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4.1. SR 08-17-2020Request for Action To Item Number Mayor and Ci T Council 4.1 Agenda Section Meeting Date Prepared by Consent August 17, 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 estimates detailed below. Background/Discussion The following pay estimates have been reviewed and found to be accurate and in accordance with approved contracts. Financial Impact PROJECT Multi -purpose Facility & Lions Park Woodland Trails Nature Play and Shelter Mission/Policy/Goal N/A Attachments ■ Pay Estimate - RJM Construction ■ Pay Estimate - ODESA II Pay Est. # Contractor 13-Partial RJM Construction LLC 1-Partial ODESA II Amount $1,383,632.22 $212,049.97 The Elk River Vision P N W I e E U 0 V A welcoming community rvitb revolutionary and spirzted resourcefulness, exceptional NATURE service, and community engagement that encourages and inspires prosperz[ Updated. August 2020 DocuSign Envelope ID: 27E72&A13£761aD8D-8646447BC430C75D ' 420-4-8540-4520 rPlease Remit Psym Construction, LLC 830 Boone Ave North Golden Valley, MN 56427 APPLICATION AND CERTIFICATE FOR PAYMENT To Owner City of Elk River Protect:19520.0033 Elk River Multi -Purpose Facility and Lion John Invoice #: 9520003313 Distribution to Attn: Justin Femdte SAM Street NW Application No.: 13 F-1 Owner 13D65 Orono Parkway Elk River, MN 55330 Appleation Date: 713IJ2020 LM Architect CJ Contractor Elk River, MN 55330 Architect: Period From: 711020 To: 713112020 CONTRACTOR'S APPLICATION FOR PAYMENT 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 Application is made for payment, as shown below, in connectwn with the Contract accordance with the Contract Documents. That all amounts have been paid by the Contractor for Work for Continuation Sheet is attached, which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. original Contract sum .......... . . . .... . ... $25,934,028.00 2_ Net Change By Change Order ............ . ....... $567,579.40 3. Contract Sum To Date .......................... $26,501,607.40 4. Total Completed and Stored To Date. .... ........ $25,814,434.02 5. Retainage: a. 4.71% of Completed Work $1,216,119.09 to. 0.00% of Stored Material S0.00 Total Retainage .............. . $1,216,119.09 6. Total Earned Less Retainage ...................... $24,598,314.93 7. Less Previous Certificates For Payments ............ $23,214,682.71 8. Current Payment Due ........................... $1,383,632.22 9. Balance To Finish, Plus Retainage ...... .. ...... $1,903,292.47 CHUNK E ORDER SUMMARY D _ Total charges $956,343.73 F strir $388,764.33 Total Approved this Month $0.00 $0.D0 TOTALS $956,343.73 $388,764,33 Net Changes By Change Order $567,579.40 CONTRACTOR: RJM Construction LLC " 8/10/2020 y: [1: Date: State of: County of: Subscribed and sworn to before me this day of Notary Public: My Commission expires: In accordance with the Contract Documents, based on on -site observations and the data comprising the above application, the Architect corollas to the Owner that to the best of the Architects 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 $1,383,632.22 (Attach o"nafioo 1f amount omftd differs from the amount apphod. lnidial all figures on this Applicatim and on the Continuation Sheet that are changed to conform w9h the amount cerfiffed.) ARCHITECT: By: JW" M446- Date: 8110/20 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment, and acceptance of payment are without ongudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET Page 2 of 3 Application and Certification for Payment, containing Application No.: 13 Contractor's signed certification is attached. Application Date: 07131/20 In tabulations below, amounts are stated to the nearest dollar. To: 07131/20 Use Column I on Contracts where variable retainage for line items may apply. Archltecfs Project No.: Invoice 9: 9520003313 Contract o 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Item Description of Work Scheduled Work CoMpleted Materials Total % Balance Retainage No. Value From Previous This Period Presently Completed (G I C) To Finish Application In Place Stored and Stored (C-G) (D+E) To Date I Not in D or EL _(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 81,027 00 0.00 48,710.00 0.00 48,710.00 60.12% 32,317.00 2,435.50 1B Survey 41,280 00 21,912.00 1,710.00 0.00 23,622.00 57.22% 17,658.00 1,181.10 2A Building Demolition 166,199.51 166,199,51 0.00 0.00 166,199.51 100.00% 0.00 8,309.98 2B Selective Demolition 231,415.21 225,322.86 6,092.35 0.00 231,415.21 100.00% 0m00 11,570.76 3C Concrete Floor Finishes 135,699.62 25,714.62 92,319.00 0.00 118,033.62 86.98% 17,666.00 5,901.68 4A Masonry Systems 2,989,891.16 2,947,266.16 7,625.00 0.00 2,954,891.16 98.83% 35,000.00' 147,744.56 5A Structural Material 1,380,909.01 1,353,486.77 8,361.00 0.00 1,361,847.77 98.62% 119,061.24 68,092.39 5B Structural Labor 457,223.00 450,410.00 5,969.00 0.00 456,379.00 99.82% i 844.00 22,81&95 1. 6A Carpentry 1,624,443.92 1,234,69&87 230,798.06 0.00 11,465,494.93 9012% 158,948.99 73,274.74 7A Waterproofing &WB 40,34100 40,342.00 0.00 0.00 1 40,342.00- 100.00% 0.00 2,017.11 7B Roofing Systems 11,056,874a73 1,045,979.17 10,395.56 0.00 1,056,374.731 99.95% 500.00 52,818.74 7C Metal Wall Panel 186,172.61 23,785.00 162,387.61 0.00 186,172.61 100.00% 0.00 9,308.63 8A Aluminum Entrances/Storefronts 642,576.46 622,852.58 19,423.88 0.00 642,276m46 99.95% 300.00 32,113.82 813 Overhead Coiling and Sectional Doors 53,610.00 8,575.00 45,035.00 0.00 53,610.00 100m00% 0.00 2,680.50 9A Gypsum Board 347,221.46 335,496.71 11,724.75 0.00 347,221.46 100a00% 0.00 17,361 m07 913 Tiling 175,149.90 168,015.00 5,247�40 0.00 173,26140 98.92% 11,887.50 8,663.12 9C Acoustical Ceilings 147,905.95 136,554.20 5,819.25 0.00 142,373.45 96.26% 5,532.50 7,116.67 9D Flooring 132,262.50 0.00 120,918.90 0.00 120,918.90 91.42% 11,343.60 6,045.95 - 9E Painting 437,219.00 371,500.00 36,219.00 0.00 407,719.00 93.25% 29,500.00 20,385.95 10A Signage 42,038.38 284.54 10,522.60 0.00 10,807.14 25.71% 31,231.24 540.36 11A Athletic Equipment 175,176.84 1173,574m91 1,601.93 0.00 175,176.84 100.00% 0.00 8,758.86 11B Concessions 101,740.00 11,927.11 89,812.72 0.00 101,739.83 100a00% 0.17 5,087.00 12A Roller Shades 28,659.10 0.00 28,659.10 0.00 28,659.10 100.00% 0.00 1,432.96 13B Ice Rink Systems 2,162,742.00 2,162,742.00 0.00 0.00 2,162,742.00 100.00% 0.00 108,137.10 13C Leg Truss System 1125,797m00 125,797.00, 0.00 0.00 125,797.00 100.00%, 0.00 6,289.8 5 1i 14A Elevators 71,700.00' 69,875.00 0.00 0.00 69,875.00 97.45% 1,825.00 3,49335 21A Fire Protection 282,144.00 245,316.00 34,506.00 0.00 279,822,00 99.18% 2,322.00 13,991.12 22A Plumbing Systems 1,315,072.00 1,226,584.00 45,188.00 0.00 1,271,772.00 96.71% 43,300.00 63,588.60 23A HVAC 1,873,37733 1,769,13133 68,444.00 0.00, 1,837,575.33 98.09% 35,802.00 91,878,77 26A Electrical Systems 1,857,176.09 1,792,065.36 45,625.37 0.001 1,837,690.73 98.95% 19,485.36 91,884.53 31A Multipurpose Earthwork 704,911.30 682,092.34 22,818.96 0.00 704,91130 100.00% 0.00 35,245.57 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET Page 3of3 Application and Certification for Payment, containing Application No.: 13 Contractor's signed certification is attached. Application Date: 07131120 In tabulations below, amounts are stated to the nearest dollar. To: 07131120 Use Column I on Contracts where variable retainage for line items may apply. Architect's Project No.: Invoice # : 9520003313 Contract: 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park A B C D E F G H I Item Description of Work Scheduled No. Value 31 B Lions Earthwork 32A Asphalt Paving 32B Concrete/Sidewalk/Curb/Gutter 32C Multipurpose Landscaping 32D Lions Landscaping 32E Chain Link Fence 33A Utilities 3B.1 Precast Concrete 313.2 Precast Concrete 313.3 Precast Raker/Plank/Stadia 01-00 General Conditions/Requirements 90-50 General Liability Insurance 90-60 Construction Contingency 90-80 Builders Risk Insurance 99-99 Contractors Fee 293,489.00 381,555.19 27,000.00 94,480.00 150, 325.79 635,496.55 1,182,922.00 930,000.00 1,048; 025.00 1,253,432.94 268,451.52 103, 037.52 65,184.58 489,303.96 From Previous Application (D+E) 510,815.67 231,859.00 375,129.02 0.00 0.00 147,901.39 635,496.55 1,182, 922.00 922,537.00 1, 048, 025.00 1, 086, 337.20 268,282.03 0.00 65,131.94 449,849.58 This Period In Place 0.00 61,630.00 6,426.17 27, 000.00 94,480.00 2,424.40 0.00 0.00 7,463.00 0.00 72,080.28 169.49 0.00 52.64 14,989.18 Materials Total % Balance Retainage Presently Completed (G I C) To Finish Stored and Stored (C-G) To Date lot in D or Ei fD+E+FI 0.00 293,489.00 100.00% 0.001 14,674.45 0.00 381,555.19 100.00% 0.00 • 19,077.76 0.00 27,000.00 100.00% 0.00 1,350.00 0.00 94,480.00 100.00% 0.00 4,724.00 0.00 150,325.79 100.00% 0.00 7,516.30 0.00 635,496.55 100.00% 0.00 31,774.83 0.00 1,182, 922.00 100.00% 0.00 i 59,146.10 0.00 930,000.00 100.00% ' 0.00 46,500.00 0.00 1,048,025.00 100.00% ' 0.00 52,401.25 0.00 1,158,417.48' 92.42% . 95,015.46 0.00 0.001 268,451.52 100.00% 0.00 0.00 0.00 0.00 0.00% 103,037.52 0.00 0.00 65,184.58 100.00% 0.00 0.00 0.00 464,838.76 95.00% 24,465.20 23,241.92 Grand Totals 26,501,607.40 24,361,784.42 1,452,649.60 0.00 25,814,434.02 97.41% 687,173.38 1,216,119.09 DocuSign Envelope ID: 27E728AB-E7614D8D-SB46A47BC430C75D INVOICE RJM Construction, LLC Invoice: 9520003313 830 Boone Ave North Invoice Date: 07/31/20 Golden Valley, MN 66427 Due Date: 08/30/20 952-837-8600 Disc Date: City of Elk River Attn: Justin Famrite 13066 Orono Parkway Elk River, MN 65330 :t : 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Final Cleaning SUBCONTRACTS Midwest Specialty Maintenance Final Cleaning Inv# 19520-00331 48,710.00 Total SUBCONTRACTS 48,710.00 Final Cleaning Sub -Total: 48,710.00 Survey SUBCONTRACTS Hakanson Anderson Associates Survey Inv# 19520-00338 1,710.00 Total SUBCONTRACTS 1,710.00 Survey Sub -Total: 1,710.00 Selective Demolition MATERIAL PURCHASES Mavo Systems, Inc. Inv# 75494 2,911.71 Total MATERIAL PURCHASES 2,911.71 SUBCONTRACTS Ebert Construction Demolition Inv# 19520-00338 3,180.64 Total SUBCONTRACTS 3,180.64 Selective Demolition Sub -Total: 6,092.36 Concrete Floor Finishes SUBCONTRACTS OC Companies Polished Concrete Inv# 19520-00331 92,319.00 Total SUBCONTRACTS 92,319.00 Concrete Floor Finishes Sub -Total: 92,319.00 Masonry Systems SUBCONTRACTS Crosstown Masonry, Inc. Concrete/Masonry Inv# 1952MO3312 7,625.00 Total SUBCONTRACTS 7,625.00 Masonry Systems Sub -Total: 7,626.00 Structural Material SUBCONTRACTS Sunrise Painting 8 Wallcovering, Inc. Prime + Paint Joists Inv# 19520-00337 3,800.00 Design Electric, Inc Joist Work - Electrical 19520-003311 4,561.00 Total SUBCONTRACTS 8,361.00 Structural Material Sub -Total: 8,361.00 Structural Labor SUBCONTRACTS DocuSign Envelope ID: 27E728AB-E761-4D8D-SB46-447BC430C75D INVOICE From: RJM Construction, LLC Invoice: 9520003313 830 Boone Ave North Invoice Date: 07/31120 Golden Valley, MN 55427 Due Date: 08130/20 952-837-8600 Disc Date: To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 66330 Contract: 19520-0033 Elk River Mufti -Purpose Facility and Lion John Weicht Park Structural Labor SUBCONTRACTS High Five Erectors II, Inc Structural Steel Erection Inv# 1952D-00339 5,969.00 Total SUBCONTRACTS 6,969.00 Structural Labor Sub -Total: 6,969.00 Carpentry MATERIAL PURCHASES Home Depot Credit Services Inv# 20201207 912.26 Tamarack Materials, Inc. 1707455-00 52.83 Construction Midwest, Inc 67649700 107.57 Quality Cutting & Coring, Inc. 35014 1,798.00 Veit Disposal Systems 584437 2,320.00 Veit Disposal Systems 584871 275.00 Veit Disposal Systems 585226 727.05 Viking Industrial Center 3196291 724.28 RJM Construction, LLC 202007-08 102.00 RJM Construction, LLC 202007-28 535.00 HRS - Heater Rental Services, LLC 16887-1 173.25 HRS - Heater Rental Services, LLC 16887A-1 173.25 HRS - Heater Rental Services, LLC 16887B 2,373.25 HRS - Heater Rental Services, LLC 16887C 1,235.05 Total MATERIAL PURCHASES 11,508.79 SUBCONTRACTS Tom Druk Inv# EXP 07/24/20 21.45 Building Material Supply Inc Bicycle Racks 19520-00332 4,887.00 Kendall Doors & Hardware, Inc Hollow Metal Doors & Frames 19520-00336 29,098.12 Fireside Hearth & Home Fire Protection Specialties 19520-00331 14,150.00 Custom Caseworks Millwork 19520-00332 147,815.00 Total SUBCONTRACTS 196,971.57 LABOR Carpenters Regular Earnings 175.00 HRS @ 83.90 14,682.50 Carpenters Overtime Earnings 1.00 HRS @ 104.90 104.90 Laborer Regular Earnings 48.00 HRS @ 76.90 3,691.20 Laborer Foreman Regular Earnings 56.00 HRS @ 80.90 4,530.40 Laborer Foreman Overtime Earnings 3.00 HRS @ 102.90 308.70 Total LABOR 23,817.70 Carpentry Sub -Total: 230,798.06 Roofing Systems MATERIAL PURCHASES DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D INVOICE From: RJM Construction, LLC Invoice: 9620003313 830 Boone Ave North Invoice Date: 07/31120 Golden Valley, MN 66427 Due Date: 08/30/20 952-837-8600 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 mooring systems MATERIAL PURCHASES Morrison Hershfield Corporation Inv# 307545 268.88 Morrison Hershfield Corporation 307546 5.269.68 Total MATERIAL PURCHASES 6,538.56 SUBCONTRACTS Top -All Roofing, Inc. Roofing Inv# 19520-00339 4,857.00 Total SUBCONTRACTS 4,857.00 Roofing Systems Sub -Total: 10,395.56 Metal Wall Panel SUBCONTRACTS Schwickerrs Tecta America Metal Wall Panels Inv# 19520-00333 162,387.61 Total SUBCONTRACTS 162,387.61 Metal Wall Panel Sub -Total: 1629387.61 Aluminum Entrances/Storefronts SUBCONTRACTS Murphy Window and Door Commerck Glass and Glazing Inv# 19520-00336 19,423.88 Total SUBCONTRACTS 19,423.88 Aluminum Entrances/Storefronts Sub -Total: 19,423.88 Overhead Coiling and Sectional Doors SUBCONTRACTS Skold Specialty Contracting, LLC Overhead Coiling Door Inv# 19520-00332 42,635.00 Overhead Coiling Door 19520-00333 2,400.00 Total SUBCONTRACTS 45,035.00 Overhead Coiling and Sectional Doors Sub -Total: 45,035.00 Gypsum Board SUBCONTRACTS RTL Construction, Inc. Gypsum Inv# 19520-00336 11,724.75 Total SUBCONTRACTS 11,724.75 Gypsum Board Sub -Total: 11,724.75 Tiling SUBCONTRACTS C D Tile & Stone, Inc Tile Inv# 19520-00334 5,247.40 Total SUBCONTRACTS 5,247.40 Tiling Sub -Total: 6,247.40 Acoustical Ceilings DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC43OC75D INVOICE From: RJM Construction, LLC Invoice: 9520003313 830 Boone Ave North Invoice Date: 07/31/20 Golden Valley, MN 65427 Due Date: 08/30120 952-837-8600 Disc Date: To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 56330 Contract : 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Acoustical Ceilings SUBCONTRACTS Twin City Acoustics Inc Acoustical Ceilings Inv# 19520-00335 5,819.25 Total SUBCONTRACTS 5,819.25 Acoustical Ceilings Sub -Total: 6,819.26 Flooring SUBCONTRACTS Becker Arena Products, Inc. Flooring Inv# 19520-00331 22,557.40 Acoustics Associates Flooring 19520-00331 98,361.50 Total SUBCONTRACTS 120,918.90 Flooring Sub -Total: 120,918.90 Painting MATERIAL PURCHASES Summit Companies Inv# 2894 2,700.00 Summit Companies 3008 6,300.00 Total MATERIAL PURCHASES 9,000.00 SUBCONTRACTS Sunrise Painting & Walicovering, Inc. Painting Inv# 19520-00337 27,219.00 Total SUBCONTRACTS 27,219.00 Painting Sub -Total: 36,219.00 Signage MATERIAL PURCHASES Timothy Ryan Inv# EXP 07/10/20 55.25 Timothy Ryan EXP 07/10/2020 55.25 Total MATERIAL PURCHASES 110.60 SUBCONTRACTS SDDI Signs Signage Inv# 19520-00331 10,412.10 Total SUBCONTRACTS 10,412.10 Signage Sub -Total: 10,522.60 Athletic Equipment SUBCONTRACTS Peterson Companies, Inc. Athletic Equipment Inv# 19520-00335A 1,601.93 Total SUBCONTRACTS 1,601.93 Athletic Equipment Sub -Total: 1,601.93 Concessions SUBCONTRACTS TriMark Hockenbergs Food Service Equipment Inv# 19520-00332 89,812.72 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D INVOICE ---------------- From: RJM Construction, LLC Invoice: 9520003313 830 Boone Ave North Invoice Date: 07/31120 Golden Valley, MN 65427 Due Date: 08/30120 952-837-8600 Disc Date: To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 56330 Contract. 