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4.3. SR 09-21-2020 Request for Action To Item Number Mayor and City Council 4.3 Agenda Section Meeting Date Prepared by Consent September 21, 2020 Ryan Sandhoefner, Engineering Technician II Item Description Reviewed by Pay Estimates Justin Femrite P.E., Public Works Director Reviewed by Action Requested Approve, by motion, the pay estimate detailed below. Background/Discussion The following pay estimates have been reviewed and found to be accurate and in accordance with approved contracts. Financial Impact P ROJECT Pay Est. # Contractor Amount Main Street Forcemain Relocation 2 - Final GM Contracting, Inc. $8,165.71 Multi-Purpose Facility & Lions Park 14 - Partial RJM Construction LLC $489,209.19 Elk River Municipal Utilities is to reimburse the city for all project costs associated with the Main Street Forcemain Relocation. Mission/Policy/Goal Opportunity to live, work, and play. Attachments  Pay Estimate – GM Contracting, Inc.  Pay Estimate – RJM Construction LLC The Elk River Vision A welcoming community with revolutionary and spirited resourcefulness, exceptional service, and community engagement that encourages and inspires prosperity. Updated: August 2020 CONTRACTOR'S PAY REQUEST DISTRIBUTION: MAIN STREET FORCEMAIN RELOCATION CONTRACTOR (1) OWNER (1) ENGINEER (1) CITY OF ELK RIVER, MN BONDING CO. (1) BMI PROJECT NO R13.120817 TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $201,796.06 TOTAL, COMPLETED WORK TO DATE $163,314.29 TOTAL, STORED MATERIALS TO DATE $0.00 DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 TOTAL, COMPLETED WORK & STORED MATERIALS $163,314.29 RETAINED PERCENTAGE ( 0%) $0.00 TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 NET AMOUNT DUE TO CONTRACTOR TO DATE $163,314.29 TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $155,148.58 PAY CONTRACTOR AS ESTIMATE NO. $8,165.71 Certificate for Final Payment I hereby certify that, to the best of my knowledge and belief, all items quantities and prices of work and material shown on this Estimate are correct and that all work has been performed in full accordance with the terms and conditions of the Contract for this project between the Owner and the undersigned Contractor, and as amended by any authorized changes, and that the foregoing is a true and correct statement of the amount for the Final Estimate, that the provisions of M. S. 290.92 have been complied with and that all claims against me by reason of the Contract have been paid or satisfactorily secured. Contractor: GM Contracting, Inc. 19810 515th Avenue, P.O BOX 736 Lake Crystal, MN 56055 By :::��2�Z= Name Title Date 9/10/2020 CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: ENGINEER: BOLTON & MENK, INC., 7533 Sunwood Drive NW, Suite 206, Ramsey, MN 55303 By jopo�-f jt% ��L , PROJECT MANAGER Date 9/10/2020 APPROVED FOR PAYMENT: OWNER: CITY ELK R, MIN TA By pu�l,'(- W..:, 0,a -- � -11 Nate Title Date And Name Title Date q06- y ., 16 (0 - K45-30 CITY OF ELK RIVER, MINNESOTA MAIN STREET FORCEMAIN RELOCATION BMI PROJECT NO. R13.120817 YnUPI FTt:n TWQnl It., ITEM NO. ITEM UNIT PRICE AS BID PREVIOUS ESTIMATE COMPLETED TO DATE I ESTIMATED QUANTITY ESTIMATED AMOUNT ESTIMATED QUANTITY ESTIMATED AMOUNT ESTIMATED QUANTITY ESTIMATED AMOUNT 1 MOBILIZATION $31.500.00 1 LUMP SUM $31 500.00 0 LUMP SUM $0.00 1 LUMP SUM $31,500.00 2 TRAFFIC CONTROL $5,250.00 1 LUMP SUM $5,250.00 0 LUMP SUM $0.00 1 LUMP SUM $5,250.00 3 REMOVE FENCE $3.00 75 L F $225.00 0 L F $0.00 75 L F $225.00 4 REMOVE CONCRETE PAVEMENT $6.77 140 S Y $947.80 6 S Y $0.00 102.88 S Y $606.511 5 REMOVE CONCRETE CURB & GUTTER $3.50 175 L F $612.50 0 L F SO -GO 0 L F $0.00 6 REMOVE 17' SANITARY FORCEMAIN $2.00 52 L F $104.00 0 L F 40.00 12 L F $24.03 7 CONSTRUCT 4" STANDPIPE & CAP $300.00 2 EACH $600.00 0 EACH $0.00 2 EACH $600.00 8 SALVAGE & REINSTALL SIGN $400,00 1 EACH $400.00 0 EACH 30.00 0 EACH $0.00 9 EXPLORATORY EXCAVATION $325.00 10 HR $3.250.0C 0 HR 0.001 7.50 HR $2,437.50 10 AGGREGATE SURFACING CLASS 2 $44.67 13 C Y $580.71 0 C Y $0,06 12.35 C Y $551.67 11 BITUMINOUS PATCH $82.60 195 S Y $16 087.50 0 S Y $0,00 0 S Y $0.00 12 4- CONCRETE WALK $10.05 880 SF $8,844.00 0 SF $0.00 418 SF $4,200.90 13 6" PEDESTRIAN RAMP $12.50 130 SF $1 625.00 0 SF $0.00 50 SF $625.00 14 8" CONCRETE DRIVEWAY $14.06 555 SF $7,803.30 0 SF $0.00 458 SF $6 439.48 15 CONCRETE CURB & GUTTER DES. B518 $50.00 175 L F $8.750.00 0 L F $0.00 0 L F $0.00 16 TRUNCATED DOMES $50.00 22 SF $1.100.00 0 SF $0.00 0 SF $0.00 17 ADJUST FRAME & CASTING $431.05 1 EACH $431.05 0 EACH $0.00 0 EACH $0.00 18 CONNECT TO EXISTING SANITARY FORCEMAIN $8.544.65 2 EACH $17,089.30 0 EACH $0.001 2 EACH $17,089.30 19 SANITARY FORCEMAIN 12" ID $115.15 766 L F $88,204.90 0 L F 0.001 756 L F $87 053.40 20 FORCEMAIN BYPASS PUMPING $4.700.00 1 LUMP SUM $4.700.00 0 LUMP SUM $0.00 1 LUMP SUM $4.700.00 21 SILT FENCE TYPE MACHINE SLICED $5.26 100 L F $526.00 0 L F $0.00 120 L F $631.20 22 STORM DRAIN INLET PROTECTION $347.32 1 EACH $347.32 0 EACH $0.00 0 EACH $0.0 23 SEEDING $7,500.00 0.07 ACRE $525.00 0 ACRE $0.00 0.07 ACRE $525.00 24 SEED MIX 25-151 $6A4 13 LB $83.72 0 LB $0.00 13 LB $83.72 25 HYDRAULIC MATRIX - TYPE BONDED FIBER $2,00 245 LB $490.00 0 lB $0.00 245 LB $490.00 26 FERTILIZER TYPE 3 $3.22 25 LB $80.501 0 1 LB $0.00 25 LB $80.50 27 COMMON TOPSOIL BORROW LV $27.78 57 C Y $1.583.46 0 C Y $0.00 $0.00 4 C Y $111.12 28 4" SOLID LINE -EPDXY $5.00 11 L F $55.00 0 L F 0 L F $0.0 TOTAL: $201,796.061 1 $0.001 $163,314.29 TP CONSTRUCTION To Owner City of Elk River Attn: Justine Femrite 13065 Orono Parkway Elk River, MN 55330 CONTRACTOR'S APPLICATION FOR PAYMENT Please Remit Payment to: RJM Construction, LLC 830 Boone Ave North Golden Valley, MN 55427 APPLICATION AND CERTIFICATE FOR PAYMENT Project:19520-0033 Elk River Multi -Purpose Facility and Lion John EItIs Street NW Elk River, MN 55330 Architect: Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet is attached. 1.Original Contract Sum .......................... 2. Net Change By Change Order .................... . 3. Contract Sum To Date ......................... . 4. Total Completed and Stored To Date ...: . 5. Retainage: a. 4.70% of Completed Work $1,238,190.72 b. 0.00% of Stored Material $0.00 Total Retainage ......... ......... 6. Total Earned Less Retainage ......... .......... 7. Less Previous Certificates For Payments ........... . 8. Current Payment Due ............... ........... 