
04/30/20
Application Date:
04/24/20
Project No.:
19520-0033
Contract Date:
07/25/19
Commitment:
195200033-330105
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by the 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 received from the Owner, and that current
payment shown herein is now due.
CONTRACTOR:
By: Steven Crosby Date: 04/27/20
State Of:
County Of:
Subscribed and sworn to before me this
Notary Public:
My commission expires:
ARCHITECTS CERTIFICATE FOR PAYMENT
day of
In accordance with the Contract Documents, based on the on -site observations and the data
compromising this application, the Architect certifies to the owner that to the best of the Architects
knowledge, information and belief the Work under the Architect's Contract has progressed as
indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED $15,113.67
(Attach explanation if amount certified differs from the amount applied for. Initial all figures on the
Application for Payment and on the Continuation sheet that are changes to conform to the amount
certified.)
ARCHITECT
By: Date:
The 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.
Page 1 of 1
DocuSign Envelope ID: 18BCC2EB-5C45-4AO3-BBDA-FOAFAF992DFC
NTINUATION SHEET
APPLICATION AND CERTIFICATION FOR PAYMENT,
containing Contractor's signed Certification is attached.
In tabulations below, amounts are stated to the nearest dollar.
Metro Utilities, Inc
APPLICATION NO.: 5
APPLICATION DATE: 04/24/20
PERIOD TO: 04/30/20
PROJECT NO.: 19520-0033
A
B
C
D
E
F
G
H
I
WORK COMPLETED
MATERIALS
TOTAL
ITEM
DESCRIPTION OF WORK
SCHEDULED
FROM PREVIOUS
PRESENTLY
COMPLETED
%
BALANCE TO
RETAINAGE (IF
NUM
VALUE
APPLICATION (D
THIS PERIOD
STORED (NOT IN
AND STORED TO
(G + C)
FINISH (C - G)
VARIABLE RATE)
+ E)
D OR E)
DATE
1
Mobilization/Bond
$24,500.00
$24,500.00
$24,500.00
100.00%
$1,225.00
2
Watermain
$75,800.00
$72,920.15
$2,879.85
$75,800.00
100.00%
$3,790.41
3
Sanitary Sewer
$37,200.00
$30,400.00
$6,800.00
$37,200.00
100.00%
$1,860.00
4
Storm Sewer
$448,500.00
$446,520.00
$1,980.00
$448,500.00
100.00%
$22,425.00
1
Site Utilities (CO #1)
$4,249.30
$4,249.30
$4,249.30
100.00%
$212.47
1
Site Utilities (CO #2)
$4,473.94
$4,473.94
$4,473.94
100.00%
$223.00
1
Site Utilities (CO #3)
$12,559.33
$12,559.33
$12,559.33
100.00%
$628.00
1
Site Utilities (CO #2)
$1,441.00
$1,441.00
$1,441.00
100.00%
$72.00
1
Site Utilities (CO #2)
$10,313.58
$10,313.58
$10,313.58
100.00%
$516.00
PAYMENT TOTALS
$619,037.15
$603,128.00
$15,909.15
$619,037.15
100.00%
$30,951.88
Page 1 of 1