19520.0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Total SUBCONTRACTS 89,812.72 Concessions Sub -Total: 89,812.72 Roller Shades SUBCONTRACTS American Drapery Systems, Inc. Window Coverings Inv# 19520-00331 28,659.10 Total SUBCONTRACTS 28,659.10 Roller Shades Sub -Total: 28,669.10 Fire Protection SUBCONTRACTS Summit Companies Fire Protection Inv# 19520-003310 16,114.75 Fire Protection 19520-003311 18,391.25 Total SUBCONTRACTS 34,506.00 Fire Protection Sub -Total: 34,506.00 Plumbing Systems SUBCONTRACTS Weidner Plumbing & Heating Co. Plumbing Inv# 19520-003312 45,188.00 Total SUBCONTRACTS 46,188.00 Plumbing Systems Sub -Total: 45,188.00 HVAC SUBCONTRACTS Sentra-Sota Sheet Metal Inc. HVAC Inv# 19520-003311 68,444.00 Total SUBCONTRACTS 68,444.00 HVAC Sub -Total: 68,444.00 Electrical Systems SUBCONTRACTS Design Electric, Inc Electrical Inv# 19520-003311 45,625.37 Total SUBCONTRACTS 45,625.37 Electrical Systems Sub -Total: 45,625.37 Multipurpose Earthwork SUBCONTRACTS Minnesota Utilities & Excavating, LLC Multipurpose Earthwork Inv# 19520-00335 22,818.96 Total SUBCONTRACTS 22,818.96 Multipurpose Earthwork Sub -Total: 22,818.96 Asphalt Paving SUBCONTRACTS Bituminous Roadways Inc Asphalt Paving Inv# 19520-00335 61,630.00 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D VOICE From: RJM Construction, LLC Invoice: 9620003313 830 Boone Ave North Invoice Date: 07/31/20 Golden Valley, MN 56427 Due Date: 08/30/20 952-837-8600 Disc Date: To: City of Elk River Attn: Justin Femrite 13065 Orono Parkway Elk River, MN 66330 Contract : 19620-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park Total SUBCONTRACTS 61,630.00 Asphalt Paving Sub -Total: 61,630.00 Concrete/Sidewalk/Curb/Gutter SUBCONTRACTS Ebert Construction Site Concrete Inv# 19520-00337C 6,426.17 Total SUBCONTRACTS 6,426.17 Concrete/Sidewalk/Curb/Gutter Sub -Total: 6,426.17 Multipurpose Landscaping SUBCONTRACTS Greenscape Companies, Inc. Multipurpose Landscaping Inv# 19520-00331 32,000.00 Multipurpose Landscaping 19520-00331L -5,000.00 Total SUBCONTRACTS 27,000.00 Multipurpose Landscaping Sub -Total: 27,000.00 Lions Landscaping SUBCONTRACTS Greenscape Companies, Inc. Lions Landscaping Inv# 19520-00331L 94,480.00 Total SUBCONTRACTS 94,480.00 Lions Landscaping Sub -Total: 94,480.00 Chain Link Fence SUBCONTRACTS Peterson Companies, Inc. Chain Link Fence Inv# 19520-00335C 2,424.40 Total SUBCONTRACTS 2,424.40 Chain Link Fence Sub -Total: 2,424.40 Precast Concrete SUBCONTRACTS Wells Concrete Products 0313.2 Precast Wall Panels Inv# 19520-00335 7,463.00 Total SUBCONTRACTS 7,463.00 Precast Concrete Sub -Total: 7,463.00 General Conditions/Requirements MATERIAL PURCHASES Spee Dee Delivery Service Inv# 4041924 4.80 Veit Disposal Systems 585688 275.00 Veit Disposal Systems 586174 1,135.00 RJM Construction, LLC 202007-08 1,025.00 Bills Inc. W771166 1.220.74 Bills Inc. W771167 288.26 Bills Inc. W771168 234.06 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D INVOICE RJM Construction, LLC Invoice: 9620003313 830 Boone Ave North Invoice Date: 07/31/20 Golden Valley, MN 65427 Due Date: 08/30/20 952-837-8600 Disc Date: City of Elk River Attn: Justin Femrite 13066 Orono Parkway Elk River, MN 56330 ,t : 19520-0033 Elk River Multi -Purpose Facility and Lion John Weicht Park General Conditions/Requirements MATERIAL PURCHASES WEX Bank Inv# 66593211 396.03 Verizon Wireless 9857161992 211.80 Verizon Wireless 9859213679 258.39 Timothy Ryan EXP 07/10/20 857.61 Timothy Ryan EXP 07/10/2020 893.57 Tom Druk EXP 07/24/20 407.16 Brett Sillerud EXP 07/31/20 62.64 Hunter Koesters EXP 06/26/20 208.80 Hunter Koesters EXP 07/10/20 180.96 Total MATERIAL PURCHASES 7,659.82 PICKUP TRUCK 920.00 Total PICKUP TRUCK 920.00 LABOR General Superintendent Regular Earnings 20.00 HRS @ 114.90 2,298.00 Quality Assurance & Control Regular Earnings 11.00 HRS @ 114.90 1,263.90 Safety Regular Earnings 11.00HRS @ 114.90 1,263.90 Superintendent Regular Earnings 200.00HRS @ 109.90 21,980.00 Laborer Regular Earnings 2.00HRS @ 76.90 153.80 Laborer Foreman Regular Earnings 16.00 HRS @ 80.90 1.294.40 MEP Engineer Regular Earnings 2.00 HRS @ 80.40 160.80 Project Administrator Regular Earnings 12.00 HRS @ 56.40 676.80 Project Engineer Regular Earnings 40.00 HRS @ 80.40 3,216.00 Project Manager Regular Earnings 152.00HRS @ 106.40 16,172.80 Project Executive Regular Earnings 106.00 HRS @ 138.40 14,670.40 Scheduler Regular Earnings 2.00 HRS @ 97.40 194.80 Total LABOR 63,345.60 P&P Bond 154.86 General Conditions/Requirements Sub -Total: 72,080.28 General Liability Insurance GENERAL LIABILITY INSURANCE 169.49 General Liability Insurance Sub -Total: 169.49 Builders Risk Insurance BUILDERS RISK INSURANCE 52.64 Builders Risk Insurance Sub -Total: 62.64 Contractors Fee CONTRACTORS FEE 14,989.18 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC43OC75D SM-4 From: RJM Construction, LLC 830 Boone Ave North Golden Valley, MN 55427 952-837-8600 To: City of Elk River Attn: Justin Femrits 13065 Orono Parkway Elk River, MN 55330 Contract: 1952D-0033 Elk River MultimPurpose Facility and Lion John Weicht Park Invoice: Invoice Date: Due Date: Disc Date: 9620003313 07/31/20 08/30/20 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D INVOICE Summary 1A Final Cleaning 48,710.00 Retainage 1,452,494.74@ 5.00% (2,435.50) 1 B Survey 1,710.00 Retainage 1,452,494.74@ 5.00% (85.50) 2B Selective Demolition 6,092.35 Retainage 1,452,494.74@ 5.00% (304.62) 3C Concrete Floor Finishes 92,319.00 Retainage 1,452,494.74@ 5.00% (4,615.95) 4A Masonry Systems 7,625.00 Retainage 1,452,494.74@ 5.00% (381.25) 5A Structural Material 8,361.00 Retainage 1,452,494.74@ 5.00% (418.05) 5B Structural Labor 6,969.00 Retainage 1,452,494.74@ 5.00% (298.45) 6A Carpentry 230,798.06 Retainage 1,452,494.74@ 5.00% (11,539.90) 7B Roofing Systems 10,395.56 Retainage 1,452,494.74@ 5.00% (519.78) 7C Metal Wall Panel 162,387.61 Retainage 1,452,494.74@ 5.00% (8,119.38) 8A Aluminum Entrances/Storefronts 19,423.88 Retainage 1,452,494.74@ 5.00% (971.19) 8B Overhead Coiling and Sectional Doors 46,035.00 Retainage 1,452,494.74@ 5.00% (2,251.75) 9A Gypsum Board 11,724.76 Retainage 1,452,494.74@ 5.00% (686.24) 9B Tiling 5,247.40 Retainage 1,452,494.74@ 5.00% (262.37) 9C Acoustical Ceilings 5,819.25 Retainage 1,452,494.74@ 5.00% (290.96) 9D Flooring 120,918.90 Retainage 1,452,494.74@ 5.00% (6,045.95) 9E Painting 36,219.00 Retainage 1,452,494.74@ 5.00% (1,810.96) 10A Signage 10,622.60 Retainage 1,452,494.74@ 5.00% (526.13) 11A Athletic Equipment 1,601.93 Retainage 1,452,494.74@ 5.00% (80.10) DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D VOICE 11B Concessions 89,812.72 Retainage 1,452,494.74@ 5.00% (4,490.64) 12A Roller Shades 28,659.10 Retainage 1,452,494.74@ 5.00% (1,432.96) 21A Fire Protection 34,606.00 Retainage 1,452,494.74@ 5.00% (1,725.30) 22A Plumbing Systems 45,188.00 Retainage 1,452,494.74@ 5.00% (2,259.40) 23A HVAC 68,444.00 Retainage 1,452,494.74@ 5.00% (3,422.20) 26A Electrical Systems 45,625.37 Retainage 1,452,494.74@ 5.00% (2,281.27) 31A Multipurpose Earthwork 22,818.96 Retainage 1,452,494.74@ 5.00% (1,140.96) 32A Asphalt Paving 61,630.00 Retainage 1,452,494.74@ 5.00% (3,081.50) 32B Concrete/Sidewalk/Curb/Gutter 6,426.17 Retainage 1,452,494.74@ 5.00% (321.31) 32C Multipurpose Landscaping 27,000.00 Retainage 1,452,494.74@ 5.00% (1,350.00) 32D Lions Landscaping 94,480.00 Retainage 1,452,494.74@ 5.00% (4,724.00) 32E Chain Link Fence 2,424.40 Retainage 1,452,494.74@ 5.00% (121.22) 313.2 Precast Concrete 7,463.00 Retainage 1,452,494.74@ 5.00% (373.15) 01-00 General Conditions/Requirements 72,080.28 Retainage 1,452,494.74@ 0.00% 0.00 90-50 General Liability Insurance 169.49 Retainage 1,452,494.74@ 0.00% 0.00 90-80 Builders Risk Insurance 52.64 Retainage 1,452,494.74@ 0.00% 0.00 99-99 Contractors Fee 14,989.18 Retainage 1,452,494.74@ 5.00% (749.46) CURRENT DUE: 1,383,632.22 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Midwest Specialty Maintenance, Inc. 9225 East River Road NW Coon Rapids, MN 55433 Contract For: 195200033-017415 - Final Cleaning 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 Project: Elk River Multi -Purpose Facility and Lion John Weicht Park $80,651.00 $376.00 $81,027.00 $48,710.00 Application No.: 1 Period To: 07/31/20 Application Date: 07/24/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-017415 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: Brian Burmgarner Date: 07/24/20 State Of: $2,435.50 County Of: (Columns F) Total Retainage $2,435.50 (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE $46,274.50 (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT $0.00 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $46,274.50 9. BALANCE TO FINISH, INCLUDING RETAINAGE $34,752.50 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $376.00 $0.00 TOTALS $376.00 $0.00 NET CHANGES by Change Orders $376.00 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 $46,274.50 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D :CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 1 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/24/20 PERIOD TO: 07/31/20 Midwest Specialty Maintenance, Inc. PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS j PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD g STORED (NOT IN i AND STORED TO = (G + C) 1 FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE 3 001 Post Construction Final $70,525.00 - $42,315.00= $42,315.00 60.00%; $28,210.00 $2,11575' !Cleaning- Multipurpose Bldg, General Interior f 002 Post Construction Final $8,526.00' -' $6,395.00 1 $6,395.00 _ 75.01 % 1, $2,131.00 3 $319.75 Cleaning - Multipurpose Bldg, Interior & Exterior Windows 003 Post Construction Final $1,600.00 - $1,600.00 Cleaning - Lions Park j 1 f Final Cleaning (CO #1) � $376.00 -. -� l $376.00 ; PAYMENT TOTALS $81,027.00 $48,710.00 k - $48,710.00 60.12% 1 $32,317.00 $2,435.50 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 8 830 Boone Avenue North John Weicht Park Golden Valley, MN 55427 Period To: 07/01/20 From: Hakanson Anderson Associates Application Date: 07/01/20 3601 THURSTON AVE Project No.: 19520-0033 STE 101 Contract Date: 07/23/19 ANOKA, MN 55303 Contract For: 195200033-022105 - Survey Commitment: 195200033-022105 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) $41,280.00 $0.00 $41,280.00 $23,622.00 $1,181,10 $1,181.10 $22,440.90 $20,816.40 $1,624.50 $18,839.10 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 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: Lisa Broughton Date: 07/01/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $1,624.50 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D ;CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 8 Containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/01/20 PERIOD TO: 07/01/20 Hakanson Anderson Associates PROJECT NO.: 19520-0033 A ? B C D E F G H I i WORK COMPLETED MATERIALS TOTAL ; ITEM SCHEDULED FROM PREVIOUS DESCRIPTION OF WORK 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 Construction Staking $41,280 001 $21,912.001 $1,710.001 $23,622.00 57.22% $17,658.00 $1,181.10 PAYMENT TOTALS $41,280 00 $21,912.00 1 $1,710.00 1 $23,622.00 57.22% 1 $17,658.00 j $1,181.10 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 ($16,335.60) $207,464.40 $207,464.40 Application No.: 8 Period To: 07/31/20 Application Date: 07/17/20 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: 07/17/20 State Of: $10,373.22 County Of: $10,373.22 $197,091.18 $194,069.57 $3,021.61 $10,373.22 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $10,852.40 $30,072.00 Total approved this month $2,884.00 $0.00 TOTALS $13,736.40 $30,072.00 NET CHANGES by Change Orders ($16,335.60) 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 Architects 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 $3,021.61 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D .CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 8 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/17/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Ebert Construction PROJECT NO.: 19520-0033 A B C D E F G H I l WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY 'AND COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD RED STONOT IN STORED TO (G + C) FINISH (C - G) VARIABLE RATE) D OR E) DATE 1 ;General Conditions/Bond $9,888.00 £ $9,591.36 ' $296.64 $9 888.00 I 100.00% 3 - ; $494.40 2 Selective Demolition $193,912.00 $193,912.00 l $193,912.00 [ 100.00% - $9,695.60 3 Allowance $20,000.00 $20,000.00 - $20,000.00 ` 100.00% - $1,000.00 1 ;Demolition (CO #1) ($3,866.00) ($3,866.00) I ($3,866.00) a 100.00%' - ($193.30) 1 Demolition (CO #2) $1,324.40 $1,324.40 - $1,324.40 100.00%- -_ $66.22 12 Demolition (CO #3) ($9,000.00) ($9,000.00) - ($9,000.00) i 100.00% - ($450.00) 1 Demolition CO #4 ($8 206 00) 100.00%, - ($410.30) 1 Demolition (CO #5) $528.001 $528.00 $528.00 , 100.00% $26.40 1 Demolition (CO #7) ($9,000.00) k - ($9,000.00) 2 ; Demolition (CO #6) $9,000.00 , - - $9,000.00 1 Demolition (CO #8) $2,884 00 E $2,884.00 $2 884 00 i 100.00% 3 - € $144.2001 PAYMENT TOTALS $207,464.40 $204,283.761 $3,180 64 j $207,464.40 100.00%' -' $10,373.22 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: QC Companies 14043 LINCOLN ST NE HAM LAKE, MN 55304 Contract For: 195200033-033505 - Polished Concrete Project: Elk River Multi -Purpose Facility and Lion John Weicht Park 1. ORIGINAL CONTRACT AMOUNT $104,390.00 2. NET CHANGE BY CHANGE ORDERS $5,595.00 3. CONTRACT SUM TO DATE $109,985.00 4. TOTAL COMPLETED AND STORED TO DATE $92,319.00 (Column G) 5. RETAINAGE 5.00% of Completed Work $4,615.95 (Columns D + E) 5.00% of Stored Materials - (Columns F) Total Retainage $4,615.95 (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE $87,703.05 (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT $0.00 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $87,703.05 9. BALANCE TO FINISH, INCLUDING RETAINAGE $22,281.95 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $5,595.00 $0.00 TOTALS $5,595.00 $0.00 NET CHANGES by Change Orders $5,595.00 Application No.: 1 Period To: 07/31/20 Application Date: 07/31/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-033505 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: Alisa Maciej Date: 07/31/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $87,703.05 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D 1CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 1 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/31/20 PERIOD TO: 07/31/20 QC Companies PROJECT NO.: 19520-0033 I A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM j DESCRIPTION OF WORK NUM SCHEDULED FROM PREVIOUS VALUE APPLICATION PRESENTLY I STORED (NOT IN COMPLETED AND STORED TO 1 % (G + C) BALANCE TO FINISH (C - G) 1 RETAINAGE (IF VARIABLE RATE) I (D THIS PERIOD + E) D OR E) DATE 1 109 6700 Fluid Applied Floor $8 370 00 $8,370.00 € Labor [ ?' 