9. Balance To Finish, Plus Retainage ..... .......... Invoice* 9520003314 Distribution to: Application No.: 14 Owner Archdeot Application Date., 8131/2020 EN Contractor Period From: 81112020 To: 8131 /2020 The undersigned Contractor certifies that to the best of the Contractors knowledge, information, and belief, the work covered by this Application for Payment has been completed in accordance with the Contract Documents. That all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. $25,772,257.00 CONTR, $729,350.40 $26,501,607.40 By'--� $26,325,714.84 State of: RJM Construction LLC Notary Public: My Commission xpi Date: 0, - 9 - 2A County of: J , 10 ,, day of 4 ,_,Ism Z�+-v $1,238,190.72 In accordance with the Contract Documents, based on on -site observations a I comprising the above application, the Architect certifies to the Owner that to $25,087,524.12 Architect's knowledge, information, and belief, the Work has progressed as l0d'rcated', $24,598,314.93 the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED, $489,209.191 ARCHITECTS CERTIFICATE FOR PAYMENT $1,414,083.28 AMOUNT CERTIFIED $ 489,209.19 CHANGE ORDER SUMMARY Addit'c �s Deductions Total prrous" onffi"caner $956,343.73 $226,993.33 Total Approved this Month $0.00 $0.00 TOTALS $956,343.73 $226,993.33 Net Changes By Change Order $729,350.40 ""AS GARDNER PUblic-Mfnnesata Jan 31. 202q 2 (Aftach explanation it amount certified ditha from the amount applied. Inifiai all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) ARCHITECT: By: I u MAZ4,5- Date: 9/10/20 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment, and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET Page 2of3 Application and Certification for Payment, containing Application No.: 14 Contractors signed certification is attached. Application Dab: 08131120 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. To: 08/31120 Architect's Project No.: Invoice 9 : 95200033% Contract: 19520.0033 Elk River Mufti -Purpose Facility and Lion John Weicht Park I A B C D E F G 1 H ( I Item Description of Work Scheduled Work Completed Materials Total % Balance Retainage No. Value From Previous This Period Presently Completed (G / C) To Finish Application In Place Stored and Stored (C-G) (D+E) To Date Not in D or E] D+E+FI 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 81,315.00 48,710.00 32,317.00 0.00 81,027.00 99.65% 288.00 4,051.35 1B Survey 25,568.00 23,622.00 1,946.00 0.00 25,568.00 100.00% 0.00 1,278.40 2A Building Demolition 166,199.51 166,199.51 0.00 0.00 166,199.51 100.00% 0.00 8,309.96 2B Selective Demolition 236,477.21 231,415.21 0.00 0.00 231,415.21 97.86% 5,062.00 11,570.76 3C Concrete Floor Finishes 135,699.62 118,033.62• 17,666.00 0.00 135,699.62 100.00% 0.00 6,784.98 4A Masonry Systems 2,982,936.83 2,954,891.16 28,045.67 0.00 2,982,936.83 100.00% 0.00 149,146.84 5A Structural Material 1,380,909.01 1,361,847.77 0.00 0.00 1,361,847.77 98.62% 19,061.24 68,092.39 5B Structural Labor 457,489.00 456.379.00 844.00 0.00 457,223.00 99.94% 266.00 22,861.15 6A Carpentry 1,639,335.09 1,465,494.93 167,725.51 0.00 1,633,220.44 99.63% 6,114.65 81,661.02 7A Waterproofing &WB 40,342.00 40,342.00 0.00 0.00 40,342.00 100.000/6 0.00 2,017.11 7B Roofing Systems 1,067,619.73 1,056,374.73 8,305.00 0.00 1,064,679.73 99.72% 2,940.00 53,233.99 7C Metal Wall Panel 186,172.61 186,172.61 0.00 0.00 186,172.61 100.00% 0.00 9,308.63 8A Aluminum Entrances/Storefronts 642,926.46 642,276.46 650.00 0.001 642,926.46 100.00% 0.00 32,146.32 813 Overhead Coiling and Sectional Doors 53,610.00 53,610.00 0.00 0.001 53,610.00 100.00% 0.00 2,680.50 9A Gypsum Board 349.769.37 347,221.46 2,547.91 0.00 349,769.37 100.00% 0.00 17,488.47 913 Tiling 175,149.90 173,262.40 1,887.50 0.00 175,149.90 100.00% 0.00 8,757.50 9C Acoustical Ceilings 147,905.95 142,373.45 5,532.50 0.00 147,905.95 100.00% 0.00 7,395.30 9D Flooring 132,262.50 120,910.90 11,343.60 0.00 132,262.50 100.00% 0.00 6,613.13 9E Painting 438,719.00 407,719.00 31,000.00 0.00 438,719.00 100.00% 0.00 21,935.95 10A Signage 12,458.18 10,807.14 0.00 0.00 10,807.14 86.75% 1,651.04 540.36 11A Athletic Equipment 175,176.84 175,176.84 0.00 0.00 175,176.84 100.00% 0.00 8,758,86 11B Concessions 101,739.83 101,739.83 0.00 0.00 101,739.83 100.00% 0.00 5,087.00 12A Roller Shades 28,659.10 28,659.10 0.00 0.00 28,659.10 100.00% 0.001 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 125,797.00 125,797.00 0.00 0.00 125,797.00 100.00% 0.00 6,289.85 14A Elevators 71.700.00 69,875.00 1,825.00 0.00 71,700.00 100.00% 0.00 3,585.00 21A Fire Protection 282,544.00 279,822.00 2,322.00 0.00 282,144.00 99.86% 400.00 14,107.22 22A Plumbing Systems 1.323,097.00 1,271.772.00 44,329.00 0.00 1,316,101.00 99.47% 6,996.00 65,805.05 23A HVAC 1,875,065.33 1,837.575.33 37,490.001 0.00 1,875,065.33 100.00% 0.00 93,753.27 26A Electrical Systems 1,874,010.43 1,837,690.73 24,191.501 0.00 1,861,882.23 99.35% 12,128.20 93,094.11 31A Multipurpose Earthwork 711,087.30 704,911.30 0.00 0.00 704,911.301 99.13% 1 6,176.001 35,245-57 CONTINUATION SHEET Page 3 of 3 Application and Certification for Payment, containing Application No.: 14 Contractors signed certification is attached. Application Date: 08131120 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. To: 08131 J20 Architect's Project No.: Invoice I# : 9=003314 Contact: 19520-0033 Elk River MultimPurpose Facility and Lion John Wefcht Park A B C D E F G H I Item Description of Work Scheduled Work Completed Materials Total % Balance Retainage No. Value From Previous This Period Presently Completed (G ► C) To Finish Application In Place Stored and Stored (C-G) (D+E) To Date 32A 32B 32C 32D 32E 33A 0100 3B.1 3B.2 3B.3 01-00 90-50 9D-00 90-70 90-80 99-99 Asphalt Paving Concrete/Sidewalk/Curb/Gutter Multipurpose Landscaping Lions Landscaping Chain Link Fence Utilities Internal Fund Transfer - Covid 19 & GCs Precast Concrete Precast Concrete Precast Raker/Plank/Stadia General Conditions/Requirements General Liability Insurance Construction Contingency Value Engineering Builders Risk Insurance Contractors Fee Grand Totals in0or 510,815.67 510,815.67 0.00 0.00 293,489.00 293,489.00 0.00 0.00 383,446.94 381,555.19 1,891.75 0.00 27,000.00 27,000.00 0.00 0.00 94,480.00 94,480.00 0.00 0.00 150,325.79 150,325.79 0.00 0.00 635,496.55 635,496.55 0.00 0.00 0.00 0.00 0.00 0.00 1,182,922.00 1,182,922.00 0.00 0.00 930,000.00 930,000.00 0.00 0.00 1,048,025.00 1,048,025.00 0.00 0.00 1,255,785.33 1,158,417.48 69,848.72 0.00 268,451.52 268,451.52 0.00 0.00 82.397.26 0.00 0.00 0.00 0.00 0.00 0.00 0.00 65,184.58 65,184.58 0.00 0.00 489,303.96 464,838.76 19,572.16 0.00 261501,607.40 610,815.67 100.00% 0.00 25,540.79 293,489.00 100.00% 0.00 14,674.45 383,446.94 100.00% 0.00 19,172.35 27,000.00 100.00% 0.00 1,350.00 94,480.00 100.00% 0.00 4,724.00 150,325.79 100.00% 0.00 7,516.30 635,496.56 100.00% 0.00 31,774.83 0.00 0.00% 0.001 0.00 1,182,922.00 100.00% 0.00 59,146.10 930,000.00 100.00% 0.00 46,500.00 1,046,025.00 100.00% 0.00 52,401.25 1,228,266.20 97.81% 1 27,519.13 0.00 268,451.52 100.00% 0.00 0.00 0.00 0.00% 82.397.261 0.00 0.00 0.00% 0.00 0.00 65,104.58 100.00% 0.00 0.00 484,410.92 99.00% 4,893.04 24,220.53 25,814A34.02 511,280.82 0.00 126,325,714.84 1 99.34% 175,892.56 1,238,190.72 2&£££ƒ M m o o I G 9 a�®= n 9 P§§#, E q 2 � =■ m / � n o m n m g co c c r \ q 3 / c= c n o c] k \ 2 k \ � X ) [ / \ d \ § k \ § ® \ % n(D«« 2 o a 7 § - ƒ z s e \ z m z 7 k; §««« « R CL E a § R R k/ 3 } } } \ % 7 J \ § 5 £ 2 m £ E Q \} o 2 • ? n % s E to § § 0 2 / 3 «cli -u E M / 0. 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N 00 v a _co y _ -z a NO A V A N _ _ _ i0 O a N A W a W {p 00 w CD 60i W V N �D OD N r, W O a W C4 V A pWp Cl O CO O Co O A t0 2 A C O/ Q� N a N p C v W O/ N ? V V V N G N N Of N Id A N N W pOi v 0) A. N V cn 4�1N O a Of W A N N N N N W W 00 `O cn o o o o o o °�° o - o °D o 3 o o °�° s 0 0D o o 0 T N 00 O OD N p O O 0 X C w ,Ty N OD O OD N m A cc 10 c0 ep tOo N CO N C ODD O zt O O N 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 (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 $80,651.00 $376.00 $81,027.00 $81,027.00 $4,051.35 $4,051.35 $76,975.65 $46,274.50 $30,701.15 $4,051.35 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months 1 $376.00 $0.00 Total approved this month $0.00 $0.00 TOTALS 1 $376.00 $0.00 NET CHANGES by Change Orders $376.00 Application No.: 2 Period To: 08/31/20 Application Date: 08/20/20 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: 08/20/20 State Of: County Of. Subscribed and sworn to before me this Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT day of In accordance with the Contract Documents, based on the on -site observations and the data compromising this application, the Architect certifies to the owner that to the best of the Architects knowledge, information and belief the Work under the Architect's Contract has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $30,701.15 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/20/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Midwest Specialty Maintenance, Inc. PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM DESCRIPTION OF WORK VALUE STORED (NOT IN AND STORED TO (G = C) FINISH (C - G) VARIABLE RATE) APPLICATION (D THIS PERIOD D OR E) DATE 1. ) 001 Post Construction Final $70,525.00 $42,315.00 $28,210.00 $70,525.0 1100.00% - $3,526.2, Cleaning - Multipurpose Bldg, General Interior 002 Post Construction Final $8,526.00 $6,395.00 Cleaning - Multipurpose Bldg, Interior & Exterior Windows 003 Post Construction Final $1,600.00 Cleaning - Lions Park 1 Final Cleaning (CO #1) $376.00 PAYMENT TOTALS I $81,027.00 $48,710.00 $2,131.00 $1,600.00 $376.00 $32,317.00 - $8,526.00 100.00% 1 $1,600.00 100.00% $376.00 100.00% $81,027.00 100.00% $426.30 $80.00 $18.80 - $4,051.35 Page 1 of 1 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 Period To: 09/30/20 Golden Valley, MN 55427 From: Hakanson Anderson Associates Application Date: 09/01/20 3601 THURSTON AVE Project No.: 19520-0033 STE 101 Contract Date: 07/23/19 ANOKA, MN 55303 Commitment: 195200033-022105 Contract For: 195200033-022105 - Survey 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 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 ($15,158.00) 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 $26,122.00 payment shown herein is now due. $25,568.00 CONTRACTOR: By: Lisa Broughton Date: 09/02/20 State Of: $1,278.40 $1,278.40 $24,289.60 $22,440.90 $1,848.70 $1,832.40 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $0.00 $15,158.00 TOTALS $0.00 $15,158.00 NET CHANGES by Change Orders ($15,158.00) 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 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 $1,848.70 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Hakanson Anderson Associates I A B C ITEM DESCRIPTION OF WORK SCHEDULED NUM VALUE Construction Staking $41,280.00 Survey (CO #1) 1 ($15,158.00) PAYMENT TOTALS $26,122.00 APPLICATION NO.: 9 APPLICATION DATE: 09/01/20 PERIOD TO: 09/30/20 PROJECT NO.: 19520-0033 D E F G H I WORK COMPLETED MATERIALS TOTAL 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) DATE $23,622.00 $17,104.00 - $40,726.00 98.66% $554.00 $2,036.30 - ($15,158.00) ($15,158.00) 100.00% - ($757.90) $23,622.00 $1,946.00 - $25,568.00 97.88%1 $554.00 $1,278.40 Page 1 of 1 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 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 51b OR Sum of Column I) 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.: 2 Period To: 08/31/20 Application Date: 08/24/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-033505 $104,390.00 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 $5,595.00 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 $109,985.00 payment shown herein is now due. $109,985.00 CONTRACTOR: By: Alisa Maciej Date: 08/25/20 State Of: $5,499.25 $5,499.25 $104,485.75 $87,703.05 $16,782.70 $5,499.25 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $5,595.00 $0.00 Total approved this month $0.00 $0.00 TOTALS $5,595.00 $0.00 NET CHANGES by Change Orders $5,595.00 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 $16,782.70 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. QC Companies APPLICATION NO.: 2 APPLICATION DATE: 08/24/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D E F G H I ITEM SCHEDULED DESCRIPTION OF WORK WORK COMPLETED FROM PREVIOUS MATERIALS TOTAL 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 09 6700 Fluid Applied Floor $8,370.00 - $8,370.00 $8,370.00 100.00% $418.50 Labor 2 09 6700 Fluid Applied Floor $3,255.00 - $3,255.00 $3,255.00 100.00% $162.75 Material 3 03 3511 SC 1 Labor $26,095.00 $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 STC 1&2 Polished Flooring $34,305.00 $34,305.00 $34,305.00 100.00% $1,715.25 Labor 6 STC 1&2 Polished Flooring $11,430.00 $11,430.00 - $11,430.00 100.00% $571.50 i Material 7 Bond Fee $3,135.00 $2,689.00 $446.00 $3,135.00 100.00% $156.75 1 Polished Concrete (CO #1) $5,595.00 $5,595.00 $5,595.00 100.00% $279.75 PAYMENT TOTALS $109,985.00 I $92,319.00 $17,666.00 $109,985.00 100.00% $5,499.25 Page 1 of 1 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 $2,916,923.00 $145,846.15 $145,846.15 $2,771,076.85 $2,743,811.85 $27,265.00 $152,146.15 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $61,711.00 $73,488.00 Total approved this month $0.00 $0.00 TOTALS 1 $61,711.00 $73,488.00 NET CHANGES by Change Orders ($11,777.00) Application No.: 13 Period To: 08/31/20 Application Date: 08/24/20 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: 08/24/20 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 $27,265.00 (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 _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 WORK COMPLETED ITEM DESCRIPTION OF WORK NUM SCHEDULED FROM PREVIOUS VALUE APPLICATION (D THIS PERIOD + E) 1 Footings & Foundation Labor $30,000.00 $30,000.00 2 Footings & Foundation Material $8,000.00 $8,000.00 3 Above Grade CMU Labor $84,000.00 $84,000.00 4 Above Grade CMU Material $26,000.00 $26,000.00 5 Slab on Grade Labor $5,300.00 $5,300.00 6 Slab on Grade Material $4,200.00 $4,200.00 7 Stone Piers Labor $17,000.00 $17,000.00 8 'Stone Piers Material $10,000.00 $10,000.00 9 1 Dug Outs/Batting Cage Labor $41,000.00 $41,000.00 10 Dug Outs/Batting Cage $28,000.00 $28,000.00 APPLICATION NO.: 13 APPLICATION DATE: 08/24/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 F MATERIALS G TOTAL H PRESENTLY COMPLETED % BALANCE TO STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) D OR E) DATE $30,000.00 100.00% $8,000.00 100.00% $84,000.00 100.00% $26,000.00 100.00% $5,300.00 100.00% $4,200.00 100.00% - $17,000.00 100.00% - $10,000.00 100.00% - $41,000.00 100.00% - $28,000.00 100.00% RETAINAGE (IF VARIABLE RATE) $1,500.00 $400.00 $4,200.00 $1,300.00 $265.00 $210.00 $850.00 $500.00 $2,050.00 $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 - $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 18 Slab on Deck Material $69,000.00 $69,000.00 - $69,000.00 100.00% $3,450.00 19 Stoops Labor $8,000.00 $8,000.00 - $8,000.00 100.00% $400.00 20 Stoops Material $2,000.00 $2,000.00 - $2,000.00 100.00% $100.00 21 Stone at Fireplace Labor $8,000.00 $8,000.00 - $8,000.00 100.00% $400.00 22 Stone at Fireplace Material $2,000.00 $2,000.00 - $2,000.00 100.00% $100.00 23 Concrete Allowance $50,000.00 $42,000.00 $1,700.00 - $43,700.00 87.40% $6,300.00 $2,185.00 24 Masonry Allowance $40,000.00 $40,000.00 - $40,000.00 100.00% $2,000.00 25 Field House Labor $70,000.00 $70,000.00 - $70,000.00 100.00% $3,500.00 26 Field House Material $18,000.00 $18,000.00 - $18,000.00 100.00% $900.00 27 Bond $43,500.00 $43,500.00 - $43,500.00 100.00% $2,175.00 PAYMENT TOTALS 1 $2,923,223.00 $2,888,223.00 $28,700.00 - $2,916,923.00 99.78%1 $6,300.00 $145,846.15 Page 1 of 2 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 13 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/24/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 CROSSTOWN MASONRY, INCORPORATED PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS �� PRESENTLY COMPLETED % BALANCE TO RETAINAG E (IF DESCRIPTION OF WORK NUM VALUE APPLICATION (D THIS PERIOD IN STOREDDOR AND STORED TO (G r C) FINISH (C - G) VARIABLE RATE) + E) E) DATE 1 Concrete/Masonry (CO #1) $697.00 $697.00 $697.00 100.00% $34.85 1 Concrete/Masonry (CO #2) $33,996.00 $33,996.00 $33,996.00 100.00% $1,699.80 1 Concrete/Masonry (CO #3) ($3,778.00) ($3,778.00) ($3,778.00) 100.00% - ($188.90) 1 Concrete/Masonry (CO #4) $689.00 $689.00 $689.00 100.00% $34.45 1 Concrete/Masonry (CO #5) ($15,209.00) ($15,209.00) ($15,209.00) 100.00% - ($760.45) 1 Concrete/Masonry (CO #6) $2,930.00 i $2,930.00 - $2,930.00 100.00% $146.50 1 Concrete/Masonry (CO #7) 1 ($8,500.00) ($8,500.00) ($8,500.00) 100.00% - ($425.00) 1 Concrete/Masonry (CO #6) $11,039,00 $11,039,10 - $11,039.00 100.00% - $551.95 J 1 Concrete/Masonry (CO #8) 1 ($15,000.00) ($15,000.00) - ($15,000.00) 100.00% - ($750.00) 1 Concrete/Masonry (CO #9) $10,085.00 $10,085.00 - $10,085.00 100.00% $504.25 1 Concrete/Masonry (CO #10) ($6,000.00) ($6,000.00) - ($6,000.00) 100.00% - ($300.00) 1 Concrete/Masonry (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) - ($10,000.00) 100.00% - ($500.00) 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 j $2,923,223.00 $2,888,223.00 $28,700.00 $2,916,923.00 99.78% $6,300.00 $145,846.15 Page 2 of 2 APPLICATION FOR PAYMENT To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 10 830 Boone Avenue North John Weicht Park Golden Valley, MN 55427 Period To: 08/31/20 From: High Five Erectors II, Inc. Application Date: 08/20/20 3005 4th Avenue East Project No.: 19520-0033 P.O. Box 477 Shakopee, MN 55379 Contract Date: 07/23/19 Contract For: 195200033-051210 - Structural Steel Erection Commitment: 195200033-051210 1. ORIGINAL CONTRACT AMOUNT 2. NET CHANGE BY CHANGE ORDERS 3. CONTRACT SUM TO DATE 4. TOTAL COMPLETED AND STORED TO DATE (Column G) 5. RETAINAGE 5.00% of Completed Work (Columns D + E) 5.00% of Stored Materials (Columns F) Total Retainage (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $435,750.00 $21,473.00 $457,223.00 $457,223.00 $22,861.15 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: 08/20/20 State Of. County Of: Subscribed and sworn to before me this - Notary Public: $22,861.15 $434,361.85 $433,560.05 $801.80 $22,861.15 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $27,821.00 $7,192.00 Total approved this month $844.00 $0.00 TOTALS 1 $28,665.00 $7,192.00 NET CHANGES by Change Orders $21,473.00 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 $801.80 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar High Five Erectors ll, Inc. A I B C f ITEM DESCRIPTION OF WORK SCHEDULED NUM VALUE 1 051200 Structural Steel $129,841.00 2 052100 Steel Joists $100,523.00 3 053100 Steel Decking $45,888.00 4 055000 Metal Fabrications $8,508.00 5 055100 Metal Pan Stairs $43,996.00 6 055213 Pipe & Tube Railings $71,614.00 7 Allowance $30,000.00 8 Bond $5,380.00 1 Structural Steel Erection (CO $4,190.00 #1) 1 Structural Steel Erection (CO ($6,888.15) #2) 1 Structural Steel Erection (CO $500.00 #3) 1 Structural Steel Erection (CO $672.00 #4) 1 Structural Steel Erection (CO $3,000.00 #5) 1 Structural Steel Erection (CO $8,650.00 #6) 1 Structural Steel Erection (CO $600.00 #7) 1 Structural Steel Erection (CO $1,200.00 #7) 1 Structural Steel Erection (CO $3,040.00 #8) 1 Structural Steel Erection (CO $1,752.00 #9) 1 Structural Steel Erection (CO ($303.85) #10) 1 Structural Steel Erection (CO $4,217.00 #10) PAYMENT TOTALS $457,223.00 APPLICATION NO.: 10 APPLICATION DATE: 08/20/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 D E F G H I WORK COMPLETED MATERIALS TOTAL FROM PREVIOUS APPLICATION (D THIS PERIOD + E) $129,841.00 PRESENTLY STORED (NOT IN D OR E) COMPLETED AND STORED TO DATE $129,841.00 % (G = C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) 100.00% $6,492.05 $100,523.00 $100,523.00 100.00% $5,026.15 $45,888.00 $45,888.00 100.00% $2,294.40 $8,508.00 $8,508.00 100.00% $425.40 $43,996.00 $43,996.00 100.00% $2,199.80 $71,614.00 $71,614.00 100.00% $3,580.70 $30,000.00 $30,000.00 100.00% - $1,500.00 $5,380.00 $5,380.00 100.00% - $269.00 $4,190.00 $4,190.00 100.00% - $209.50 ($6,888.15) ($6,888.15) 100.00% - ($344.41) $500.00 $500.00 100.00% - $25.00 $672.00 $672.00 100.00% - $33.60 $3,000.00 $3,000.00 100.00% - $150.00 $8,650.00 $8,650.00 100.00% - $432.50 $600.00' $600.00 100.00% - $30.00 $1,200.001 $1,200.00 100.00% - $60.00 $3,040.00 $3,040.00 100.00% - $152.00 $1,752.00 $1,752.00 100.00% - $87.60 ($303.85) ($303.85) 100.00% - ($15.19) $4,217.00 - $4,217.00 100.00% - $210.85 $456,379.00 $844.00 $457,223.00 j 100.00% -I $22,861.15 Page 1 of 2 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 10 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/20/20 In tabulations below, amounts are stated to the nearest dollar PERIOD TO: 08/31/20 High Five Erectors II, Inc. PROJECT NO.: 19520-0033 A B C D E F G H 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 $844.00 $844.00 100.00% $42.20 1 Structural Steel Erection (CO $844.00 #11) PAYMENT TOTALS $457,223.001 $456,379.00 $844.00 - $457,223.00 100.00%1 1 $22,861.15 Page 2 of 2 APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: H & B Specialized Products 6560 Edenvale Blvd Eden Prairie, MN 55346 Contract For: 195200033-110505 - Gymnasium 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 $96,582.00 ($2,372.00) $94,210.00 $94,210.00 $4,710.50 $4,710.50 $89,499.50 $3,625.20 $85,874.30 $4,710.50 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $0.00 Total approved this month $0.00 $2,372.00 TOTALS $0.00 $2,372.00 NET CHANGES by Change Orders ($2,372.00) Application No.: 2 Period To: 08/31/20 Application Date: 08/20/20 Project No.: 19520-0033 Contract Date: 11/26/19 Commitment: 195200033-110505 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: Wanda Meyer Date: 08/24/20 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 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 $85,874.30 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. H & B Specialized Products APPLICATION NO.: 2 APPLICATION DATE: 08/20/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 --A—F B C D E F G H 1 2 3 1 ITEM DESCRIPTION OF WORK NUM IMaterial Labor i Shops/Engineering/Misc Gymnasium Equipment (CO #1) PAYMENT TOTALS WORK COMPLETED MATERIALS TOTAL SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) + E) D OR E) DATE $72,188.00 $72,188.00 $72,188.00 100.00% $20,578.00 $20,578.00 $20,578.00 100.00% $3,816.00 $3,816.00 $3,816.00 100.00% ($2,372.00) - ($2,372.00) ($2,372.00) 100.00% $94,210.001 $3,816.00 1 $90,394.00 - $94,210.00 100.00% BALANCE TO RETAINAGE (IF FINISH (C - G) VARIABLE RATE) $3,609.40 $1,028.90 $190.80 ($118.60) - $4,710.501 Page 1 of 1 APPLICATION FOR PAYMENT To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 3 830 Boone Avenue North John Weicht Park Period To: 08/31/20 Golden Valley, MN 55427 From: Building Material Supply, Inc. Application Date: 08/13/20 4555 W. 77th Street Project No.: 19520-0033 Edina, MN 55435 Contract Date: 11/13/19 Contract For: 195200033-102105 - Toilet Partitions and Commitment: 195200033-102105 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) $133,323.00 $6,692.00 $140,015.00 $140,015.00 $7,000.75 $7,000.75 $133,014.25 $125,944.35 $7,069.90 $7,000.75 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $7,442.00 $0.00 Total approved this month $0.00 $750.00 TOTALS 1 $7,442.00 $750.00 NET CHANGES by Change Orders 1$6,692.00 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: Heather Blanchet Date: 08/13/20 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 $7,069.90 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on the Application for Payment and on the Continuation sheet that are changes to conform to the amount certified.) ARCHITECT: By: Date: The Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. Page 1 of 1 (CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Building Material Supply, Inc. APPLICATION NO.: 3 APPLICATION DATE: 08/13/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TAIL 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 Toilet Partitions -Material $41,131.00 $41,131.00 100.00% $2,056.55 $41,131.00 Toilet Accessories -Material $44,545.00 $44,545.00 $44,545.00 100.00% $2,227.25 Toilet Partitions -Install $26,700.00 $26,700.00 $26,700.00 100.00% $1,335.00 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 - $750.00 $750.00 100.00% $37.50 Insurance -Additional $385.00 $385.00 - $385.00 100.00% $19.25 Endorsements 3 Lockers (CO #1) $3,448.00 - $3,448.00 $3,448.00 100.00% - $172.40 1 Toilet Partitions and $2,518.00 - $2,518.00 $2,518.00 100.00% - $125.90 Accessories (CO #2) 1 Toilet Partitions and $1,476.00 - $1,476.00 $1,476.00 100.00% - $73.80 Accessories (CO #3) 2 Bicycle Racks (CO #4) ($750.00) - ($750.00) ($750.00) 100.00% - ($37.50) PAYMENT TOTALS $140,015.00 1 $132,573.001 $7,442.00 $140,015.00 100.00% - $7,000.75 Page 1 of 1 APPLICATION FOR PAYMENT To: RJM Construction, LLC. Project: Elk River Multi -Purpose Facility and Lion Application No.: 7 830 Boone Avenue North John Weicht Park Period To: 08/31/20 Golden Valley, MN 55427 From: Kendall Doors & Hardware, Inc. Application Date: 08/20/20 1312 Northland Drive Project No.: 19520-0033 Suite 100 Contract Date: 11/13/19 Mendota Heights, MN 55120 Commitment: 195200033-081105 Contract For: 195200033-081105 - Hollow Metal Doors & 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 $198,271.84 $290,885.84 $289,006.34 $10,140.42 $10,140.42 $278,865.92 $251,113.77 $27,752.15 $12,019.92 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $190,455.72 $0.00 Total approved this month $9,138.62 $1,322.50 TOTALS $199,594.34 $1,322.50 NET CHANGES by Change Orders $198,271.84 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: 08/21/20 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 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 $27,752.15 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar Kendell Doors & Hardware, Inc. APPLICATION NO.: 7 APPLICATION DATE: 08/20/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D E F G H WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE 1 Hollow Metal $84,079.00 $84,079.00 - $84,079.00 100.00% - 2 Finish