2 09 6700 Fluid Applied Floor $3,255.00 $3,255.00 Material 3 03 3511 SC 1 Labor $26,095.00 1 i $26,095.00 ( $26,095.00 100.00% $1,304.75 4 03 3511 SC1 Material $17,800.00 = $17,800.00 - $17,800.00 100.00% _ $890.00 5 &2 Polished Flooring $34,305.00 _ $34,305.00 $34,305.00 100.00% j $1,715.25 [ Labor 6 STC 1&2 Polished Flooring $11,430.00 $11,430.00 $11,430.00 100.00%' $571.50 Material f F 17 Bond Fee $3 135 00 $2,689.00 $2,689 001 85.77% i $446.001 $134.45 1 ; Polished Concrete (CO #1) $5,595.00 -_ - $5,595.00 f PAYMENT TOTALS $109 985.00 ; $92,319 00 - 3 $92,319.00�83.94% $17,666.00 $4,615.95 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 ($11,777.00) $2,923,223.00 $2,888,223.00 $144,411.15 $144,411.15 $2,743,811.85 $2,736,568.10 $7,243.75 $179,411.15 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $59,436.00 $42,487.00 Total approved this month $2,275.00 $31,001.00 TOTALS $61,711.00 $73,488.00 NET CHANGES by Change Orders ($11,777.00) Application No.: 12 Period To: 07/31/20 Application Date: 07/22/20 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: 07/22/20 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 $7,243.75 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D 'CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 12 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/22/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 CROSSTOWN MASONRY, INCORPORATED PROJECT NO.: 19520-0033 A B C D j E F G H ; I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS i 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 j 1 Footings & Foundation Labor $30,000.001 $30,000.00 $30,000.00' 100.00% $1,500.00 2 Footings & Foundation Material $81000.00 $8,000.00 $8,000.00 100.00%- $400.00 3 Above Grade CMU Labor $84,000.00 $84,000.00 r t $84,000.00 100.00% $4,200.00 4 Above Grade CMU Material $26,000.00 $26,000.00 ? $26,000.00 100.00% 1$1,300.00 1. 5 Slab on Grade Labor $5,300 00 $5,300.00 = $5,300.00 ? 100.00% $265.00 6 Slab on Grade Material $4,200.00 $4,200.00 5 $4,200.00 100.00% $210.00 7 Stone Piers Labor $17,000.00 $17,000.00 -( 8 ' Stone Piers Material $10,000.00 i i $10,000.00 !' - 9 = Dug Outs/Batting Cage Labor $41,000 00. $41,000.00 f $41,000.00' 100.00% $2,050.00 10 Dug Outs/Batting Cage $28,000.00 $28,000.00 $28,000.00 ; 100.00% $1,400.00' 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 $812,000.00 $812,000.00 : 100.00% $40,600.00 14 ;Above Grade CMU Material $348,000 00 $348,000.00 $348 000 00, 100.00% $17,400.00 15 Slab on Grade Labor $236,000.00 $236,000.00 [. $236 000 00 ; 100.00% $11,800.00 , =16 :Slab on Grade Material $210,000.00 $210,000.00 - - i $210,000.00 ^^ 100.00% _ $10,500.00 17 Slab on Deck Labor $140,000.00 $140,000.00 - $140,000.00 , 100.00% ( $7,000.00 j 18 Slab on Deck Material $69,000 00 $69,000.00 - $69 000.00 I 100.00% $3,450.00 19 Stoops Labor $8,000.00 $8,000.00 _ $8,000.00 j 100.00% $400.00 20 Stoops Material $2,000.00 € $2,000.00. $2,000.00 100.00% $100.00 i 21 Stone at Fireplace Labor $8,000.00 € $8,000.00 @ $8,000.001 100.00% $400.00 r I 22 Stone at Fireplace Material 4 $2,000.001 $2,000.00 E 7 $2,000.001 100.00% $100.00 23 Concrete Allowance $50,000.00 ` $25,420.00 $16,580.00 i $42,000.001 84.00% $8,000.00 ° $2,100.00 124 Masonry Allowance 3 $40,000 00 $20,229.00 $19,771.00 $40,000.00 100.00% $2,000.00 125 ; Field House Labor i $70,000.00 $70,000.00 $70,000.001 100.00% $3,500.00 1 126 Field House Material $18,000 00 $18.000.00. $18,000.00' 100.00% $900.00 27 ;Bond $43,500.00 € $43,500.00' $43,500.001 100.00% $2,175.00 PAYMENT TOTALS; $2,923,223.00 E $2,880,598.00 = $7,625.00 $2,888,223.001 98.80%1 $35,000.00 € $144,411.15 Page 1 of 2 DocuSign Envelope ID: 27E728AB-E761-4D8D-8846-447BC430C75D 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 A B C D E APPLICATION NO.: 12 APPLICATION DATE: 07/22/20 PERIOD TO: 07/31/20 PROJECT NO.: 19520-0033 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' $697.001 100.00% -' $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) j ($15,209.00) ($15,209.00)' = ($15,209.00) 100.00% ($760.45) 1 Concrete/Masonry (CO #6) 1 $2,930.00 $2,930.00 _ I $2,930.00 100.00% - - $146.50 1 Concrete/Masonry (CO #7) ($8,500.00) ($8,500.00)' j ($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 1 ' Concrete/Masonry (CO #8) ($15,000.00) _ ($15,000.00) ($15,000.00) _ - s"� 1 Concrete/Mason CO #9 ry ( ) $10,085.00 $10,085.00 $10,085.00 100.00% _'. $504.25 1 Concrete/Masonry (CO #10) [ ($6,000.00) ($6,000.00)' 1 ($6,000.00) 100.00% - ($300.00) 1 ;ConcretelMasonry (CO #11) ($9,351.00) ($9,351.00)' ($9,351.00) , 100.00% ($467.55) 1 ' Concrete/Masonry (CO #10) ($10,000.00) ($10,000.00) 3 _ ($10,000.00) 100.00%. - ($500.00) 1 1 Concrete/Masonry (CO #12) ($5,650.00) ($5,650.00) ($5,650.00) 100.00% _ - ] ($282.50) 1 Concrete/Masonry (CO #13) $2,275.00 = $2,275.00 $2,275.00 _ 100.00%, - _ $113.75 PAYMENT TOTALS $2,923,223.00 $2,880,598.00 j $7,625.00 3 - $2,888 223 00 98.80%' $35,000.001 $144,411 15 Page 2 of 2 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447SC430C75D 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 $77,406.00 $490,156.00 $460,656.00 Application No.: 7 Period To: 07/31/20 Application Date: 07/20/20 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: 07/22/20 State Of: $23,032.80 County Of: ... ........_. $23,032.80 $437,623.20 $408,155.15 $29,468.05 $52,532.80 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $98,269.00 $10,863.00 Total approved this month $0.00 $10,000.00 TOTALS $98,269.00 $20,863.00 I NET CHANGES by Change Orders 1$77,406.00 1 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 $29,468.05 (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: 27E728AB-E76104D8D-81346-447BC430C75D !CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 7 containing Contractors signed Certification is attached. APPLICATION DATE: 07120120 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31120 SUNRISE PAINTING PROJECT NO.: 19520-0033 A B C D - ----- ------- E F G H WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIO us PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NU M VALUE APPLICATION (D THIS PERIOD STORED NOT IN 1 AND STORED TO (G C) FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE 1 PAINTING $407,750.00 $375,500�00 $2,75100 $378,250.00 92.77% $29,500.00 $184912.50'. 12 '6OND $5,000.00 $5,000.001 $5,000.00 100.00% $250.00 1 Painting (CO #1) $10,000.00 $10,000.00 $10,000.00 100.00% $500.001 1 Painting (CO #3) ($9,000.00) ($9,000.00) ($9,000.00) 100.00%' ($450.00) Prime + Paint Joists (CO #2) $63,800.00 $60,000.00' $3,800.00. $63,800.00 100.00%'E $3,190�001 I Painting (CO #4) i ($1,863.00) ($1,86100) 1 ($1,863.00) 10100% i ($93.15) I Painting (CO #5) $13,100.00 $13,100.00 $13,100.00 100.00% $655.001. Painting (CO #6) $6,100.00 $6,100.001 $6,100.00 100.00%' $305.00 1 Painting (CO #6) $5,269.00 $5,269.00. $5,269.00 100.00% $263.45' 1 Painting (CO #7) ($10,000.00) ($10,000.00) ($10,000.00) 100.00% ($500.00)1 PAYMENT TOTALS $490,156.001 $429,637.001 $31,019.001- $460,656.00 93.98% $29,500.001 $23,032.80 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 Project: Elk River Multi -Purpose Facility and Lion John Weicht Park $1,786,914.00 $90,692.06 $1,877,606.06 $1,862,251.73 5.00% of Completed Work $93,112.58 (Columns D + E) 5.00% of Stored Materials _ (Columns F) Total Retainage $93,112.58 (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE $1,769,139.15 (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT $1,721,462.10 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $47,677.05 9. BALANCE TO FINISH, INCLUDING RETAINAGE $108,466.91 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $125,357.98 $44,468.59 Total approved this month $9,802.67 $0.00 TOTALS $135,160.65 $44,468.59 NET CHANGES by Change Orders $90,692.06 Application No.: 11 Period To: 07/31/20 Application Date: 07/17/20 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: 07/17/20 State Of. County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $47,677.05 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D (CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/17/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Design Electric, Inc PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED MATERIALS TOTAL ] ITEM j 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) ' i S + E) D OR E) DATE 1 I BOND/PERMIT $35,908 00' $35,908.00 i $35 908 00. 100.00% € $1,795.40 /MOBILIZATION 2 i ? SITE WORK/UNDERGROUND $33,158 00 $33,158.00 $33 158 001 100.00% _ - $1,657.90 3 DEMOLITION/TEMP WIRING $64,200 00 f $63,800.00 $400.00 i $64 200 00 100.00% - $3,210.00 4M I CONDUIT - MATERIAL I $122,167.00 $121,000.00 _ $1,167.00 $122 167 00 #I r 100.00% _ - $6,108.35 3 !, 4L j CONDUIT - LABOR $180,320.00[ $177,000.00, $3,320.00 - $180,320.00 " 100.00% _ - $9,016.00 5M BOXES/WIRE/DEVICES - $110,400 00 r $110,400.00 - $110 400 00 , 100.00% - $5,520.00 MATERIAL 5L BOXES/WIRE/DEVICES - $67,200 00 € $65,300.00 _ $1,900.00 $67 200 00 100.00% _ - $3,360.00 LABOR 6M FIXTURES - MATERIAL $425,654.00 $425,654.00 - - $425 654 00 E 100.00% - $21,282.70 6L FIXTURES - LABOR $90,400.00 1 $80,000.00 $8,592.00 $88,592.00 98.00% _ $1,808.00 = $4,429.60 `7M GEAR - MATERIAL $145,168.00 $145,168.00 - $145,168.00 100.00% -� $7,258.40 7L i GEAR -LABOR $38,400.00 - $37,500.00 - $900.00 $38,400.00 100.00% = $1,920.00 _1 8M LOW VOLTAGE ROUGH -IN - �' $46,722.00 _ $46,722.00 _ - $46,722.00 100.00%= - _ $2,336.10 MATERIAL i 8L LOW VOLTAGE ROUGH -IN - $73,120.00 _ $71,000.00 _ $2,120.00 - $73,120.00 100.00%? $3,656.00 _LABOR 9M EQUIPMENT CONNECTIONS $68,400.00 $68,400.00 � $68,400.00 100.00% - $3,420.00 [ I MATERIAL _ 3 9L 1 EQUIPMENT CONNECTIONS $12,200.001 $11,500.00 $700.00 $12,200.00 E 100.00% _I $610.00 LABOR =10M FIRE ALARM - MATERIAL $84,697.00 $77,798.00 $5,205.06 $83 003 06'' 98.00% $1,693.94 $4,150.15 .10L FIRE ALARM -LABOR $20,000.00 $17,000.00 $2,600.00 $19 600 00 1 98.00%, $400.00 1 $980.00 =11 M I SOFTBALL FIELD - $153,200 00 ( $153,200.00 - $153,200.001 100.00% - $7,660.00 MATERIAL E j ! 11 L SOFTBALL FIELD -LABOR $15,600 00 $15,600.00 - $15 600 00 + 100.00% $780 00 j 112 1 Electrical (CO #1) $945 49 € $945.49 - $945.49 ? 100.00% $47.271 PAYMENT TOTALS $1,877,606.06 $1,812,065.36 $50,186.37 $1,862,251.73 99.18% $15,35433s $93,112.58' Page 1 of 2 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/17/20 PERIOD TO: 07/31/20 Design Electric, Inc PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED MATERIALS TOTAL ITEM NUM DESCRIPTION OF WORK SCHEDULED VALUE :APPLICATION FROM PREVIOUS THIS PRESENTLY COMPLETED STORED (NOT IN AND STORED TO % I (G + C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) (D + E) PERIOD D OR E) DATE Electrical (CO #2) $1,340.58 $1,340.58 i - $1,340.58 100.00% i $67 03 I Electrical (CO #3) i $1,582.00 1 $1,582.00 $1,582.00 100.00% , $79.10 1 Electrical (CO #4) j _ ($24,378.00) ($24,378.00) 3 ($24,378.00) 100.00% ($1,218.90) 1 Electrical (CO #5) ($12,69173) _ ($12,693.73) ? ($12,693.73)' 100.00% 1 ($634.69) 1 1 Electrical (CO #6) $396.52 $396.52 $396.52':. 100.000/0 $19.83 1 Electrical (CO #7) $2,162.06 $2,162.06 $2,162.06 E 100.000 $108.10 1 Electrical (CO #S) $7,694.97 $7,000.00 $694.97 ? $7,694.97 100.00% $384.75 1 Electrical (CO #10) $5,773.48 $5,773.48 $5,773.481 100.00%' $288.67 2 Joist Work ffi[efr€e, (CO #9i $24,561.00 $20,000.001 $4,561.00 $24,561.00 100.00% 1 $1,228.05 1 Electrical (CO #7) $1,035.41 ' $1,035.41 ( $1,035.41 ` 100.00% j $51.77 1 Electrical (CO #7) $12,342.68 $12,342.68 $12 342 68 I 100.00% $617.13 t Electrical (CO #7) $1,170.60 ° $1,170.60 $1 170 60 , 100.00% $58.53 1 Electrical (CO #7) ($7,396.86) ($7,396.86) ($7,396 86) ` 100.00% ($369.84) I Electrical (CO #11) $42,232.20 s $35,000.00 $7,232.20 $42 232 20 100.00% 3 $2,111.61 ' 1 Electrical (CO #12) $12,952 00 $10,000.00 $2,952.00 $12 952.00 ` 100.00% $647.60 Electrical (CO #13) $1,677.131 $1,677.13 - $1 677 13 ; 100.00% $83.86 , 1 E Electrical (CO #14) $9,491 86 _ $9,491.86 Electrical (CO #15) $1,044 26 $835.41 $835 41 ;,, 80.00% $208.85 $41.77 1 'Electrical (CO #15) $5,221 53; $4,177.23 - $4,177.231 80.00% $1,044.301 $208.86 1 Electrical (CO #16) $3,536.88 - $2,829.50 L $2,829.50 j 80.00% _ $707.381 $141.48 PAYMENT TOTALS; $1,877,606.06 $1,812,065.36 $50,186.371 $1,862,251.731 99.18%. $15,354.33 $93,112581 Page 2 of 2 DocuSign Envelope ID: 27E728AB-E7614D8D-8B46-447BC430C75D 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: 07/31/20 From: High Five Erectors II, Inc. Application Date: 07/27/20 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 $435,750.00 $20,629.00 $456,379.00 $456,379.00 5.00% of Completed Work $22,818.95 (Columns D + E) 5.00% of Stored Materials - (Columns F) Total Retainage $22,818.95 (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE $433,560.05 (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT $427,889.50 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $5,670.55 9. BALANCE TO FINISH, INCLUDING RETAINAGE $22,818.95 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $21,852.00 $6,888.15 Total approved this month $5,969.00 $303.85 TOTALS $27,821.00 $7,192.00 NET CHANGES by Change Orders $20,629.00 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: Tara Thompson Date: 07/27/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on the on-ske 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 $5,670.55 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 9 containing Contractors signed Certification is attached. APPLICATION DATE: 07/27/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 High Five Erectors II, Inc. PROJECT NO.: 19520-0033 A B C D E F I G H WORK COMPLETED MATERIALS TOTAL ITEM j DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD STORED (NOT IN , AND STORED TO i (G + C) FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE 1 051200 Structural Steel $129,841.001 $129,841.00 $129,841.00 100.00% $6,492.05 . 2 052100 Steel Joists $100,523.00 l $100,523.00 i$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 $8,508.001 _ i $8 508 001 y 100.00% $425.40 5 055100 Metal Pan Stairs $43,996.00 $43,996.00 ( $43 996 00 100.00% $2,199.80 6 055213 Pipe 1£ Tube Railings $71,614.00 $71,614.00 j $71 614 00 100.00% F $3,580.70 7 Allowance $30,000.00 $29,696.15 $303.85 i, $30,000.00 = 100.00% - [ $1,500.00 8 ;Bond $5,380.00 E $5,380.00 - $5,380.00 100.00% - $269.00 1 Structural Steel Erection (CO 3 $4,190 00 11 $4,190.00 z $4 190 00 ` 100.00% _ $209.50 #1) 1 Structural Steel Erection (CO ($6,888 15) ($6,888.15) -� ($6,888.15) 100.00%i - ($344.41)1 # C 1 ;Structural Steel Erection (CO $500.00 _ $500.00 _ - - $500.00 100.00% $25.00 #3) x 1 Structural Steel Erection (CO $672.001 $672.00 - - _ $672.00 = 100.00% - $33.60 I #4) € 1 Structural Steel Erection (CO $3,000.00 $3,000.00- - -- $3,000.00 100.00%a - $150.00 #5) 1 Structural Steel Erection (CO $8,650.00 $8,650.00 - - - _ $8,650.00 100.00% - $432.50 #6) 1 E Structural Steel Erection (CO $600.00 $600.00 - $600.00 E 100.00%' - $30.00 I £ #7) s I I 1 Structural Steel Erection (CO $1,200.00 $1,200.00 ° - -_ $1,200.00 E 100.00% - $60.00 #7) 1 Structural Steel Erection (CO $3,040.00' $3,040.00 - -_ $3,040.00 € 100.00%- - $152.00 #8) 1 [Structural Steel Erection (CO $1,752.00_ -? $1,752.00 $1,752.001 100.00%1 -? $87.60 #9) 1 Structural Steel Erection CO ( ($303.85) - ($303.85) - _ ($303.85) i 100.00% 1 - ($15.19) #10) 1 e Structural Steel Erection (CO $4,217.00 _ - ( $4,217.00 - $4,217.00 100.00% 3 - $210.85 #10) ] ( PAYMENT TOTALS ! $456,379.00 $450,410.00 $5,969.00 $456,379.00 100.00% - 3 $22,818.95 Page 1 of 2 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Building Material Supply, Inc. 4555 W. 77th Street Edina, MN 55435 Contract For: 195200033-102105 - Toilet Partitions and Accessories 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 $133,323.00 $7,442.00 $140,765.00 $132,573.00 Application No.: 2 Period To: 07/31/20 Application Date: 07/20/20 Project No.: 19520-0033 Contract Date: 11/13/19 Commitment: 195200033-102105 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: Heather Blanchet Date: 07/20/20 State Of: $6,628.65 County Of: Subscribed and sworn to before me this Notary Public: My commission expires: $6,628.65 ARCHITECTS CERTIFICATE FOR PAYMENT day of $125,944.35 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 $121,301.70 entitled to payment of the AMOUNT CERTIFIED. $4,642.65 $14,820.65 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $3,448.00 $0.00 Total approved this month $3,994.00 $0.00 TOTALS It $7,442.00 $0.00 NET CHANGES by Change Orders $7,442.00 AMOUNT CERTIFIED $4,642.65 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/20/20 PERIOD TO: 07/31/20 Building Material Supply, Inc. PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED ( MATERIALS TOTAL 3 ITEM DESCRIPTION OF WORK NUM SCHEDULED VALUE FROM PREVIOUS PRESENTLY STORED IN COMPLETED AND STORED TO % + C) BALANCE TO FINISH RETAINAGE (IF APPLICATION (D THIS PERIOD (NOT y (G (C - G) VARIABLE RATE) + E) D OR E) DATE Toilet Partitions -Material $41,131.00 $41,131.00 $41,131.00 E 100.00% $2,056.55 Toilet Accessories -Material $44,545.00. $44,545.00 $44,545.00 = 100.00% j $2,227.251 `Toilet Partitions -Install $26,700.00 E _ $26,700.00 $26,700.00 _ 100.00%j $1,335.00 l Toilet Accessory -Install $14,925.00 $14,925.00 $14,925.00 100.00% $746.25 €Bike Racks -Material ` $4,887.00 $4,887.00 $4,887.00 100.00% $244.35 Bike Racks -Install $750.00 f $750.00 - i' Insurance -Additional $385.001 $385.00 $385.00 100.00% i $19.25 i' Endorsements 3 Lockers (CO #1) $3,448.00 E $3,448.00 E Toilet Partitions and $2,518.00 $2,518.00 I Accessories (CO #2) € I r 1 1 Toilet Partitions and $1,476.001 $1,476.00 Accessories (CO #3) PAYMENT TOTALS $140,765.00 $127,686.00 i $4,887.00 I $132 573.001 94.18%1 $8,192.00 $6,628.65 1 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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: 07/31/20 From: Kendell Doors & Hardware, Inc. Application Date: 07/18/20 1312 Northland Drive Project No.: 19520-0033 Suite 100 Contract Date: 11/13/19 Mendota Heights, MN 55120 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 $190,455.72 $283,069.72 $259,793.55 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: 07/18/20 State Of: $8,679.78 County Of: $8,679.78 $251,113.77 $223,379.64 $27,734.13 $31,955.95 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $166,392.73 $0.00 Total approved this month TOTALS $24,062.99 $190,455.72 $0.00 $0.00 NET CHANGES by Change Orders $190,455.72 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 Architecfs 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 $27,734.13 (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 vc@gnEnvelope ID: £E72AB-21-4oD-8B46-447Bc3Oc5D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION ; e containing Contractor's signed Certr2ti is Aand aPLcro DATE: o1182i0 In bk�!_sbelow, amounts are stated to the nearest dlQE mo TO: oz7@/02 Kekdvo & Hardware, Inc. PROJECT NO.: ,R2omS A B c .� D E ! F G H \ k ; WORK COMPLETED MATERIALS � TOTAL _ ITEM ' Nu sADu�D VALUE ) PRESENTLY COMPLETED %s��er �TA�c7�smpToowoK ('�/ VARIABLE RATE)�( 1 Hollow Metal k4,05a $84p9.00 j g k4,079A} ,Ae%; \ \ \Finish Hardware kA5.00 �I@em� - \ #m8m1 92.78 %1 #,so/ kss21 1 Hollow Metal Doors &Frames $2gg� tE� $1,818.51 2 tJg� 100a&1 g . (CO ®) = \ Imllow A@ »_ &Frames $13amga $127&oa' kA8.74 ; ; 2 $ @Aea 1ea&1 p A669.4\ I(CO *2 : \Allow Metal Doors & Frames | $soea ��a2.34 $3A0.e6 j @&o,In/ ,«A& \ k50.e1 I(CO ®)� \ �A�� Metal »_&� _,� �292� � $2542. j � »A2. 1Ka&1 \ � $1 2714 (CO #4 I Hollow « o _ &� _� �22aA �2�aa j »,72 a� 100a&1 $13e e f(CO *)a } / ; : , \ • \ 1mllow Metal »_ &Frames } ge� qe.30 , j j ke� ,Ka& \ $ E421 (CO *)e \. ;Hollow Metal Doors &Frames } #09.84 #09.84 j #@A 12a& \ H5.49 I(CO «j7 ' j +lam «v_&�_s A27� rgm �Bm7A j A27A ,ma&} d $33er' I(CO ®)a . . : 1 +lam Metal m_ &Frames m#« mai, \ j m#� 1Ea&} \ £7.481 �(CO #)9 jHollow Metal Doors &Frames $1,402q - « A2q j$1,402.91 100a&} \ #%e . Gomm . j .Allow Metal Doors &Fra _s QzeKa ' 22� oaf \ � � (CO q1 � ! . , , � v ¥TOTALS. . #s3#s7@ »aoe5.4\ #sose12 . \ ps,n3.s¥ 91.78 %1 »3,27e 9; s 7@78 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Fireside Hearth & Home 2700 Fairview Avenue N Roseville, MN 55113 Contract For: 195200033-104405 - Fire Protection Specialties 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 $14,150.00 $0.00 $14,150.00 $14,150.00 Application No.: 1 Period To: 08/31/20 Application Date: 08/05/20 Project No.: 19520-0033 Contract Date: 01/09/20 Commitment: 195200033-104405 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: Alex Koch Date: 08/05/20 State Of: $707.50 County Of: $707.50 Subscribed and sworn to before me this Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT day of $13,442.50 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 $0.00 entitled to payment of the AMOUNT CERTIFIED. $13,442.50 $707.50 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $0.00 $0.00 TOTALS $0.00 111 $0.00 I NET CHANGES by Change Orders 1 $0.00 AMOUNT CERTIFIED $13,442.50 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D 'CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 1 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/05/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Fireside Hearth & Home PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL I ITEM SCHEDULED FROM PREVIOUS DESCRIPTION OF WORK PRESENTLY STO D IN ' COMPLETED % AND SDATE TOREDTO + C) BALANCE TO FINISH G) RETAINAGE (IF VARIABLE RATE) NUM VALUE APPLICATION (D THIS PERIOD (EOT D (G (C - + E) i 1Fireplace 3 $14,15000 $14,150.00 $14,150.00 100.00% $707.50 j PAYMENT TOTALS; $14,150.001 $14,150.00 -, $14,150.00 100.00%_ - $707.50 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8646-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Custom Caseworks 1021 Industrial Dr. S Sauk Rapids, MN 56379 Contract For: 195200033-062020 - Millwork 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 $132,918.00 $151,729.84 $284,647.84 $262,937.14 $13,146.87 $13,146.87 $249,790.27 $109,366.03 $140,424.24 $34,857.57 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $156,729.84 $0.00 Total approved this month $0.00 $5,000.00 TOTALS $156,729.84 $5,000.00 NET CHANGES by Change Orders $151,729.84 Application No.: 2 Period To: 07/31/20 Application Date: 07/21/20 Project No.: 19520-0033 Contract Date: 12/06/19 Commitment: 195200033-062020 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: Christine Weyer Date: 07/21/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $140,424.24 (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 oomxaonEnvelope ID: o7s7uuxo-Era1 'CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: u containing--------n —----- APPLICATION DATE: onuxu |ntabulations below, amounts are stated oothe nearest dollar. PERIOD TO: 07/31/20 CvsmmCoueendm PROJECT NO.: 19520-0033 WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY i COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) 1 & Install DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 ($17,261.62) $1,003,428.38 ................._. $1,003,428.38 N/A N/A Application No.: 9 Period To: 07/31/20 Application Date: 07/22/20 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: 07/22/20 State Of: County Of: Subscribed and sworn to before me this Notary Public: day of My commission expires: $50,171.42 ARCHITECTS CERTIFICATE FOR PAYMENT $953,256.96 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 $948,642.81 entitled to payment of the AMOUNT CERTIFIED. $4,614.15 $50,171.42 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $4,090.00 $26,208.62 Total approved this month $4,857.00 $0.00 TOTALS $8,947.00 $26,208.62 NET CHANGES by Change Orders ($17,261.62) AMOUNT CERTIFIED $4,614.15 (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: 27E728AB-E761-4D8D-81346-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 9 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/22/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Top -All Roofing, Inc 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) i FINISH (C - G) VARIABLE RATE) 4 ' + E) D OR E) DATE 1 I Material Insulation $384,950.00 $384,950.00 f - t $384,950.00 100.00% $19,247.50 2 Material Vapor Barrier $50,600 00 $50,600.00 E - I $50,600.00 100.00% $2,530.001 3 = Material EPDM & Accessories $195,960.00 $195,960.00 i $195,960.00 j 100.00% $9,798.00 4 Material Sheet Metal $32,040.00 $32,040.00 1 - - I $32,040.00 100.00% $1,602.00 3 5 Labor Insulation $80,070.00 ; $80,070.00 ` - $80,070.00 j 100.00% E $4,003.50 16 i Labor Vapor Barrier $21,110.001 $21,110.00 r -_ $21,110.00 i 100.00%1 $1,055.50 7 I Labor EPDM &Accessories $148,060.00 $148,060.00 i - $148,060.00 ] 100.00% ; $7,403.00 8 Labor Sheet Metal $29,900.00 $29,900.00 E - - $29,900.00? 100.00% $1,495.00 9 ' Allowance for Conditions $45,000.00 ; $45,000.00 € - - $45,000.00 100.00% $2,250.00 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%1 $103.00 3 1 ' Roofing (CO#2) ($12,00000) ($12,000.00) -3 - ($12,000.00)? 100.00% , ($600.00) 1 Roofing (CO #3) $1,560 00 ` $1,560.00 i - - $1,560.00 100.00%1 $78.00 1 'Roofing (CO #4) ($12,208 62) i ($12,208.62) € - ($12,208.62) 100.00% ($610.43) 1 Roofing (CO #5) $470.00 I $470.00 f - $470 00 ; 100.00% i $23.50 1 Roofing (CO #6) ($2,000.00) € ($2,000.00) ` - ($2,000 00) 100.00% ($100.00) j 1 ° Roofing (CO #7) $220 00 G $220.00 - $220 00 100.00% $11.00 1 Roofing (CO #8) $4,637 00 - $4,637.00 - $4,637.00 100.00% 1 $231.85 l PAYMENT TOTALS j $1,003,428 38 $998,571.38 $4,857.001 $1,003,428.38 100.00% [ - $50,171.42 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $10,955.00 Total approved this month $5,315.36 $10,602.75 TOTALS $5,315.36 $21,557.75 NET CHANGES by Change Orders ($16,242.39) Project: Elk River Multi -Purpose Facility and Lion John Weicht Park $202,415.00 ($16,242.39) $186,172.61 $186,172.61 Application No.: 2 Period To: 07/31/20 Application Date: 07/22/20 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: 07/23/20 State Of: $9,308.63 County Of: Subscribed and sworn to before me this Notary Public: day of My commission expires: $9,308.63 ARCHITECTS CERTIFICATE FOR PAYMENT $176,863.96 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 $22,595.75 entitled to payment of the AMOUNT CERTIFIED. $154,268.23 $9,308.63 AMOUNT CERTIFIED $154,268.23 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D ,CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/22/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Schwickert's Tecta America, LLC PROJECT NO.: 19520-0033 A B - C - - D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM NUM DESCRIPTION OF WORK j SCHEDULED ; FROM PREVIOUS VALUE PRESENTLY STORED IN COMPLETED AND STORED TO % + C) BALANCE TO FINISH RETAINAGE (IF APPLICATION (D THIS PERIOD (NOT (G (C - G) ;VARIABLE RATE) + E) D OR E) _ DATE 3 I 1 ; Insurance/Bonds $12,574 00 i $12,574.00 - - $12 574 00 � 100.00% l - f $628.70 2 = Shop Drawings $11,211.001 $11,211.00 € - $11 211 00 % 100.00%, $560.55 3 Mobilzation/Equipment $11,710.001 - $11,710.00 -_ $11,710.00 100.00% ' $585.50' 4 'Safety $9,311.00 $9,311.00 $9,311.00' 100.00% $465.55 5 iWall Insulation/Z-Furring $10,888.001 $10,888.00 $10 888 001 100.00%' $544.40 Materials 3 6 = Wall Insulation/Z-Furring Labor 1 $9,646 00 € $9,646.00 - $9 646 00 100.00% $482 30 7 ) Solid Phenolic Rainsceen $33,465.001 $33,465.00 $33,465.00 i 100.00% k $1,673.25 Panels Materials . 8 Solid Phenolic Rainsceen $11,282.001 $11,282.00 - $11,282.001 100.00%, $564.10 ;Panels Labor 9 x Solid Phenolic Rainscreen i $17,619 00 I $17,619.00 - $17 619 00' 100.00% [ $880.95 i Panel Flashing Materials 110 Solid Phenolic Rainscreen $8,113.00 $8,113.00 $8,113.00 I 100.00%- $405.65 Panel Flashing Labor j ill s ACM Fabrication Materials $20,003 00 r $20,003.00 - $20 003 001 100.00% 1 E $1,000.15 .12 ACM Fabrication Labor $17,519 00 $17,519.00 - ` $17 519 00 I 100.00% 3 $875.95 13 ACM Flashing Materials $5,419 00 1 $5,419.00 $5,419.00 j 100.00%; $270.95" 14 € ACM Flashing Labor $4,923 00 ` $4,923.00 - $4,923.001 100.00% 1 $246.15 15 ACM Inst. Materials hat ( $7 241.00 i , $7 241.00 - 7 241.00 I $ 100.00% $362.05 j /fasteners/etc.) 16 ACM Inst. Labor $6,491 001 $6,491.00 - $6 491 00 100.00% j $324.55 ] 17 1 $5,000 Allowance per Contract $5,000.00 „ $5,000.00 - $5,000.00 i 100.00% $250.00 I 1 I Metal Wall Panels (CO #1) ? ($10,955.00) - ($10,955.00) ($10,955.00) ] 100.00% € ($547.75) 1 j Metal Wall Panels (CO #2) $5,315 36 - $5,315.36 $5,315.361 100.00% E $265.77 1 Metal Wall Panels (CO #3) ($5,000.00) - ($5,000.00) ($5,000.00) 100.00% ` - ($250.00) 1 Metal Wall Panels (CO #4) i ($5,602.75) - ($5,602.75) ($5,602.75) 100.00% E 3 ($280.14) PAYMENT TOTALS $186,172.61 ' $23,785.00' $162,387.611 $186,172.611 100.00% $9,308 631 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Murphy Window and Door Commercial, Inc 12536 314th Ave NW Princeton, MN 55371 Contract For: 195200033-088105 - Glass and Glazing 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 $601,000.00 $40,800.00 $641,800.00 $641,800.00 $32,090.01 $32,090.01 $609,709.99 $591,257.31 $18,452.68 $32,090.01 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $44,050.00 $11,500.00 Total approved this month $8,250.00 $0.00 TOTALS $52,300.00 $11,500.00 NET CHANGES by Change Orders $40,800.00 Application No.: 6 Period To: 07/31/20 Application Date: 07/24/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-088105 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: Hank Thompson Date: 07/27/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $18,452.68 (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: 27E728AB-E7614D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 6 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/24/20 PERIOD TO: 07/31/20 Murphy Window and Door Commercial, Inc PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED I FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD STORED (NOT IN I AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE j 1 08-900 Curtain Wall & $147,882.52 = $144,924.87 $2,957.65 , $147,882.52 j 100.00% $7,394.13 Storefront Metal 2 08-700Hardware i $89,971.203 $88,171.78 $1,799.42 $89,971.20 100.00% j $4,498.56 3 08-300 Automatic Entrances $22,578.001 $22,578.001 I $22,578.00 100.00% ] $1,128.90 i 4 08-800 Glazing I $113,807.50 $111,531.353 $2,276.15 ! $113,807.50) I 100.00% $5,690.38 I 5 08-950 Brake Metal $71100.00 $6,958.00 ] $142.00 - $7,100.00 100.00% $355.00 6 07-900 Joint Sealers $3,675.73 $3,602.22 j $73.51 -' $3,675.73 100.00% [', $183.79 7 08-050 Misc Fasteners, $3,944.65 $3,865.76 $78.891 $3,944.65 100.00%1 $197.23 Shims, Backer Rod 8 01-542 Man Lifts, Storage, & $25,560.00. $25,048.801 $511.20 - $25,560.00 100.00% $1,278.00 i Equipment 9 01-750 Bonds & Insurance f $14,200.00 $14,200.00 -I $14,200.00� 100.00% $710.00 10 01-010 Refundable Allowance $7,500.00 $7,500.00 - - $7,500.00 100.00% $375.00 ill 08-910 Shop Drawings - $9,958.00 $9,958.00 - $9,958.00 = 100.00% -, $497.90 f 12 08-920 Structural Calcs ) $17,569.20 _ $17,569.20 - $17,569.201 100.00%) - $878.46 113 108-930 Field Installation Labor $119,253.20 $116,868.14 $2,385.06 $119,253.20 I 100.00%' - $5,962.66 14 E 01-770 Mobilization 1 $18,000.00 _ $18,000.00 - $18,000.00 100.00% _ -$900.00 1 I Glass and Glazing (CO #1) $43,100.00 $43,100.00 $43,100.00 E 100.00% - $2,155.00 =1 1 Glass and Glazing (CO #2) ($4,000.00) 1 ($4,000.00) - ($4,000.00) k 100.00% - ($200.00) s 1 ` Glass and Glazing (CO #2) ($7,500.00) 1 ($7,500.00) - ? ($7,500.00) € 100.00% - ? 1 Glass and Glazing (CO #3) $950 00 1 $950.00 $950.001 100.00% $47.50 1 Glass and Glazing (CO #4) $7,800.00 ` $7,800.00 $7,800.001 100.00% - $390.00 1 _ Glass and Glazing (CO #5) $450.00 $450.00 $450.00 = 100.00% - ( $22.50' PAYMENT TOTALS $641,800.00 $622,376.12 1 $19,423.88( $641,800.001 100.00%1 -? $32,090.01 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 ($8,150.00) $53,610.00 $51,210.00 Application No.: 2 Period To: 07/31/20 Application Date: 06/25/20 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: 07/08/20 State Of: $2,226.00 County Of: $334.50 Subscribed and sworn to before me this Notary Public: day of My commission expires: $2,560.50 ARCHITECTS CERTIFICATE FOR PAYMENT $48,649.50 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 $8,146.25 entitled to payment of the AMOUNT CERTIFIED. $40,503.25 $4,960.50 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $8,500.00 Total approved this month $350.00 $0.00 TOTALS $350.00 $8,500.00 NET CHANGES by Change Orders ($8,150.00) AMOUNT CERTIFIED $40,503.25 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D [CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 06/25/20 PERIOD TO: 07/31/20 SKOLD SPECIALTY CONTRACTING, LLC PROJECT NO.: 19520-0033 A B C D [ E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED DESCRIPTION OF WORK FROM PREVIOUS 1 PRESENTLY COMPLETED % € BALANCE TO RETAINAGE (IF NUM i VALUE i APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) % FINISH (C - G) VARIABLE RATE) i + E) D OR E) DATE 1 1 Material $46,415.00 $5,325.00 $28,000.00 $6,69000; $40,015,00 86.21%1 $6,40000 $2,000.75 2 (Installation $15,345.00; $3,250.00 $7,945.00 [ $11,195.00 72.96% $4,150.00 $559.75 1 Overhead Coiling Door (CO #1) ` ($8,500.00) - - - ($8,500 00) 1 Overhead Coiling Door (CO #2) $350.00 - - - - $350.00 PAYMENT TOTALS $53,610.001 $8,575.00€ $35,945.00 $6,690.001 $51,210.00 95.52%1 $2,400.00 i $2,560.50 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 ($8,150.00) $53,610.00 $53,610.00 Application No.: 3 Period To: 07/31/20 Application Date: 07/23/20 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: 07/28/20 State Of: $2,680.50 County Of: Subscribed and sworn to before me this Notary Public: day of My commission expires: $2,680.50 ARCHITECTS CERTIFICATE FOR PAYMENT $50,929.50 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 $48,649.50 entitled to payment of the AMOUNT CERTIFIED. $2,280.00 $2,680.50 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $350.00 $8,500.00 Total approved this month $0.00 $0.00 TOTALS $350.00 $8,500.00 NET CHANGES by Change Orders ($8,150.00) AMOUNT CERTIFIED $2,280.00 (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: 27E728AB-E761-4D8D-8B46-44713C430C75D X610 NYlki1lLAX 9 M ► IM:I:W1 APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 3 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/23/20 PERIOD TO: 07/31/20 SKOLD SPECIALTY CONTRACTING, LLC PROJECT NO.: 19520-0033 A B C D E F G H j WORK COMPLETED MATERIALS TOTAL ITEM ( DESCRIPTION OF WORK 1 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) j + E) D OR E) DATE 1 Material $46 415 00 $40,015.00 $40,015.00 86.21% $6,400.00E $2,000.7512 Installation$2,050.00 ,. - I $13,245.00 f 86.31% $2,100.00 $662.25 1 Overhead Coiling Door (CO #1) ($8,500.00) - ( - I i ($8,500.00)' 1 Overhead Coiling Door (CO #2) $350.00 $350.00 i - $350.00 100.00% $17.50 PAYMENT TOTALS $53 ,610.001 $51,210.00 $2,400.00 $53.610.00 = 100.00% $2,680 50 P Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 Project: Elk River Multi -Purpose Facility and Lion John Weicht Park Application No.: 6 Period To: 07/31/20 Application Date: 07/22/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-092905 $309,300.00 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 $37,921.46 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 $347,221.46 payment shown herein is now due. $347,221.46 CONTRACTOR: By: Katie Hislop Date: 07/22/20 5.00% of Completed Work $17,361.07 (Columns D + E) 5.00% of Stored Materials _ (Columns F) Total Retainage $17,361.07 (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE $329,860.39 (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT $318,721.88 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $11,138.51 9. BALANCE TO FINISH, INCLUDING RETAINAGE $17,361.07 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $37,921.46 $0.00 Total approved this month $0.00 $0.00 TOTALS $37,921.46 $0.00 NET CHANGES by Change Orders $37,921.46 State Of. County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $11,138.51 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 6 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/22/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 RTL Construction, Inc. PROJECT NO.: 19520-0033 A B C {D E F G H [ I 1 j I WORK COMPLETED MATERIALS TOTAL i ITEM DESCRIPTION OF WORK NUM SCHEDULED FROM PREVIOUS VALUE APPLICATION (D PRESENTLY THIS PERIOD STORED (NOT IN - COMPLETED AND STORED TO % (G = C) BALANCE TO FINISH (C - G) '. RETAINAGE (IF s VARIABLE RATE) 1 j + E) D OR E) DATE 1 Bonds/Shops $6,000.00 1 $6,000.00 $6,000 00 I 100.00% $300.00 2 Allowance $15,000.00 $15,000.00 ) $15,000.00 100.00% -1 $750.00 1 3 Drywall Assembles $190,000.00 $180,500.00 $9,500.00 _ $190,000.00 € 100.00% $9,500.00 , 4 Insulation $15,000.00 $15,000.00 -[ $15,000.00 100.00%1 $750.001 5 E Materials $83,300.00 _ $81,634.00 $1,666.00 1 - $83,300.00 100.00% - _ $4,165.00 E 1 I Gypsum (CO #1) $23,308.52 $23,308.52 $23.308.52 100.00% j - $1,165.43 r 1 €Gypsum (CO #2) $1,241.68 $1,241.68 - � - $1,241.68 100.00% ? - , $62.08 f 1 Gypsum (CO #3) ; $2,196.261 _ $2,196.26 - $2,196.26 100.00% - $109.81 )1 � Gypsum (CO #4) $11,175.00 $10,616.25- $558.75€ -- $11,175.00` 100.00% - $558.75 PAYMENTTOTLSj $347,221.461 $335,496.71 $11,724.751 $347,221 46 t 100.00%3 $17,361.07 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 4 830 Boone Avenue North John Weicht Park Golden Valley, MN 55427 Period To: 07/31/20 From: CD Tile and Stone, Inc. Application Date: 07/17/20 3103 103rd Lane NE Project No.: 19520-0033 Suite 160 Blaine, MN 55449 Contract Date: 07/23/19 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 $17,282.40 $173,262.40 $173,262.40 $8,663.12 $8,663.12 $164,599.28 $159,614.25 $4,985.03 $8,663.12 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $29,535.00 $17,500.00 Total approved this month $5,247.40 $0.00 'TOTALS $34,782.40 $17,500.00 NET CHANGES by Change Orders $17,282.401 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: 07/21/20 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 certfies 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 $4,985.03 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 4 Containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/17/20 PERIOD TO: 07/31/20 CD Tile and Stone, Inc. PROJECT NO.: 19520-0033 A B C D f E F } G H l WORK COMPLETED MATERIALS TOTAL E ITEM SCHEDULED DESCRIPTION OF WORK I FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD STO IN AND SDTORE D TO (G + C) FINISH (C - G) ;VARIABLE RATE) )ATE D OR EOT 0 Labor ) $85,790.00 $85,790.00 $85,790.00 ` 100.00% $4,289.50 I 0 Materials � $70,190.00 , $70,190.00 = - � $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 #2 ) ($3,000.00) (CO _ ($3,000.00)_ - - ($3,000.00) 100.00% ($150.00) t 1 Tile (CO #3) I $2,885.00 $2,885.00 - - $2,885.00 i 100.00% $144.25 1 Tile (CO #4) ( $26,650.00 $26,650.003 -I $26,650.00 100.00%; $1,332.50€ 1 Tile (CO #5) € $5,247.40 , $5,247.40 ! - $5,247.40 1 100.00% l $262.37 i PAYMENT TOTALS i $173,262.40 = $168,015.00 1 $5,247.40 € - J $173,262.401 100.00% $8,663.12 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 $1,495.95 $150,905.95 $142,373.45 $7,118.68 Application No.: 5 Period To: 07/31/20 Application Date: 07/14/20 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: 07/14/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: $7,118.68 ARCHITECTS CERTIFICATE FOR PAYMENT $135,254.77 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 $129,726.49 entitled to payment of the AMOUNT CERTIFIED. $5,528.28 $15,651.18 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $19,314.20 $15,105.00 Total approved this month $2,286.75 $5,000.00 TOTALS $21,600.95 $20,105.00 NET CHANGES by Change Orders $1,495.95 AMOUNT CERTIFIED $5,528.28 (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.) /1061:III9:1411 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: 27E728AB-E761-4D8D-8B46-447SC430C75D !CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 5 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/14/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Twin City Acoustics, Inc. PROJECT NO.: 19520-0033 A = B C D E F G y 3 H P WORK COMPLETED MATERIALS TOTAL 1 ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO y RETAINAGE (IF NUM VALUE APPLICAE ION (D THIS PERIOD STO IN AND STORED TO (G + C) FINISH (C - G) j VARIABLE RATE) , ) EOT DATE ] 1 095100 - Material $97,380.00 ; $97,380.00 = -' $97,380 00 100.00% 1 -' $4,869.00 2 095100 - Labor $44,500.00 $44,500.001 - $44,500.00 100.00% - $2,225.00 3 098430 - Material $3,450.00 $3,450.001 _ $3,450.00 100.00% kp $172.50 4 098430-Labor $1,830.001 $1,830.00 -� $1,830.00 100.00% - $91.50; I5 Bonds $2,250.001 $2,250.00 -_ $2,250.00 100.00% - $112.501 1 Acoustical Ceilings (CO #1) ($15,105.00) ($15,105.00) -' ($15,105.00) 100.00% 1 ($755.25) 1 ;Acoustical Ceilings (CO #2) $14,827.00 - $7,413.50 -1 $7,413.50 50.00% 1 $7,413.50 $370.68 1 ° Acoustical Ceilings (CO #3) $2,238.00? $1,119.00 $1,119.00 _ 50.00% $1,119.00 $55.9.5 1 Acoustical Ceilings (CO #4) [ I [ $2,249.20 ' $2,249.20' -; $2,249.20 100.00% € - $112.46 1 = Acoustical Ceilings (CO #5) ($5,000.00), ($5,000.00)3 ($5,000.00) 100.00% - ($250.00) 11 Acoustical Ceilings (CO #6) $2,286.75 - $2,286.75 $2,286.75 100.00% -? $114.34 PAYMENT TOTALS , $150,905.951 $136,554.20 '. $5,819.25 $142,373.45 94.35% f $8,532.50 j $7,118.68 , Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Becker Arena Products, Inc. 72 Shakopee, MN 55379 Contract For: 195200033-096800 - Flooring 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 $33,901.00 $0.00 $33,901.00 $22,557.40 $1,127.87 $1,127.87 $21,429.53 $0.00 $21,429.53 $12,471.47 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.: 1 Period To: 08/31/20 Application Date: 08/05/20 Project No.: 19520-0033 Contract Date: 06/12/20 Commitment: 195200033-096800 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: Tanya Baur Date: 08/05/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $21,429.53 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D !CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. APPLICATION NO.: 1 In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 08/05/20 PERIOD TO: 08/31/20 Becker Arena Products, Inc. r PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED 1 MATERIALS TOTAL s ITEM NUM DESCRIPTION OF WORK SCVALUE�D I FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF APPLICATION (D ' THIS PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) ; VARIABLE RATE) + E) D OR E) I DATE 3 1 [ Lions Park Batting Cage Turf $9 140 00 -• 635 64 , $6 - $6,635.64 72.60% $2,504.36 $331.78 12 Varsity Locker Room Rubber $24 761 00 ` $15,921 76 ` $15,921.76 64.30%- $8,839.24 € $796.09 Flooring j PAYMENT TOTALS $33 901 00 $22,557 40 . $22,557.401 66.54% [ $11 343.60 1 E1 127 87 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Acoustics Associates, Inc. 1250 Zane Ave N Minneapolis, MN 55422 Contract For: 195200033-096805 - Flooring 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 Application No.: 1 Period To: 07/31/20 Application Date: 07/30/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-096805 $103,900.00 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 ($5,538.50) 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 $98,361.50 payment shown herein is now due. $98,361.50 CONTRACTOR: By: Kenneth Alme Date: 07/30/20 State Of: $4,918.07 County Of: $4,918.07 $93,443.43 $0.00 $93,443.43 $4,918.07 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $2,635.00 $8,173.50 TOTALS $2,635.00 $8,173.50 NET CHANGES by Change Orders ($5,538.50) 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 $93,443.43 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 1 containing Contractors signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/30/20 PERIOD TO: 07/31/20 Acoustics Associates, Inc. PROJECT NO.: 19520-0033 A B C D E F G H [ I l WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK NUM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF VALUE APPLICATION (D THIS PERIOD STORED (NOT IN F AND STORED TO (G + C) FINISH (C - G) ;VARIABLE RATE) + E) D OR E) DATE 1 1 Floor Prep $1,845.00 $1,845.00 $1,845.00 100.00%y $92.25 2 Carpet Tile - Material i $59,405.00 _ $59,405.00 i $59,405.00 E 100.00% $2,970.25 3 I Carpet Tile - Labor $13 059.00 $13,059.00 $13,059.00 100.00%' € $652.95 4 Resilient Flooring - Materials ] 1 $10 266 00 $10,266.00 3 $10,266.00' 100.00% $513.30 5 Resilient Flooring - Labor $9 325 00 $9,325.00 $9,325.00 ° ' 100.00 /o $466.25 1 6 1 Allowance I $10,000.00 $10,000.001 $10,000.00 100.00% $500.00 1 Flooring (CO #1) i $2,635.00 $2,635.00 $2,635.00 100.00% ! $131.75 i I 1 Flooring (CO #2) � ($8,000.00) -, ($8,000.00) , ($8,000.00) i 100.00% ($400.00 ) x 1 = Flooring (CO #3) ($173.50) _ - ($173.50) - ($173.50) : 1 100.00%l ($8.68) I PAYMENT TOTALS $98,361.50 E - $98,361.50 i - $98,361.50 100.00%1 $4,918.07 j Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 $77,406.00 $490,156.00 $460,656.00 Application No.: 7 Period To: 07/31/20 Application Date: 07/20/20 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: 07/22/20 State Of: $23,032.80 County Of: $23,032.80 $437,623.20 $408,155.15 $29,468.05 $52,532.80 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $98,269.00 $10,863.00 Total approved this month $0.00 $10,000.00 TOTALS $98,269.00 $20,863.00 NET CHANGES by Change Orders $77,406.00 Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 Architects 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 $29,468.05 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D !CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 7 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/20/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 SUNRISE PAINTING PROJECT NO.: 19520-0033 A B C D E F G H I � WORK COMPLETED MATERIALS TOTAL I ITEM DESCRIPTION OF WORK NUM SCHEDULED ;FROM PREVIOUS VALUE APPLICATION (D THIS PERIOD PRESENTLY STORED (NOT IN COMPLETED _ AND STORED TO % (G + C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) + E) D OR E) DATE 1 ; PAINTING $407,750.00 $375,500.00 $2,750.00 $378,250.00 92.77% $29,500.00' $18,912.50 12 BOND j I $5,000.00 $5,000.00 $5,000.00 ° 100.00 /° $250.00 a 3 1 Painting (CO #1) $10,000.00 $10,000.00 $10,000.00' 100.00% $500.00 1 ; Painting CO #3 $9 000.00 i $9 000.00 i 9 000.00 100.00%, 2 =' Prime + Paint Joists (CO #2) 1 $63,800 00 = $60,000.00 $3,800.00 $63 800 00 1 100.00%' $3,190.00 1 ! Painting (CO #4) ($1,863.00) ($1,863.00) € ($1,863.00)' 100.00%1' ($93.15); 1 j Painting (CO#5) $13,100.00 $13,100.00 $13,100.00 100.00% $655.00 1 ' Painting (CO #6) $6,100.00 $6,100.00 $6,100.00 - 100.00% 1 $305.00 1 1 Painting (CO #6) j $5,269.001 $5,269.00 $5,269.001 100.00% $263.45 1 Painting (CO #7) ($10,000.00) ($10,000.00) ($10,000.00) 100.00% ($500.00) , ' PAYMENT TOTALS $490,156.00 ? $429,637.00E $31,019.00 - $460,656.00 93.98% $29,500.00 -- $23,032.80 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: SDDI Signs 17125 Adelmann Street SE Prior Lake, MN 55372 Contract For: 195200033-101405 - Signage 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 $8,843.00 $2,980.60 $11,823.60 $10,412.10 Application No.: 1 Period To: 07/01/20 Application Date: 07/16/20 Project No.: 19520-0033 Contract Date: 06/12/20 Commitment: 195200033-101405 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: Catherine Sowder Date: 07/22/20 State Of: $520.61 County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: $520.61 ARCHITECTS CERTIFICATE FOR PAYMENT $9,891.49 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 Architects Contract has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is $0.00 entitled to payment of the AMOUNT CERTIFIED. $9,891.49 $1,932.11 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $2,980.60 $0.00 TOTALS $2,980.60 $0.00 NET CHANGES by Change Orders $2,980.60 AMOUNT CERTIFIED $9,891.49 (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: 27E728AS-E761-4D8D-8846-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 1 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/16/20 PERIOD TO: 07/01/20 SDDI Signs PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED I DESCRIPTION OF WORK FROM PREVIOUS i 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) i D OR E) DATE 1 Request for Payment of $8,843.00 $8,843.00 $8,843.00 100.00% f $442.15 interior signage 1 Signage (CO #1) $1,490.30 $1,490.30 $1,490.30 100.00% I $74.52 f 1 Signage (CO #2) $1,490.30 , $78.80 I _ $78.80 , 5.29% I[ $1,411.50 $3.94 PAYMENT TOTALS! $11,823 60 - $10,412.10 E -� $10 41210 - 88.06% 1 $1,411.50 $520 61 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 $41,221.84 $175,176.84 $175,176.84 N/A N/A $8,758.86 $166,417.98 $164,896.15 $1,521.83 $8,758.86 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $39,619.91 $0.00 Total approved this month $1,601.93 $0.00 TOTALS $41,221.84 $0.00 NET CHANGES by Change Orders $41,221.84 Application No.: 5 Period To: 07/31/20 Application Date: 07/20/20 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: 07/21/20 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 $1,521.83 (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.) ►_1:Zya��x�� 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: 27E728AB-E761-4D8D-8B46-447BC430C75D ;CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 5 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/20/20 PERIOD TO: 07/31/20 Peterson Companies, Inc 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 % i BALANCE TO RETAINAGE (IF NUM VALUE APPLI (D THIS PERIOD STO IN AND SDTORE D TO (G + C) FINISH (C - G) VARIABLE RATE) i +AETIION DEOR EOT .ATE 1 Survey and Layout $4,310.00 I $4,310.00 - - $4,310.00 [ 100.00% - $215.51 2 Athletic Equipment - Labor $27,489.00 $27,489.00 - - $27,489.00 1 100.00%= $1,374.45 3 € Athletic Equipment - Materials $68,608.00 $68,608.00 - - $68,608.00 100.00% $3,430.40 14 j Scoreboard - Labor $11,420.00 [ $11,420.00 - $11 420 00 , 100.00% $571.00 5 Scoreboard - Materials I $22,128.00 k $22,128.00 € $22,128.00; 100.00% $1,106.401 1 Athletic Equipment (CO #1) $29,154.00 s $29,154.00 € $29,154.00 100.00% _ $1,457.70 1 Athletic Equipment (CO #2) $7,150.00 i $7,150.00 ( $7,150.00 1 E 100.00% E $357.50 1 ' Athletic Equipment (CO #3) $3,315.91 1 $3,315.91 I $3,315.91 100.00% [ $165.80 j ] 1 Athletic Equipment (CO #4) $1,601.93 =, - € $1,601.93 $1,601.93 100.00% [ $80.10 I PAYMENT TOTALS i $175,176.841 $173,574.91 $1,601.931 $175,176.841 100.00% - $8,758.86 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: TriMark Hockenbergs 13098 George Weber Dr Ste 100 Rogers, MN 55374 Contract For: 195200033-114005 - Food Service 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 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 $101,739.83 $0.00 $101,739.83 $101,739.83 Application No.: 2 Period To: 08/31/20 Application Date: 08/05/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-114005 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: Dan Tran Date: 08/06/20 State Of: $5,087.00 County Of: $5,087.00 Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT $96,652.83 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 $11,330.76 entitled to payment of the AMOUNT CERTIFIED. $85,322.07 $5,087.00 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 AMOUNT CERTIFIED $85,322.07 (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: 27E728AB-E7614D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION NO.: 2 APPLICATION 08/05/20 DATE: PERIOD TO: 08/31/20 PROJECT NO.: 19520- 0033 A B C D E F G H I ITEM DESCRIPTION OF ji [ UNIT SCHEDULED WORK COMPLETED , MATERIALS PRESENTLY TOTAL COMPLETED ° f /° BALANCE RETAINAGE NUM.] WORK COST VALUE FROM PREVIOUS THIS STORED (NOT IN D OR E) AND STORED TO [ (G + C) TO FINISH ! (IF VARIABLE Ii E APPLICATION (D + E) - PERIOD ? DATE ( (C - G) L RATE) 1 ; WALK-IN FREEZER $10,783.48 AMT $10,783.48 $10,783.48 - [ $10,783.48 1100.00% j - $539.1 (CITY 1.0p 1.0 1.0E - 2 `FREEZER $1,291.68 AMT $1,291.68[ - $1,291.68 - $1,291.68 100.00% - $64.5 !,EVAPORATOR [ CITY 1.0 € 1.0 1.0 ' I - 3 FREEZER $3,269.85 [ AMT : $3,269.85 $3,269.85 -i $3,269.85 100.00%11 - $163.4 CONDENSER € QTY ; 1.01 1.0 € 1.0 - 4 FREEZER SHELVING $2,197.16 AMT $2,197.16 $2,197.16 -[ $2,197.16 100.00% - $109.8 E CITY 1.01 __ 1.0 1.0 E 5 ' MOP SINK $375.74 AMT ` $375.74 $375.74 -� $375.74 E 100.00%' - $18 7' 1 QTY 1.0 1.0 - ) 1.0 - 5.1 WALL MOUNT $54.93 AMT $54.93 _ $54.93 - 2 $54.93 100.00% I $2.7 SHELVING ( : QTY 1.0 1.0 1.0E _ 5 ' MOP BUCKET $51.95 AMT $51.95 $51.95 - $51.95 100.00% $2.6 CITY 1.0 1.0 1.0 7 DRY STORAGE $1,982.68 AMT $1,982.68 t $1,982.68 $1,982.68 1 100.00% - $99.1 SHELVING I CITY ` 1.0 1.0 1.0' E B FLOOR TROUGH $767.89 f AMT $767.89 $767.891 $767.89 100.00% I $38.3' CQTY 1.0 1.0 1.0 9 i ICE MAKER $6,627.82 AMT $6,627.82 - $6,627.82 1 $6,627.82 f 100.00% £ ) $331.3' CITY 1.0 1.0 ? 1.0 14 REACHIN $4,120.36 AMT $4,120.36 $4,120.36 $4,120.361 100.00% $206.0; REFRIGERATOR CITY 1.0 1.0 1.0 15 1 REACH IN FREEZER $4,464.38 AMT $4,464.38 $4,464.381 $4,464.38 € 100.00% $223.2: CITY 1.0 = 1.01 1.0 € 17 WORKTABLE $864.29 AMT $1,728.58 $1,728.58 $1,728.581 100.00%. $86.4, CITY t 2.0 2.0� 2.0' 18 ' WALL MOUNT $79.59 ] AMT '' $159.18 - I $159.18 $159.18 100.00% $7.9 SHELVING ? CITY 2.0 - 2.0 2.0 20 MULTI COOK OVEN I $10,483.58 _AMT $10,483.58 - ` $10,483.58 $10,483.58 100.00% $524.11 CITY 1.0 - 1.0 1.0 t 20.1 HEATED LOW TEMP $2,106.86 AMT j $2,106.86; - € $2,106.86 $2,106.86 100.00% $1053 HOLDING CABINET CITY 1.01 - 1.0 1.0 22 E COUNTERTOP FOOD $278.40 _ AMT j $278.40 - _ $278.40 $278.401 100.00% $13.9; PAYMENT TOTALS_ $101,739.831 $11,92711 $89,812.72� $101,739.83'9 100.00%y $5,087.01 Page 1 of 3 v cu§gnavope 2 £E72a- 21*vom46-4ae go75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR YMENT , containing Contractors signed Certification is attached. In tabulations below, amoun! are statedb the nearest dollar. APPLICATION NO:2 APPLICATION 0810520 DATE: PERIOD TO: g@/o2 PROJECT NO.: ,E2D @S A; B � c , D . E , F G H , ITEM = DESCRIPTION OF } UNIT SCHEDULED WORK COMPLETED ; MATERIALS �m�rYI TOTAL % AND BALANCE �FaeH77vRIAB��k �rI�GE iVALUE COSTl FROM PREVIOUS THIS INDE) +ED>o G APPLICATION p+E) PERIOD �� (C-G) RATE) N JQTY 1: \ 1a1 t/ \ » WORK TABLE «e� a T #a� \ Ha� . - wa� (,ma 1 q,� ; .oTY ,:. - 1a1 1.0 a AND SINK »Aq 1 a T} k�e57 \ #mom j k#� {1#a* - #zaa _ ;On} »a - �01 , In( - 2 SOILED DISH r kq pE25'a T| $1,075.25 \ «,075.25 , j $1,07 5.251 100.00% a3.7e iQTY 1:2 - ,: , . ,$ 2 DISH TABLE SORTING $o7g1AM T| go7g' \ $ram 1 . $o7@ ,O«& $s@ ;SHELF E o �: 1a1 , ,a _ \ » UNDER COUNTER A,A«AMT A189.41 A,@ 1 § A,B 1,Sa%} j #e. 1DISHWASHER � CITY 1.0 ,a1 ,$1 ! # THREE $ pKa/ a T $1,678.34 g paA 2 « peA ,ma&| \ #ate COMPARTMENT &A ;oTY 1.01 1.01,o \ a !WALL MOUNTED k¢43 a T $137 2 « e.72 1 \ $ p� ,Ea& / #a SHELVING OTY 4.0 4.01 ao @ :moo c 9� p9E� m,mag\ $ p4A \ «� 4A \ $ a4A1,mA&1 \ $54� SINK oT , n , a z ,.0 1.02 a WALL �o «yea a T $252g1 \ »S� | gs2@ ,Am&i - $2m SHELVING i Qn i \ z@, \ �\ ySrScmN� tat A@2a/a T�2e2� 2eI3Eo ,OE&i� $25g 'SINKS On ,a � ;. @ WALL MOUNTED � «07aT $25. \$2512m $25A| t1�24 ,Ae& $o� sK+� �oTY 2a �0 j zo IREACHIN ��3#,.41 5 AM T �3a,.41 . \ �aN,.41 w �3G,.41 100.2>� - $Sp REFRIGERATOR IQTY 1.0 g ,a } 1.0 . - 40 HEATED MOBILE $29sg/ a T »pg� \ $2£s94 - $2rss/ 1Ae% - «34m .c E� T {on. t/ \ ,a \ 1:1 ( \ « SHELVING WITH i #eaa T $35476 $3547 $354#},gm% - «7.74 IFS UE •CITY 4.0: \ 4.0'' 4:1 _ a 1DROP-IN SINK } r@� AMIT $350.33� \ rgg - gg@,AKi� - q7.52 |Qn( ,a \ 1.0 1.0 S FOOD PANWARMER t82.00 1A T| gEa \ »82m1 \ &s2@11g2&| \ $14.g 'QTY 1.01 1.01 ,a • - PAYMENT TOr $ e,73 se\ $ tgz g{#$ez7\ g $ @,73 9.a\ 100 \ $5a7.2 ooxumIgnEnvelope ID: u7s7oaAn'sre1 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification ioattached. |ntabulations below, amounts are stated bothe nearest dollar. APPLICATION NO.: u APPLICATION 08m5/20 DATE: PERIOD TO: 08131x20 PROJECT NO.: 19520- 0033 ITEM DESCRIPTION OF UNIT SCHEDULED WORK COMPLETED TOTAL COMPLETED 1 BALANCE MATERIALS PRESENTLY % RETAINAGE NUM. WORK COST VALUE FROM PREVIOUS 1 THIS AND STORED TO TO FINISH STORED (NOT IN D OR E) I (G + C) (IF VARIABLE QTY PAYMENT TOTALS DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: American Drapery Systems, Inc 676 Mendelssohn Ave N Golden Valley, MN 55427 Contract For: 195200033-122105 - Window Coverings 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 $27,886.00 $773.10 $28,659.10 $28,659.10 Application No.: 1 Period To: 07/31/20 Application Date: 07/07/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-122105 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: Date: State Of: $1,432.96 County Of: Subscribed and sworn to before me this Notary Public: day of My commission expires: $1,432.96 ARCHITECTS CERTIFICATE FOR PAYMENT $27,226.14 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 $0.00 entitled to payment of the AMOUNT CERTIFIED. $27,226.14 $1,432.96 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $773.10 $0.00 TOTALS $773.10 $0.00 NET CHANGES by Change Orders $773.10 AMOUNT CERTIFIED $27,226.14 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D :CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 1 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/07/20 PERIOD TO: 07/31/20 American Drapery Systems, Inc PROJECT NO.: 19520-0033 A B C D E F G H I 1 WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS ' PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD I STORED (NOT IN ' AND STORED TO (G + C) _ FINISH (C - G) VARIABLE RATE) 1 + E) D OR E) DATE ( Material $22,549 46 ; $22,549.46 ? $22,549.46 e 100.00% $1,127.47 Installation $3,833 29 € $3,833.29 $3,833.29 [ 100.00% l $191.66 Shop Drawings $429.50 1 $429.50 f $429.50 100.00%2 $21.48 s Freight $1,073.75 1 i $1,073.75 ' $1,073.75 100.00% 3 € $53.69 1 I Window Coverings (CO #1) $773.10 $773.10 $773.10 { 100.00% ( $38.66 Y PAYMENT TOTALS $28,659.10 E - $28,659.10 $28,65910 100.00% 1 $1,432.96 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 55.103 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 $23,337.00 $279,822.00 $261,430.75 Application No.: 10 Period To: 07/01/20 Application Date: 06/05/20 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: 07/28/20 State Of: N/A County Of: Subscribed and sworn to before me this N/A Notary Public: $12,873.81 $248,556.94 $233,050.18 $15,506.76 $31,265.06 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $11,955.00 $0.00 Total approved this month $11,382.00 $0.00 TOTALS $23,337.00 $0.00 NET CHANGES by Change Orders $23,337.00 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 $15,506.76 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D C�INHI011MV40010NM A 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.: 10 APPLICATION DATE: 06/05/20 PERIOD TO: 07/01/20 PROJECT NO.: 19520-0033 ' i A B C [ D E F G E H I WORK COMPLETED MATERIALS TOTAL ] j ITEM I DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS ; PRESENTLY I COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD I STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) I VARIABLE RATE) + E) D OR E) DATE 1 Labor $87,885.00 $79,096.50 $4,394.25 ' $83,490.75 95.00% $4,394.25 $4,174.55 2 Material $111,200.00 $100,080.00 $5,560.00 _ $105,640.00 E 95.00%- $5,560.001 $5,282.00 3 [ Design $31,200.00 $31,200.001 $31,200.00 100.00%s $1,560.00 14 IFabrication $20,200.00 $18,180.00_ $1,010.00 $19,190.uo 95.00%_ $1,010.00 $959.50 5 [Bonds $6,000.00 $6,000.00 _ $6,000.00 100.00% 3 $300.00 " 1 Fire Protection (CO #1) $11,955.00 $10,759.50 _ $1,195.50 $11,955.00 100.00%1 $597.76 1 Fire Protection (CO #2) $5,952.00 i $5,952.00 j i 1 Fire Protection (CO #3) $3,955.00 I $3,955.00 $3,955.00 { 100.00% 1 I Fire Protection (CO #4) $1,475.00 - _ - - - - $1,475.00 1- PAYMENT TOTALS I $279,822.00 I $245,316.001 $16,114.75 - $261,430.75 93.43% $18,391 25 - $12,873.81 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 $23,337.00 $279,822.00 $279,822.00 N/A N/A $13,422.03 $266,399.97 $248,556.94 $17,843.03 $13,422.03 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $23,337.00 $0.00 Total approved this month $0.00 $0.00 TOTALS $23,337.00 $0.00 NET CHANGES by Change Orders $23,337.00 Application No.: 11 Period To: 07/31/20 Application Date: 07/28/20 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: 07/28/20 State Of: County Of. Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $17,843.03 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D !CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/28/20 PERIOD TO: 07/31/20 Summit Companies 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 t' RETAINAGE (IF NUM 1 VALUE APPLICATION ION (D _ THIS PERIOD STORED(NOTIN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) i D 1 Labor $87,885 00 i, $83,490.75 s $4,394.25 $87,885 00 100.00% $4,394.27 2 Material $111,200.00 1' $105,640.00 $5,560.00 $111,200 00' 100.00% $5,560.00 3 Design $31,200.00 $31,200.00 € j $31,200 00 100.00% $1,560.00 4 =Fabrication $20,200.00 $19,190.00 $1,010.00 $20,200.00 100.00% $1,010.00 15 € Bonds $6,000.00 $6,000.00 1 $6,000.00 100.00% - - $300.00 1 'Fire Protection (CO #1) $11,955.00 $11,955.00 1 $11,955.001 100.00% $597.76' 3 1 Fire Protection (CO #2) $5,952.00 $5,952.00 $5,952.001 100.00% - 1 Fire Protection (CO #3) $3,955 00, $3,955.00 ? $3,955 00 100.00% 1 Fire Protection (CO #4) $1,475.00 g $1,475.00 $1,475.00 100.00% { - PAYMENT TOTALS 1 $279,822 00' $261,430.75 $18,391.251 $279,822 00' 100.00% - $13,422.03 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 12 830 Boone Avenue North John Weicht Park Golden Valley, MN 55427 Period To: 07/20/20 From: WEIDNER MECHANICAL Application Date: 07/15/20 29 WILSON AVENUE NE Project No.: 19520-0033 BOX ST ST CLOUD, M , 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 $99,525.00 $1,305,525.00 $1,271,772.00 $63,588.60 $63,588.60 $1,208,183.40 $1,165,254.80 $42,928.60 $97,341.60 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $104,708.00 $5,183.00 Total approved this month $0.00 $0.00 TOTALS $104,708.00 $5,183.00 NET CHANGES by Change Orders $99,525.00 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: 07/14/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 Architects 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 $42,928.60 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION 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.: APPLICATION DATE: PERIOD TO: PROJECT NO.: 12 07/15/20 07/20/20 19520-0033 A I B C D E F G H I I ; WORK COMPLETED MATERIALS TOTAL ITEM NUM I = DESCRIPTION OF WORK SCHEDULED I FROM PREVIOUS VALUE i 1 ' PRESENTLY 1 STORED (NOT IN COMPLETED AND STORED TO % (G + C) BALANCE TO 1 FINISH (C - G) G RETAINAGE (IF VARIABLE RATE) j APPLICATION (D THIS PERIOD ; + E) D OR E) DATE 1 10.105 Bond $10,333 00 $10,333.00 1 $10,333.00 ? 100.00% $516.65 j 2 10.109 Allowance $7,500 00 lj $7,500 00 3 10.115 Pipe & Fittings $235,689 00 $226,000.00 $9,000.00 $235,000.00 99.71 % $689 00 $11,750.00 14 10.119 Drains & Carriers $47,196 00 = $47,196.001 $47,196.00 100.00% $2,359.80 5 ' 10.123 Pumps & Tanks $5,400.00.$5,400.00 s $5,400.00 J 100.00% $270.00 6 10.127 Water Heaters $82,739 00 ;9 $82,739.00 ` $82,739.00 ; 100.00% $4,136.95 17 10.137 Plumbing Fixtures & $79,004.00 s $79,004.00 $79,004.00 100.00% $3,950.20 Trim 18 10.139 Misc Plumbin g $42,488 00 . $41,700.00 $788.00 ` $42,488.001 ° 100.00/o $2,124.40 9 11.185 Labor - Plumbing $560,753 00 ( $519,600.00 $35,000.00 $554,600.00 98.90% $6,153 00' $27,730.00 10 30.300 Digging/Backfill ( $37,034 00 = $37,034.00 $37,034.001 100.00% $1,851 70 j J 11 30.325 Rentals $13,000 00 € $12,600.00 E $400.00 $13,000.00? 100.00% $650.00 12 130.360 Pipe Covering $84,864.00 $82,000.00' $82,000.00' 96.63% $2,864.00 $4,100.00 ! 1 Plumbing (CO #1) $7,430.00 1 $7,430.00 ° $7,430.001 100.00% $371.50 1 F Plumbing (CO #2) ($2,203.00) ($2,203.00). ] ( ($2,203.00) 100.00% ($110.15) 1 Plumbing (CO #3) ($2,980.00) ($2,980.00) ($2,980.00) 100.00% ($149.00)1 1 = Plumbing (CO #4) $2,506 00 $2,506.00 $2,506.00 ? 100.00% $125.30 1 Plumbing (CO #5) $10,815 00 F $10,815.00 $10,815.00 100.00% _ $540.75 1 Plumbing (CO #6) $1,338 001 $1,338.00, $1,338.001 100.00% $66.90 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 $10,615.001 $10,615.00 100.00% $530.75 =1 Plumbing (CO #10) $25,562 001 $25,562.001 $25,562.00 100.00% $1,278.10: 1 Plumbing (CO #6) $2,041.00 $2,041.00 = $2,041.00 100.00% $102.05 1 Plumbing (CO #11) $26,547.00 $10,000.00 ! - $10,000.00 37.67% _ $16,547.00 $500.00 PAYMENT TOTALS $1,305,525.00� $1,226,584.00 $45,188.00E - $1,271,772.00_ ° 97.42/° $33,753.00 E63,58860 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Sentra-Sota Sheet Metal Inc. PO Box 400 Waite Park, MN 56387 Contract For: 195200033-233005 - HVAC 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 $1,776,000.00 $97,377.33 $1,873,377.33 $1,837,575.33 $91,878.77 $91,878.77 $1,745,696.56 $1,680,674.76 $65,021.80 $127,680.77 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $114,447.33 $17,750.00 Total approved this month $680.00 $0.00 TOTALS $115,127.33 $17,750.00 NET CHANGES by Change Orders $97,377.33 Application No.: 11 Period To: 07/31/20 Application Date: 07/24/20 Project No.: 19520-0033 Contract Date: 07/30/19 Commitment: 195200033-233005 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: Jeff Waletzko Date: 07/24/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $65,021.80 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/24/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Sentra-Sofa Sheet Metal Inc. PROJECT NO.: 19520-0033 A B C D j E F i t G H s I WORK COMPLETED MATERIALS TOTAL I ITEM NUM DESCRIPTION OF WORK SCHEDULED VALUE :APPLICATION FROM PREVIOUS (D PRESENTLY COMPLETED THIS PERIOD STORED (NOT IN AND STORED TO _ % (G + C) I BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) + E) D OR E) DATE 1 Mobilization - Labor $5,000.00 3 $5,000.00 1 - $5,000.001 100.00% l $250.00 i 2 Mobilization -Material $2,500.00 $2,500.00 $2,500.00 ? 100.00% F -, $125.00 3 HVAC Demo - Labor $15,000.00.$15,000.00 $15,000.00 100.00%! - $750.00 4 HVAC Demo - Material $5,000.00 l $5,000.00, $5,000.00 100.00% { - 3 $250.00 5 230593 Test and Balance $22,000.001 - - $22,000.00 3 6 530700 Insulation $32,000.00 $26,000.001 $6,000.00 _ $32,000.00 ® 100.00% ;, - $1,600.00 7 232300 Refrigeration Piping $55,000.00 $49,700.001 $5,300.001 $65,000.001 100.00% -_ $2,750.001 18 250900Controls $230,000.00' $159,734.003 $57,144.00 $216,878.00 94.29% € $13,122.00' $10,843.90 9 233000 Ductwork - Labor $75,000.00 $75,000.00 - $75,000.00 1 100.00% , -1 $3,750.001 10 233000 Ductwork -Material $23,300.001 $23,300.00 - _ - I $23,300.00' 100.00% , - $1,165.00 11 j 233000 Misc Round - Labor 1 $8,000.00 j $8,000.001 $8,000.001 100.00% 1 - _ $400.00 12 233000 Misc Round -Material $4,500.00= $4,500.00 s - t $4,500.00 100.00% - , $225.00 j 13 s 233000 Spiral Pipe - Labor I $84,500.001 $84,500.00 F - - _ $84,500.001 100.00% - $4,225.00 . 14 233000 Spiral Pipe - Material $45,000.00 $45,000.00 - $45,000.00 100.00% - $2,250.00 15 233000 Fabric Duct - Labor $2,500.00 $2,500.001 - ( $2,500.00 100.00% - $125.00 1. 16 233000 Fabric Duct - Material $4,000.00 = $41000.00 3 - $4,000.001 100.00% - $200.00 17 233423 Fans/Hoods - Labor I $10,000.00 j $10,000.00 ` - $10,000.00 100.00% [ _ - $500.00 18 1233423 Fans/Hoods — Material $22,000.001 $22,000.001 -_ t $22,000.00 100.00% - $1,100.00 233616 VAV Boxes - Labor $8,000.00j $8,000.00 I19 01 100.00% $400.00 . 20 1233616 VAV Boxes - Material $24,000.001 $24,000.00 - $24,000.00 100.00% - $1,200.00 21 233713 Grilles/Registers - $17,000.00 3 $17,000.00' -? ( $17,000.00 100.00% - I $850.00 Labor 1 22 1233713 Grilles/Registers - _ $30,000.001 $30,000.001 $30,000.00' 100.00% [ - I $1,500.00 Material ? I 23 1236213 ACCU - Labor $4,000.00 $4,000.00 ? $4,000.00 100.00% _ $200.00 24 236213 ACCU -Material $80,000.00 1 $80,000.00 - - $80,000.00 100.00% " - I $4,000.00 25 = 237400 Rooftop Units - Labor f $44,000.001 $44,000.001 j _ -- } $44,000.00 i 100.00% 1 - , $2,200.001 26 237400 Rooftop Units - $445,500.001 $445,500.00 i - _ $445,500.00' 100.00% - _ $22,275.001 I Material I PAYMENT TOTALS � $1,873,377.331 $1,769,131.331, $68,444.00 , -1 $1,837,575.33 98.09% ' E35,802.001 $91,878.77 Page 1 of 3 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/24/20 PERIOD TO: 07/31/20 Sentra-Sots Sheet Metal Inc. PROJECT NO.: 19520-0033 s A i B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM NUM ( DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF VALUE APPLICATION (D _ THIS PERIOD f STORED (NOT IN 1 AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) 1 + E) D OR E) DATE 27 1238100 Packaged AC Units - _ $6,000.00 $6,000.00 $6,000.00 100.00% ` $300 00 Labor (28 238100 Packaged AC Units - $25,000.00 i $25,000.00 3 ( l $25,000.00 ° 100.00 /° $1,250.00 Material E i - Ij . 29 238419 Desiccant Dehumid $40,000.00 $40,000.00 - - $40,000.00 100.00% - _ $2,000.00 Units - Labor 3 30 238419 Desiccant Dehumid i i Units - Material $300,000 00 F $300,000.00 ; $300 000 00 ° 100.00 /° $15,000.00 31 232100 Hydronic Piping $80,000.001 $80,000.00 132 Mobilization - Labor $1,000.001 $1,000.00 j $1,000.00 100.00% $50.00 133 Mobilization - Material $500.00 1 $500.00 $500.00 i 100.00%]$25.00 I 134 Ductwork - Labor $2,500.001 $2,500.00 $2,500.001 100.00%,$125.00 35 I Ductwork -Material ? $500 00 1 $500.00 $500 00 100.00% $25.00 36 ;,Grilles/Registers -Labor 1 $500 00 $500.001 - $500.00 1 100.00% . $25.00 37 Grilles/Registers -Material $200.001 $200.00 r -1 $200.00 100.00% 1 - $10.00 38 l Fans - Labor '51,000.00 $1,000.00' $1,000.00 100.00% ( $50.00 139 Fans -Material I $1,000.00 $1,00o.00 E$1,000.00 100.00%1 $50.00 140 Permit $20,000.00 $20,000.00 _ $20,000.00 100.00% _ $1,000.00 t 1 HVAC (CO #1) $7,692 93 $7,692.93 t $7 692 93 I 100.00% $384.65 1 HVAC (CO #2) $2,751 00 $2,751.00 ; - $2 751 00 ? o 100.00 /o s - � $137.55 1 HVAC (CO #3) $49,987.00 $49,987.00 $49,987.00 1 100.00% ; $2,499.35 3 1 HVAC (CO #4) ($17,750.00) 1 ($17,750.00) - ] ($17,750.00) _ 100.00% t ($887.50) 1 HVAC (CO #5) $7,784.00 $7,784.00 ? - - $7,784.00 100.00% -' $389.20 t 1 HVAC (CO #6) $4,485.00 1 $4,485.00 $4,485.00 [ 100.00% , $224.25 1 I HVAC (CO #7) $3,750.00 € $3,750.00 $3,750.00 100.00% i $187.50 1 HVAC (CO #8) $12,276.00 $12,276.00 , $12,276.00 100.00% 1 $613.80 1 ;HVAC (CO #9) $9,166.00' $9,166.00 $9,166.00 o 100.00 /o $458.301 1 = HVAC (CO #10) $8,718.00 3 $8,718.00 j $8,718.001 100.00% 3 i $435.90 , .1 ;HVAC (CO #11) $2,673.40 € $2,673.40 1 $2,673.40 f 100.00% 1 E$133.67 1 HVAC (CO #12) $5,164.00 $5,164.00 -' $5,164.001 100.00% _ E $258.20 PAYMENT TOTALS, $1,873,377.33 $1,769,131.33 $68,444.00 -1 $1,837,575.331 98.09%1 $35,802.001 $91,878.77 Page 2 of 3 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/24/20 In tabulations below, amounts are stated to the nearest dollar.. PERIOD TO: 07/31/20 Sentra-Sots Sheet Metal Inc. PROJECT NO.: 19520-0033 A B C D E F G H II WORK COMPLETED MATERIALS ( TOTAL ITEM SCHEDULED DESCRIPTION OF WORK 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 i 1 E HVAC (CO #13) $680.00 e ( ` —I - - -1 $680.00 —I PAYMENT TOTALS' $1,873,377.33 $1,769,131.33 J $68,444.00 - $1,837,575.331 98.09%1 $35,802.00 1 $91,878 77 Page 3 of 3 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 $90,692.06 $1,877,606.06 $1,862,251.73 $93,112.58 $93,112.58 $1,769,139.15 $1,721,462.10 $47,677.05 $108,466.91 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $125,357.98 $44,468.59 Total approved this month $9,802.67 $0.00 TOTALS $135,160.65 $44,468.59 NET CHANGES b Change Orders Y g $90,692.06 Application No.: 11 Period To: 07/31/20 Application Date: 07/17/20 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: 07/17/20 State Of: County Of: Subscribed and sworn to before me this day of Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT 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 $47,677.05 (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: 27E728AB-E761-4D8D-8B46�47BC430C75D .CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/17/20 PERIOD TO: 07/31/20 Design Electric, Inc PROJECT NO.: 19520-0033 A B C D E F 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) I VARIABLE RATE) + E) D OR E) DATE = 1 E BOND/PERMIT $35,908.00 $35,908.00 $35,908.00 100.00%, i $1,795.40 /MOBILIZATION e 2 1 SITE WORKIUNDERGROUND $33,158.00 $33,158.00 `° $33,158.00 100.00% $1,657.90 3 i DEMOLITION/TEMP WIRING $64,200.00 1 $63,800.00 4 $400.00 $64,200.00 3 100.00% $3,210.00' 4M CONDUIT -MATERIAL $122,167.00 = $121,000.001 $1,167.00 � $122,167.00 ` 100.00% j - $6,108.35 3 4L CONDUIT - LABOR $180,320.00 E $177,000.00'1 $3,320.001 $180,320.00 100.00% $9,016.00 F 5M 1 BOXES/WIRE/DEVICES - $110,400.001 $110,400.00 - $110,400.00 100.00%, $5,520.00 MATERIAL 5L BOXESMIRE/DEVICES - $67,200.00 $65,300.00 5 $1,900.00 [ - $67,200.00 100.00% $3,360.00 LABOR € E ; E 6M FIXTURES - MATERIAL $425,654.00 E $425,654.00: - - $425,654.00 I 100.00% - $21,282.70 16L FIXTURES - LABOR $90,400.001 $80,000.00 $8,592.00 $88,592.00 98.00% 1 $1,808 00 ` $4,429.60 7M GEAR - MATERIAL ] $145,168.00 $145,168.00 $145,168.00 100.00% $7,258.40 7L GEAR -LABOR ] $38,400 00' $37,500.00 $900.001 $38,400.00 100.00% j $1,920.00 8M LOW VOLTAGE ROUGH -IN - j $46,722 00 ; $46,722.00 $46,722.00 100.00% i $2,336.10 MATERIAL 8L f LOW VOLTAGE ROUGH -IN - $73,120 00 $71,000.001 $2,120.00 $73,120.00 100.00% $3,656.00 j P LABOR J9M EQUIPMENT CONNECTIONS $68,400 00 $68,400.001 $68,400.00 100.00% I I $3,420.00 - MATERIAL 9L j EQUIPMENT CONNECTIONS E $12,200.00 3 $11,500.00 $700.00 $12,200.00 100.00% 1 $610.00 E LABOR I j 10M FIRE ALARM - MATERIAL ' $84,697.001 $77,798.00'=; $5,205.06 $83,003.06 98.00%1 $1,693.94 $4,150.15 I 10L FIRE ALARM -LABOR $20,000.00 ? $17,000.00' $2,600.00 $19,600.00 [ 98.00%' $400.00 $980.00 11M SOFTBALL FIELD - $153,200.00 $153,200.00' $153,200.00 [ 100.00% € $7,660.00 MATERIAL I 11L SOFTBALL FIELD -LABOR $15,600.00 $15,600.00 - $15,600.00 100.00%' $780.00 12 3 I p - f - ] - 1 Electrical CO #1 ( ) $945 49 $945.49 1 - $945.49 - ° 100.00 /° . $47.27 PAYMENT TOTALS $1,877,606.061 $1,812,065.36 $50,186.37 $1,862,251.73 99.18%1 $15 354.33 = $93 112.58 Page 1 of 2 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 11 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/17/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Design Electric, Inc PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED j MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS j PRESENTLY COMPLETED I % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D ;STORED NOT IN AND STORED TO THIS PERIOD ( G + C I ( ) = FINISH C - G ( ) VARIABLE RATE ) i + E) D OR E) DATE 1 Electrical (CO #2) $1,340.581 $1,340.58 $1,340.581 100.00% 1 $67.03 1 ? Electrical (CO #3) $1,582.00 $1,582.00 I $1,582.00 100.00% $79A0 1 ) Electrical (CO #4) ($24,378.00) i ($24,378.00) E ($24,378.00) 100.00% ` ($1,218.90) 1 Electrical (CO #5) ($12,693 73) 3 ($12,693.73) ($12,693 73) ; 100.00% i ($634.69) 1 ' Electrical (CO #6) $396.52 $396.52 1 $396 52 100.00% - $19.83 1 Electrical (CO #7) $2,162 06 I $2,162.06 $2 162 06 = 100.00% $108.101 1 Electrical (CO #8) $7,694 97 $7,000.00 $694.97 $7,694.97 1 100.00% $384.75 1 Electrical (CO #10) $5,773 48 I° $5,773.48 ( $5,773.46 100.00% $288.67 12 Joist Work - Electrical (CO #9) $24,561.00 l $20,000.00 $4,561.00 $24 ,561.001 100.00% [ $1,228.05 1 )Electrical (CO #7) $1,036.41 � $1,035.41 _ - $1,035.41 = 100.00%= $51.77 1 j Electrical (CO #7) $12,342.68 [ $12,342.68 3 $12,342.68 , 100.00% f $617.13 } 1 Electrical (CO #7) $1,170 60 $1,170.60 i $1 170 60 100.000% f $58.53 1 1 Electrical (CO #7) ($7,396 86) ($7,396.86)' ($7,396 86) 100.00% 1 ($369.84) 1 Electrical (CO #11) $42,232 20 € $35,000.00 $7,232.20 $42 232.20 1 100.00% $2,111.61 1 `. Electrical (CO #12) $12,952.00 1 $10,000.00 $2,952.00 $12,952.00 ' 100.00%, $647.60 ) 1 Electrical (CO #13) $1,677.13 i $1,677.13 _ $1,677.13 100.00% $83.86 i 1 Electrical (CO #14) $9,491.86 _ $9,491.86 1 f Electrical (CO #15) $1,044.26 E $835.41 € $835411 80.00% $208.85 1 $41.77 11 1 Electrical (CO #15) $5,221.531 $4,177.231 $4,177.231 80.00% $1,044.301 $208.86 11 [ Electrical (CO #16) $3,536.881 $2,829.50 i $2,829.501 80.00% _ $707.38 1 $141.48 1 PAYMENT TOTALS ; $1,877,606.06 C $1,812,065.36 1 $50,186.371 - $1,862,251.73 i 99.18% , $15,354.33 € $93,112 58 Page 2 of 2 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 Application No.: 5 Period To: 07/31/20 Application Date: 07/24/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-312205 $572,787.00 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 $135,694.30 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 $708,481.30 payment shown herein is now due. $708,481.30 CONTRACTOR: By: Jodi Russ Date: 07/24/20 State Of: $29,449.15 County Of: $29,449.15 Subscribed and sworn to before me this Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT day of $679,032.15 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 $657,354.14 entitled to payment of the AMOUNT CERTIFIED. $21,678.01 $29,449.15 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $124,483.30 $4,012.00 Total approved this month $16,156.00 $933.00 TOTALS $140,639.30 $4,945.00 NET CHANGES by Change Orders $135,694.30 AMOUNT CERTIFIED $21,678.01 (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 oc»gnEnvelope O 27E728AsE7e-4ovm46-447s go 2D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION : s containing Contractor's signedCertification B M&«d In tabulations below, am2n are stated b the nearest A,I APPLICATION DATE: 07/2/20 mo TO: Q7@/02 Minnesota Ullls&Excavating, LLc PROJECT NO.: ,ezome ; a B } c { D ( E F G H WORKMPLErD MATERIALS TOTAL 1 = ITEM { v s mPTo o wo K SCHEDULED \md9�Evos ; mNTY c ±to ; % 1 LACE RTAAc 7 Nue i ; VALUE .APPLICATION (D THIS PEmo ;STORED (NOT w; AND so T m-q FINISH&- % .v maw RAt)I . . � � +Q , . � , Do m , � . yr . , , ( Earthwork ( , $572a�Qp mse1s &; Ag2e6 \ m72a7a1 1Am%1 2 q%%@� | jMultipurpose �e_�Go . #$4gK #�4gm w \ k$4gm ,AK» -_ - �� \� � Multipurpose � +_r (CO »se�2@ »«e�2m} \ j $2meta0 ,Am»} *2 \ - _ , ; 'Multipurpose bs_@ (CO } $3 157 001 $3157 m - �3,57 a 100a% } _ _ :m) / j Multipurpose Eae_m (CO $,p&o/ m1,09 Eo0 - \ ��pea ,AK% ( 1* )5 j (Multipurpose G2_m (CO t,$ Aea/ 71� Kn)o; - - §1AaDm} ,ma& 1■e , :mo d mo« «a \ �a�oa $a9oa j \ $3Son\ ,Am% Multipurpose �#_m (CO0 1\ $23ea; $2a8A( �25sK ,gm« z ,7): ( jMultipurpose � e_« (CO pR32a »s32a 2 &«aoo\ �A00% \ j . je(CO 4�n/ 4$4D01 4£%001 ,gm% j \ « j , \ \ Multipurpose EaG_@ (CO �ak7.o/ d �a97.oe 2 $aHz00 ,A@% \ $s25( -* )® _ ! , / }Multipurpose � ±_� (CO (2$ p%om; \ (2■� 4a) - (2■ p4A) ,«Are - 71a� ) 1 Multipurpose �+_Rro . (g$@a/ \ {s$ea\ j �s$ea/ ,@a= t (4■eA) � aq�( } /Multipurpose � G_m (CO mm,@a \ m s,�em - $$,5em ,mA&} \ koze( = , . : E r TOTALS S #o■41. \ @ses23} k� ki - #oe#,� ; . , ,g&&, « #9,4 S DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Bituminous Roadways, Inc. 1520 Commerce Drive Mendota Heights, MN 55120 Contract For: 195200033-321205 - Asphalt Paving Project: Elk River Multi -Purpose Facility and Lion John Weicht Park 1. ORIGINAL CONTRACT AMOUNT $324,100.00 2. NET CHANGE BY CHANGE ORDERS ($30,611.00) 3. CONTRACT SUM TO DATE $293,489.00 4. TOTAL COMPLETED AND STORED TO DATE $293,489.00 (Column G) 5. RETAINAGE 5.00% of Completed Work $14,674.45 (Columns D + E) 5.00% of Stored Materials _ (Columns F) Total Retainage $14,674.45 (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE $278,814.55 (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT $220,266.05 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $58,548.50 9. BALANCE TO FINISH, INCLUDING RETAINAGE $14,674.45 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $7,264.00 $26,095.00 Total approved this month $0.00 $11,780.00 TOTALS $7,264.00 $37,875.00 NET CHANGES by Change Orders ($30,611.00) Application No.: 5 Period To: 07/31/20 Application Date: 07/24/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-321205 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: Pam Hague Date: 07/24/20 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 $58,548.50 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 5 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/24/20 PERIOD TO: 07/31/20 Bituminous Roadways, Inc. PROJECT NO.: 19520-0033 A B C 3 D E F G H I WORK COMPLETEDi MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED ' FROM PREVIOUS j PRESENTLY COMPLETED % BALANCE TO I 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 $16,425.001 $14,295.001 $2,130.001 - $16 425 001 100.00% 1 $821.25 2 1 Utility Patching $27,311.001 $27,311.00 - - $27,311.00 100.00% - - ( $1,365.55 13 Lion Park Drive Grading $8,850.00 € $8,850.00 _ P $8,850.00 100.00% _ $442.50 4 Lions Park Light Duty $21,107 00 ` $21,107.00. $21 107 00 s' 100.00% $1,055.35 Bituminous 5 Lions Park Medium Duty $106,732.00, $70,602.001 $36,130.00 $106,732.00 i 100.00% _ $5,336.60 Bituminous i 6 Ice Arena Heavy Duty $97,750.00 $78,700.00 i $19,050.00 3 $97,750.00 100.00% € $4,887.50' Bituminous 17 Ice Arena Aggregate Surfacing $15,735.00 $15,735.00 $15,735.00 100.00% $786.75 8 Utility Adjustments in $8,250.00' $8,250.00 , $8,250.00 F 100.00% $412.50 Pavement s 1 9 Striping & Lot Marking' $1,500.00 _ $400.00 $1,100.00 $1,500.00 1 100.00% $75.00 I =10 Traffic Signage $5,440.00 $5,440.00 $5,440.00 100.00% $272.00 11 =Allowance $15,000 00 , $15,000.00 1 $15 000.00 100.00% $750.00 1 1 Asphalt Paving (CO #1) $5,614 00 ! $5,614.00 , - i $5 614.00 ; 100.00% , $280.70 1' Asphalt Paving (CO #2) $1,650 00 1 $1,650.00 1 - $1,650.00 = 100.00% $82.50 1 j Asphalt Paving (CO #3) ($26,095.00) ($26,095.00) [ -_ - ($26,095.00) 100.00% ($1,304.75) 1 Asphalt Paving#4 (CO( ) ($11,000 00) ($11,000.00) ($11,000.00) 100.00% ($550.00) 1 Asphalt Paving (CO #5) ($780 00) ($780.00) E ($780.00) .. ° 100.00 /o ($39.00 ) PAYMENT TOTALS 1 $293,489.00 . $231,859.00' $61,630.00 j $293,489.00 100.00%1 $74,674.45 ] Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 ($8,606.71) $378,793.29 $378,793.29 Application No.: 7 Period To: 07/31/20 Application Date: 07/01/20 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: 07/21/20 State Of. N/A County Of. Subscribed and sworn to before me this N/A Notary Public: $19,172.87 $359,620.42 $353,411.35 $6,209.07 $19,172.87 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $7,248.90 $17,940.44 Total approved this month $6,032.25 $3,947.42 TOTALS $13,281.15 $21,887.86 NET CHANGES by Change Orders ($8,606.71) 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 $6,209.07 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 7 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 07/01/20 PERIOD TO: 07/31/20 Ebert Construction PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED iMATERIALS TOTAL j ITEM NUM DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS j APPLICATION (D i THIS PERIOD PRESENTLY COMPLETED STORED (NOT IN ( AND STORED TO % (G + C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) + E) D OR E) DATE i 1 General Conditions $14,700.00 $14,700.001 $14,700.00 i 100.00%i $734 70 E 12 MPB - Walks - Materials $30,617.00 _ $30,617.00 $30,617.00 100.00% $1,522.62 3 i MPB - Walks - Labor $44,082.00 $44,081.99 $0.01 $44,082.00 E 100.00% ° $2,222.62 4 MPB - Curb - Materials $18,273.00 $18,273.00 - $18,273.00 100.00% 3 $913.65 5 MPB - Curb - Labor $22,333 00 G $22,332.67 i $0.3 3 - $22,333.00 100.00% $1,114.97 6 Lion -Walks -Materials $83,053.00 $83,053.00 1 - $83,053.00 100.00% $4,152.65 7 Lion -Walks -Labor $123,318.00 $123,318.00 - - $123,318.00 ; 100.00% £ - $6,165.90 8 )Lion -Curb -Materials $18,461.00 $18,461.00 - $18,461.00' 100.00% - $922.65 9 Lion - Curb - Labor $22,563.00 $22,563.00' I $22,563.00 100.00% $1,128.02 110 Allowance $10,000.00 $5,659.00 $4,341.00 1 E $10,000.00 100.00% I $500.09 I 1 Site Concrete (CO #1) $3,311.40 $3,311.40 $3,311.40 100.00% 1 $166.00 1 Site Concrete (CO #2) ($1,570.47) ($1,570.47) ($1,570.47) 1 100.00% € ($79.00) 1 Site Concrete (CO #3) ($4,286.00) € ($4,286.00) ($4,286.00) [ 100.00%' ($214.00) f 1 ` Site Concrete (CO #4) ($1,561.90) 1 ($1,561.90) _ ($1,561.90) _ 100.00% _ ($78.00) 1 € Site Concrete (CO #5) j ($10,522.07) ($10,522.07) ($10,522.07) j 100.00% [ 1 Site Concrete (CO #6) $3,937.50 $3,937.50 $3,937.50 1 ° 1 100.00 /o i 1 ; Site Concrete (CO #7) ($3,947.42)(' ($3) ($3,947.42) 100.00%,947.42 1 Site Concrete (CO #8) $6,032.25 [ $6,032.25 $6,032.25 100.00%? PAYMENT TOTALS $378,793.29 : $372,367.12 $6,426.17 $378,793.29 100.00%, - $19,172.87 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Greenscape Companies, INC 11684 219th ave Elk River Elk River, MN 55330 Contract For: 195200033-329005 - Multipurpose Landscaping 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 $39,800.00 ($7,800.00) $32,000.00 $32,000.00 Application No.: 1 Period To: 08/31/20 Application Date: 08/04/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-329005 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: Luke Melquist Date: 08/04/20 State Of: $1,600.00 County Of: $1,600.00 Subscribed and sworn to before me this Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT day of $30,400.00 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 $0.00 entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $30,400.00 $30,400.00 (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 $1,600.00 certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $0.00 $7,800.00 TOTALS $0.00 $7,800.00 NET CHANGES by Change Orders ($7,800.00) 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: 27E728AS-E761-4D8D-8B46-447BC430C75D 'CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 1 containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. APPLICATION DATE: 08/04l20 PERIOD TO: 08/31/20 Greenscape Companies, INC PROJECT NO.: 19520-0033 A B C D ; E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK NUM SCHEDULED j FROM PREVIOUS VALUE PRESENTLY COMPLETED °AND % BALANCE TO RETAINAGE (IF ; APPLICATION (D - THIS PERIOD STORED (NOT IN STORED TO (G + C) FINISH (C - G) VARIABLE RATE) D OR E) DATE I Seed/Sod I $13,000 00 - f $13,000.00 l - $13,000.00 100.00% : $650.00 Temp Irrigation $5,000.00 = $5,000.00 ] $5,000.00 i 100.00% - $250.00 Allowance $15,000.00 $15,000.00 E $15,000.00 100.00% - $750.00 Plantings $6,800.00 $6,800.00 $6,800.009 100.00% $340.00 i 1 = Multipurpose Landscaping ($7,800 00) ($7,800.00) ($7,800 00)1 100.00%- E I ($390.00)(CO #1) f PAYMENT TOTALS $32,000.00 l - $32,000.001 $32,000 00 _ 100.00% I -? $1,600 00 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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: 08/31/20 From: Greenscape Companies, INC Application Date: 08/04/20 11684 219th ave Project No.: 19520-0033 Elk River Elk River, MN 55330 Contract Date: 07/23/19 Contract For: 195200033-329010 -Lions Landscaping Commitment: 195200033-329010 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) $96,500.00 ($7,020.00) $89,480.00 $89,480.00 $4,474.00 $4,474.00 $85,006.00 $0.00 $85,006.00 $4,474.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $180.00 $7,200.00 TOTALS $180.00 $7,200.00 NET CHANGES by Change Orders ($7,020.00) 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: Luke Melquist Date: 08/04/20 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 $85,006.00 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on the Application for Payment and on the Continuation sheet that are changes to conform to the amount certified.) ARCHITECT: By: Date: The Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. Page 1 of 1 mm$gnEnvelope ID: 2E72a-761-40D-246-447sgo3D ONT|NUAT|ON SHEET APPLICATION AND CERTIFICATION FORPAYMENa APPLICATION NO: , containing Contractors signedCertification is attached. APPLICATION DATE: ozeo4& In mk�losbelow, amounts are stated b the nearest dl§E mo TO: oze@/n2 G me2p Companies, INC PROJECT NO : ,a2ome . A B c D - E F , G H j WORK CO9KETED MArmALs TOTAL C �ITEM �smPToowoK SCHEDULED �M�Evos� �PLc2 VALUE 0(DtS�moDORM+ '�m��Y IN'AND COMPLETED STORED P i p,q BALANCE TO mNeHr-a �TA�GE7( VARIABLE ter}Nu E) .�so�D@o DATE . ,. . j Planting« trees and shrubs ` »aAoo/ - »%oma! / $23poa` _ ,ma&\ » -, $. ea� \ Irrigation #EOA@ #7,0Ea \ #&ogm, ,ma& \ A350.00 / lak g6,500A1 . g6,500.00 \ ge,50 oa ,maa \ $1,32 5.00 14 5 16 \ \ \ \ 7 g 10- � 12- 3 : \ \ \ K j4 j Lions Landscaping (CO®) ` mead - $1180a1 / $Ka 10oai1 \ A@. 1 Lions @k� ping (CO2 � (, oi\ - �2$ aoDm� - (2■ a�om� ,gK>| \ §gDA( �( 2 .Multipurpose we aAn | (■ pnA) - (a■ pROmi j (s■ poom ,} ,may; � \ (2$ go>o : (CO ■» : PAYMENT TOTALS #9,480.00 / #9,480.0011 \ #9,480.001 100.00&} \ E aaoo Page Iy1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D 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 $23,407.79 $150,325.79 $150,325.79 Application No.: 5 Period To: 07/31/20 Application Date: 07/20/20 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: 07/21/20 State Of: $7,516.30 County Of: $7,516.30 $142,809.49 $140,506.31 $2,303.18 $7,516.30 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $55,055.23 $34,071.84 Total approved this month $31,578.40 $29,154.00 TOTALS $86,633.63 $63,225.84 NET CHANGES by Change Orders $237407,79 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 Architects 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 $2,303.18 (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: 27E728AS-E761-4D8D-8B46-447SC430C75D ;CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 5 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/20/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 Peterson Companies, Inc PROJECT NO.: 19520-0033 A B C D E F G H I i' WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS j PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF I 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 j) $2,875.00 100.00% - $143.73 `2 Concrete Maintenance Strip $23,272.50 $23,272.501 $23,272.50 100.00% - $1,163.63 3 Chain Link Fences and Gates $47,698.50 $47,698.50 ? $47,698.50 _ 100.00% $2,384.93 -Labor 4 Chain Link Fences and Gates $53,072.00 $53,072.00 $53,072.00 100.00% -$2,653.60 - Materials ) 1 = Chain Link Fence (CO #4) $17,600.001 $17 600 00 i - $17,600.001 100.00% - $880.00 2 'Athletic Equipment (CO #5) $3,315.91 $3,315.91 - $3,315.91 ' 100.00% $165.80 2 Athletic Equipment (CO #6) I II ($3,315.91) 1 ($3,315.91) - - ($3,315.91) ° 100.00 /o - ($165.80)? 1 = Chain Link Fence (CO #7) $3,383.391 $3,383.39 - $3,383.39 100.00% - $169.17 1 i Chain Link Fence (CO #7) $1,601 93 3 $1,601.931 - I - $1.601.93' 100.00% [ -? $80.10 1 Chain Link Fence (CO #8) $29,154.00 $29,154.001 - $29,154.00 100.00% $1,457.70 2 Athletic Equipment (CO #9) ($29,154.00)' ($29,154.00) I - € ($29,154.00) 100.00% ($1,457 70) 1 I Chain Link Fence (CO #10) ($1,601 93) : ($1,601.93)1 - ($1,601.93) 100.00% ($80.10) 1 Chain Link Fence (CO #11) $2,424.401 $2,424.40' - $2,424.40 100.00% j $121.22 2 € Athletic Equipment (CO #1) $29,154.00 € $29,154.00 - $29,154.00 1 100.00% - $1,457.70 1 Chain Link Fence (CO #2) ($29,154.00) E ($29,154.00) - ($29,154.00) j 100.00% 3 ($1,457.70) PAYMENT TOTALS $150,325.79 $147,901.39 $2,424.40 $150,325.79 100.00% _ $7,516.301 Page 1 of 1 DocuSign Envelope ID: 27E728AB-E761-4D8D-8B46-447BC430C75D APPLICATION FOR PAYMENT To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 5 830 Boone Avenue North John Weicht Park Golden Valley, MN 55427 Period To: 07/31/20 From: WELLS CONCRETE - MN Application Date: 07/01/20 PO BOX 656 Project No.: 19520-0033 ALBANY, MN 56307 Contract Date: 07/23/19 Contract For: 195200033-034205 - 0313.2 Precast Wall Commitment: 195200033-034205 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 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) $925,000.00 $5,000.00 $930,000.00 $930,000.00 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: JOAN MERGEN Date: 07/24/20 State Of: N/A County Of. Subscribed and sworn to before me this day of N/A Notary Public: $46,500.01 My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT $883,499.99 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 $876,410.14 entitled to payment of the AMOUNT CERTIFIED. $7,089.85 $46,500.01 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $85,000.00 $80,000.00 Total approved this month $0.00 $0.00 TOTALS $85,000.00 $80,000.00 NET CHANGES by Change Orders $5,000.00 AMOUNT CERTIFIED $7,089.85 (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: 27E728AB-E761-4D8D-8B46-447BC430C75D 'CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 5 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/01/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 07/31/20 WELLS CONCRETE - MN PROJECT NO.: 19520-0033 A ( B C D E F G H I WORK COMPLETED MATERIALS TOTAL I ITEM DESCRIPTION OF WORK SCHEDULED 1 FROM PREVIOUS is PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICAETIION (D THIS PERIOD NOT IN ;AND STORED TO + C (G ) FINISH C - G ( ) VARIABLE RATE ) D OR E) DATE 1 Engineering & Drafting $36,999.32 $36,999.32 j, $36,999 32 3 100.00% $1,849.98 2 Production/Materials $610,538.78 $610,538.78, $610,538.78 100.00%' $30,526.94 3 Erection $277,461.90 ; $269,998.90 $7,463.00 $277,461.90' 100.00% _ $13,873.09 1 0313.2 Precast Wall Panels $85,000.00 $85,000.00 $85,000.00 3 100.00% $4,250.00 (CO #1) j 1 3 03B.2 Precast Wall Panels ($60,000.00); ($60,000.00) 1 ($60,000.00) 100.00% j ($3,000.00) i (CO #2) i 1 03B.2 Precast Wall Panels ( ($20,000.00) l ($20,000.00) € ($20,000.00) i 100.00% ($1,000.00) (CO #3) l PAYMENT TOTALS - $930,000.00 1 $922,537.00 ; $7,463.00 1 $930,000 00 1 100.00% [ - $46,500.01 Page 1 of 1 R Q a Z W d ©► Z 0 ra' V CL O O N co 0 h N M C) D a cis m O N o N ch U a z Z C r w SO M M fiats CX EY_ wpZLO m Mvsz O:b ya ui 0Cgj, InX (D CO) C m Gi E w .8t O mU 'Dnism. w ca Q MW a) E o o CL m L8wm o� E m m 3 •E a 8w w H 8 C O W r m m a� 0 § .6 .c U oa E $ ,� m co C= Ec: a� L �N W C O9 m .21 CL U) `m Oa TO = E Om m O t N 0 E m LO m m E vis c ca _U r 3 E m O f0 Q U C c O z z ° Ix N Ni v kd m N ' .perp NI 0 N owl C'ri i m .Q�• 6A Q $ ari � m co co .Q 'ao 0 = S of to o E < crnCLE U a A co Ez2 C C m O � 7 �C O L - C o caE 3 w :- o 0 V y oCo a W U m � C N ya�L° O ao I- c� E ) 8 m H O W m� W O 2-:-9 m om' C� mU�ma. 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