Hardware $8,535.00 $7,918.91 - $7,918.91 92.78% $616.09 $395.95 1 Hollow Metal Doors & Frames $2,119.32 $2,119.32 1 - $2,119.32 100.00% - - (CO #1) 1 Hollow Metal Doors & Frames $133,389.00 $133,389.00 - $133,389.00 100.00% $6,669.45 (CO #2) 1 Hollow Metal Doors & Frames $17,013.00 $17,013.00 - $17,013.00 100.00% $850.65 (CO #3) 1 Hollow Metal Doors & Frames $2,542.87 $2,542.87 - - $2,542.87 100.00% $127.14 (CO #4) 1 Hollow Metal Doors & Frames $2,723.59 $2,723.59 - - $2,723.59 100.00% $136.18 (CO #5) 1 Hollow Metal Doors & Frames $368.30 $368.30 - $368.30 100.00% $18.42 (CO #6) 1 Hollow Metal Doors & Frames $909.84 $909.84 - - $909.84 100.00% - $45.49 (CO #7) 1 Hollow Metal Doors & Frames $6,777.30 $6,777.30 $6,777.30 100.00% - $338.87 (CO #8) 1 Hollow Metal Doors & Frames $549.51 $549.51 - - $549.51 100.00% - $27.48 (CO #9) 1 Hollow Metal Doors & Frames $1,402.91 $1,402.91 - - $1,402.91 100.00% - $70.15 (CO #10) 1 Hollow Metal Doors & Frames $22,660.08 $22,324.39 - $22,324.39 98.52% $335.69 $1,116.22 (CO #11) 1 Hollow Metal Doors & Frames $5,085.97 $5,085.97 - $5,085.97 100.00% - $254.30 (CO #12) 1 Hollow Metal Doors & Frames $3,555.16 $2,627.44 - $2,627.44 73.90% $927.72 $131.37 (CO #13) 1 Hollow Metal Doors & Frames $497.49 $497.49 - $497.49 100.00% - $24.87 (CO #14) 1 Hollow Metal Doors & Frames ($350.00) ($350.00) ($350.00) 100.00% - ($17.50) (CO #15) 1 Hollow Metal Doors & Frames ($972.50) ($972.50) - ($972.50) 100.00% - ($48.62) PAYMENT TOTALS $290,885.84 $259,793.55 $29,212.79 $289,006.34 99.35% $1,879.50 $10,140A2 Page 1 of 2 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 7 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/20/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Kendell Doors & Hardware, Inc. PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM DESCRIPTION OF WORK VALUE STORED NOT IN AND STORED TO (G _ C) FINISH (C - G) VARIABLE RATE APPLICATION (D THIS PERIOD D OR E) DATE ) (CO #15) PAYMENT TOTALS 1 $290,885.84 $259,793.55 $29,212.79 $289,006.34 99.35% $1,879.50 $10,140.42 Page 2 of 2 APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Ebert Construction 23350 County Road 10 Corcoran, MN 55357 Contract For: 195200033-064015 - Carpentry 1. ORIGINAL CONTRACT AMOUNT 2. NET CHANGE BY CHANGE ORDERS 3. CONTRACT SUM TO DATE 4. TOTAL COMPLETED AND STORED TO DATE (Column G) 5. RETAINAGE 5.00% of Completed Work (Columns D + E) 5.00% of Stored Materials (Columns F) Total Retainage (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) Project: Elk River Multi -Purpose Facility and Lion John Weicht Park $546,800.00 ($30,158.54) $516,641.46 $516,641.46 $25,832.09 $25,832.09 $490,809.37 $491,306.01 ($496.64) $25,832.09 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $1,976.48 $21,720.00 Total approved this month $8,303.41 $18,718.43 TOTALS 1 $10,279.89 $40,438.43 NET CHANGES by Change Orders ($30,158.54) Application No.: 9 Period To: 08/31/20 Application Date: 08/19/20 Project No.: 19520-0033 Contract Date: 11/12/19 Commitment: 195200033-064015 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by the Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. CONTRACTOR: By: Caleb Pelkey Date: 08/19/20 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 ($496.64) (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar Ebert Construction APPLICATION NO.: 9 APPLICATION DATE: 08/19/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D I E F 1 G H WORK COMPLETED MATERIALS 7 TOTAL ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % I BALANCE TO RETAINAGE (IF FROM PREVIOUS NUM VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE $250.00 1 Bonds, Insurance, Mobilize $5,000.00 $5,000.00 - $5,000.00 100.00% 2 General Conditions $21,000.00 $21,000.00 - $21,000.00 100.00% $1,050.00 3 Allowance $50,000.00 $40,107.75 $9,892.25 $50,000.00 100.00% $2,500.00 4 061000 Rough Carpentry M $59,700.00 $59,700.00 - $59,700.00 100.00% $2,985.00 5 061000 Rough Carpentry L $153,000.00 $153,000.00 - - $153,000.00 100.00% $7,650.00 6 061753 Shop Fam Wood $3,000.00 $3,000.00 - - $3,000.00 100.00% $150.00 Trusses 7 064216 Wood Paneling $135,000.00 $135,000.00 - - $135,000.00 100.00% $6,750.00 8 072119 Foamed -In -Place $17,000.00 $17,000.00 - - $17,000.00 100.00% $850.00 Insulation 9 081113 HM Doors and Frames $81,000.00 $81,000.00 - - $81,000.00 100.00% $4,050.00 10 097733 FRP $4,500.00 $4,500.00 - - $4,500.00 100.00% $225.00 11 101100 Visual Display Boards $7,800.00 $7,800.00 - - $7,800.00 100.00% $390.00 12 102600 Wall and Corner $7,000.00 $7,000.00 - - $7,000.00 100.00% $350.00 Guards 13 105113 Metal Lockers $2,800.00 $2,800.00 - - $2,800.00 100.00% $140.00 1 Carpentry (CO #1) $416.90 $416.90i - $416.90 100.00% $20.85 1 Carpentry (CO #2) $1,559.58 $1,559.58 - $1,559.58 100.00% $77.98 1 Carpentry (CO #3) ($3,720.00) ($3,720.00)', - ($3,720.00) 100.00% ($186.00) 1 Carpentry (CO #4) ($15,000.00) ($15,000.00) - ($15,000.00) 100.00% ($750.00) 1 Carpentry (CO #5) ($3,000.00) ($3-000.00- - ($3,000.00) 100.00% ($150.00) 1 Carpentry (CO #6) ($10,534.48) 1 ($10,534.48) - ($10,534.48) 100.00% ($526.72) 1 Carpentry (CO #7) $2,076.80 $2,076.80 - $2,076.80 100.00% $103.84 1 Carpentry (CO #8) ($7,892.25) ($7,892.25) - ($7,892.25) 100.00% - ($394.61) 1 Carpentry (CO #9) ($291.70) ($291.70) - ($291.70) 100.00% ($14.58) 1 Carpentry (CO #9) $6,226.61 $6,226.61 - $6,226.61 100.00% $311.33 PAYMENT TOTALS j $516,641.46 $517,164.23 ($522.77) $516,641.46 100.00% $25,832.09 Page 1 of 1 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 $153,874.84 $286,792.84 $286,792.84 $14,339.65 $14,339.65 $272,453.19 $249,790.27 $22,662.92 $14,339.65 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $156,729.84 $5,000.00 Total approved this month $2,145.00 $0.00 TOTALS 1 $158,874.84 $5,000.00 NET CHANGES by Change Orders 1$153,874.84 Application No.: 3 Period To: 09/01/20 Application Date: 07/27/20 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: 08/26/20 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 $22,662.92 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 3 containing Contractor's signed Certification is attached. APPLICATION DATE: 07/27/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 09/01/20 Custom Caseworks PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM DESCRIPTION OF WORK VALUE APPLICATION (D THIS PERIOD STORED NOT IN AND STORED TO (G = C) FINISH (C - G) VARIABLE RATE) D OR E) DATE 1 Architectural Casework Supply $41,622.99 $41,622.99 $41,622.99 100,00% - $2,081.15 2 Architectural Casework Install $15,185.90 $15,185.90 $15,185,90 100.00% - $759.30 3 Solid Surface & Quartz Supply $47,559.60 $47,559.60 $47,559.60 100.00% - $2,377.98 & Install 4 Stainless Steel Countertops $7,897.33 $7,897.33 $7,897.33 100.00% - $394.87 (Qty 4) - John Wiecht Park 5 Claridge Prefeb Trophy Cases $15,652.18 $15,652.18 $15,652.18 100.00% - $782.61 6 5K Allowance $5,000.00 $5,000.00 $5,000.00 100.00% - $250.00 1 Millwork (CO #1) $6,141.84 $6,141.84 $6,141.84 100.00% - $307.09 1 Millwork (CO #2) $150,588.00 $128,877.30 $21,710.70 $150,588.00 100.00% - $7,529.40 1 Millwork (CO #3) ($5,000.00) ($5,000.00) ($5,000.00) 100.00% - ($250.00) 1 Millwork (CO #4) $2,145.00 $2,145.00 $2,145.00 100.00% - S107.25 PAYMENT TOTALS $286,792.84 $262,937.14 $23,855.701 $286,792.84 100.00% $14,339.65 Page 1 of 1 APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Top -All Roofing, Inc 2231 Edgewood Ave. So. Minneapolis, MN 55426 Contract For: 195200033-075305 - Roofing 1. ORIGINAL CONTRACT AMOUNT 2. NET CHANGE BY CHANGE ORDERS 3. CONTRACT SUM TO DATE 4. TOTAL COMPLETED AND STORED TO DATE (Column G) 5. RETAINAGE 0% of Completed Work (Columns D + E) 0% of Stored Materials (Columns F) Total Retainage (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) Project: Elk River Multi -Purpose Facility and Lion John Weicht Park $1,020,690.00 ($8,956.62) $1,011,733.38 $1,011,733.38 N/A N/A $50,586.67 $961,146.71 $953,256.96 $7,889.75 $50,586.67 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $8,947.00 $26,208.62 Total approved this month $8,305.00 $0.00 TOTALS $17,252.00 $26,208.62 NET CHANGES by Change Orders ($8,956.62) Application No.: 10 Period To: 09/01/20 Application Date: 08/17/20 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: 08/27/20 State Of: County Of: Subscribed and sworn to before me this Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT day of In accordance with the Contract Documents, based on the on -site observations and the data compromising this application, the Architect certifies to the owner that to the best of the Architects knowledge, information and belief the Work under the Architect's Contract has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $7,889.75 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar Top -All Roofing, Inc APPLICATION NO.: 10 APPLICATION DATE: 08/17/20 PERIOD TO: 09/01/20 PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK NUM 1 Material Insulation 2 Material Vapor Barrier 3 Material EPDM & Accessories 4 Material Sheet Metal 5 Labor Insulation 6 Labor Vapor Barrier 7 Labor EPDM & Accessories 8 Labor Sheet Metal 9 Allowance for Conditions 10 Bonding 1 Roofing (CO #1) 1 Roofing (CO #2) 1 Roofing (CO #3) 1 Roofing (CO #4) 1 Roofing (CO #5) 1 Roofing (CO #6) 1 Roofing (CO #7) 1 Roofing (CO #8) 1 Roofing (CO #9) 1 Roofing (CO #9) 1 Roofing (CO #10) PAYMENT TOTALS SCHEDULED VALUE i $384,950.00 FROM PREVIOUS APPLICATION (D + E) 1i $384,950.00 THIS PERIOD PRESENTLY STORED (NOT IN D OR E) COMPLETED AND STORED TO DATE $384,950.00 % (G + C) — 100.00% $50,600.00 $50,600.00 $50,600.00 100.00% $195,960.00 $195,960.00 $195,960.00 100.00% $32,040.00 $32,040.00 $32,040.00 100.00% $80,070.00 $80,070.00 $80,070.00 100.00% $21,110.00 $21,110.00 $21,110.00 100.00% $148,060.00 $148,060.00 $148,060.00 100.00% $29,900.00 $29,900.00 $29,900.00 100.00% $45,000.00 $45,000.00 $45,000.00 100.00% $33,000.00 $33,000.00 $33,000.00 100.00% $2,060.00 $2,060.00 $2,060.00 100.00% ($12,000.00) ($12,000.00) ($12,000.00) 100.00% $1,560.00 $1,560.00 $1,560.00 100.00% ($12,208.62) ($12,208.62) ($12,208.62) 100.00% $470.00 $470.00 $470.00 100.00% ($2,000.00) ($2,000.00) ($2,000.00) 100.00% $220.00 $220.00 $220.00 100.00% $4,637.00 $4,637.00 $4,637.00 100.00% $3,600.00 $3,600.00 $3,600.00 100.00% $992.00 $992.00 $992.00 100.00% $3,713.00 $3,713.00 $3,713.00 100.00% $1,011,733.38 $1,003,428.38 $8,305.00 $1,011,733.38 100.00% BALANCE TO RETAINAGE (IF FINISH (C - G) VARIABLE RATE) $19,247.50 $2,530.00 $9,798.00 $1,602.00 $4,003.50 $1,055.50 $7,403.00 - $1,495.00 - $2,250.00 - $1,650.00 - $103.00 - ($600.00) - $78.00 - ($610.43) - $23.50 - ($100.00) - $11.00 - $231.85 - $180.00 - $49.60 - $185.65 $50,586.67 Page 1 of 1 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 Application No.: 7 Period To: 08/31/20 Application Date: 08/24/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-088105 $601,000.00 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 $41,450.00 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 $642,450.00 payment shown herein is now due. $642,450.00 CONTRACTOR: By: Hank Thompson Date: 08/24/20 State Of: $32,122.51 $32,122.51 $610,327.49 $609,709.99 $617.50 $32,122.51 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $52,300.00 $11,500.00 Total approved this month $650.00 $0.00 TOTALS 1 $52,950.00 $11,500.00 NET CHANGES by Change Orders $41,450. 00 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 $617.50 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Murphy Window and Door Commercial, Inc 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 1 1 1 1 1 1 1 APPLICATION NO.: 7 APPLICATION DATE: 08/24/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D I E F G IH ITEM NUM WORK COMPLETED MATERIALS TOTAL I DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % FROM PREVIOUS I VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) + E) D OR E) DATE $147,882,52 - 08-900 Curtain Wall & $147,882.52 - $147,882.52 100.00% Storefront Metal 08-700 Hardware $89,971.20 $89,971.20 - - $89,971.20 100.00% 08-300 Automatic Entrances $22,578.00 $22,578.00 - - $22,578.00 100.00% 08-800 Glazing $113,807.50 $113,807.50 - - $113,807.50 100.00% 08-950 Brake Metal $7,100.00 $7,100.00 - - $7,100.00 100.00% 07-900 Joint Sealers $3,675.73 $3,675.73 - - $3,675.73 100.00% 08-050 Misc Fasteners, $3,944.65 $3,944.65 - - $3,944.65 100.00% Shims, Backer Rod 01-542 Man Lifts, Storage, & $25,560.00 $25,560.00 - - $25,560.00 100.00% Equipment 01-750 Bonds & Insurance $14,200.00 $14,200.00 - - $14,200.00 100.00% 01-010 Refundable Allowance $7,500.00 $7,500.00 - - $7,500.00 100.00% 08-910 Shop Drawings $9,958.00 $9,958.00 - - $9,958.00 100.00% 08-920 Structural Calos $17,569.20 $17,569.20 - - $17,569.20 100.00% 08-930 Field Installation Labor $119,253.20 $119,253.20 - - $119,253.20 100.00% 01-770 Mobilization $18,000.00 $18,000.00 - - $18,000.00 100.00% Glass and Glazing (CO #1) $43,100.00 $43,100.00 - - $43,100.00 100.00% Glass and Glazing (CO #2) ($4,000.00) ($4,000.00) - - ($4,000.00) 100.00% Glass and Glazing (CO #2) ($7,500.00) ($7,500.00) - - ($7,500.00) 100.00% Glass and Glazing (CO #3) $950.00 $950.00 - - $950.00 100.00% Glass and Glazing (CO #4) $7,800.00 $7,800.00 - - $7,800.00 100.00% Glass and Glazing (CO #5) $450.00 $450.00 - - $450.00 100.00% Glass and Glazing (CO #6) $300.00 - $300.00 - $300.00 100.00% Glass and Glazing (CO #7) $350.00 $350.00 - $350.00 100.00% PAYMENT TOTALS $642,450.00 $641,800.001 $650.00 $642,450.00 100.00% BALANCE TO RETAINAGE (IF FINISH (C - G) VARIABLE RATE) $7,394.13 $4,498.56 $1,128.90 $5,690.38 $355.00 $183.79 I $197.23 $1,278.00 $710.00 $375.00 $497.90 $878.46 $5,962.66 - $900.00 - $2,155.00 ($200.00) - ($375.00) - $47.50 - $390.00 - $22.50 - $15.00 $17.50 $32,122.51 Page 1 of 1 APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: RTL Construction, Inc. 290 Sarazin Street Shakopee, MN 55379 Contract For: 195200033-092905 - Gypsum 1. ORIGINAL CONTRACT AMOUNT 2. NET CHANGE BY CHANGE ORDERS 3. CONTRACT SUM TO DATE 4. TOTAL COMPLETED AND STORED TO DATE (Column G) 5. RETAINAGE 5.00% of Completed Work (Columns D + E) 5.00% of Stored Materials (Columns F) Total Retainage (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) Project: Elk River Multi -Purpose Facility and Lion John Weicht Park $309,300.00 $40,469.37 $349,769.37 $349,769.37 $17,488.47 $17,488.47 $332,280.90 $329,860.39 $2,420.51 $17,488.47 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $37,921.46 $0.00 Total approved this month $2,547.91 $0.00 TOTALS $40,469.37 $0.00 NET CHANGES by Change Orders $40,469.37 Application No.: 7 Period To: 08/31/20 Application Date: 08/25/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-092905 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by the Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. CONTRACTOR: By: Katie Hislop Date: 08/25/20 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 $2,420.51 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. RTL Construction, Inc. 1 2 3 4 5 1 1 1 1 1 APPLICATION NO.: 7 APPLICATION DATE: 08/25/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D I E F -F G H I ITEM NUM WORK COMPLETED MATERIALS TOTAL DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF T G+C FINISH C G VARIABLE RATE Bonds/Shops Allowance Drywall Assembles Insulation Materials Gypsum (CO #1) Gypsum (CO #2) Gypsum (CO #3) Gypsum (CO #4) Gypsum (CO #5) VALUE $6,000.00 APPLICATION (D + E) $6,000.00 THIS PERIOD STORED (NOT IN D OR E) AND STORED O DATE $6,000.00 ( ) 100.00% ( - ) ) $300.00 - $15,000.00 $15,000.00 - $15,000.00 100.00% $750.00 $190,000.00 $190,000.00 $190,000.00 100.00% $9,500.00 $15,000.00 $15,000.00 $15,000.00 100.00% $750.00 $83,300.00 $83,300.00 $83,300.00 100.00% $4,165.00 $23,308.52 $23,308.52 $23,308.62 100.00% $1,165.43 $1,241.68 $1,241.68 $1,241.68 100.00%, $62.08 $2,196.26 $2,196.26 $2,196.26 100.00% $109.81 $11,175.00 $11,175.00 $11,175.00 100.00% $558.75 $2,547.91 $2,547.91 $2,547.91 100.00% $127.40 PAYMENT TOTALS $349,769.37 $347,221.46 $2,547.91 $349,769.37 100.00% - $17,488.47 Page 1 of 1 APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: CD Tile and Stone, Inc. 3103 103rd Lane NE Suite 160 Blaine, MN 55449 Contract For: 195200033-093105 - Tile 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: 08/31/20 Application Date: 08/21/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-093105 $155,980.00 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 $19,169.90 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 $175,149.90 payment shown herein is now due. $175,149.90 CONTRACTOR: By: Rita Hamsmith Date: 08/21/20 State Of: $8,757.50 County Of: Subscribed and sworn to before me this $8,757.50 $166,392.40 $164,599.28 $1,793.12 $8,757.50 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $34,782.40 $17,500.00 Total approved this month $1,887.50 $0.00 TOTALS $36,669.90 $17,500.00 NET CHANGES by Change Orders 1$19,169.90 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 $1,793.12 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 5 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/21/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 CD Tile and Stone, Inc. PROJECT NO.: 19520-0033 A B C t D E F G H i I `ITEM I WORK COMPLETED MATERIALS TOTAL I DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE _ 0 Labor $85,790.00 $85,790.00 $85,790.00 100.00% $4,289.50 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 (CO #2) ($3,000.00) ($3,000.00) - ($3,000.00) 100.00% ($150.00) 1 Tile (CO #3) $2,885.00 $2,885.004 $2,885.00 100.00% $144.25 1 Tile (CO #4) $26,650.00 $26,650.001 $26,650.00 100.00% $1,332.50 1 Tile (CO #5) $5,247.40 $5,247.40 $5,247.40 100.00% $262.37 1 Tile (CO #6) $1,887.50 $1,887.50 $1,887.50 100.00% $94.38 PAYMENT TOTALS 1 $175,149.901 $173,262.40 $1,887.50 I $175,149.90 1 100.00% $8,757.50 Page 1 of 1 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 Application No.: 6 Period To: 08/31/20 Application Date: 08/18/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-095105 $149,410.00 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 ($1,504.05) 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 $147,905.95 payment shown herein is now due. $147,905.95 CONTRACTOR: By: Julie Haupert Date: 08/19/20 State Of: $7,395.30 County Of: Subscribed and sworn to before me this $7,395.30 $140,510.65 $135,254.77 $5,255.88 $7,395.30 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $21,600.95 $20,105.00 Total approved this month $0.00 $3,000.00 TOTALS 1 $21,600.95 $23,105.00 NET CHANGES by Change Orders ($1,504.05) 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 $5,255.88 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Twin City Acoustics, Inc. APPLICATION NO.: 6 APPLICATION DATE: 08/18/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A j B C D E F G H ITEM NUM 1 DESCRIPTION OF WORK 095100 - Material SCHEDULED VALUE $97,380.00 WORK COMPLETED MATERIALS FROM PREVIOUS PRESENTLY APPLICATION (D THIS PERIOD STORED (NOT IN + E) D OR E) $97,380.00 TOTAL COMPLETED AND STORED TO DATE $97,380.00 % (G + C) 100.00% BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) $4,869.00 2 4 095100 - Labor $44,500.00 $44,500.00 $44,500.00 100.00% $2,225.00 3 If 098430 - Material $3,450.00 $3,450.00 $3,450.00 100.00% $172.50 4 1098430 - Labor $1,830.00 $1,830.00 $1,830.00 100.00% $91.50 5 'Bonds $2,250.00 $2,250.00 $2,250.00 100.00% $112.50 1 Acoustical Ceilings (CO #1) ($15,105.00) ($15,105.00) ($15,105.00) 100.00% ($755.25) 1 Acoustical Ceilings (CO #2) $14,827.00 $7,413.50 $7,413.50 $14,827.00 100.00% $741.35 1 Acoustical Ceilings (CO #3) $2,238.00 $1,119.00 $1,119.00 $2,238.00 100.00% $111.90 1 Acoustical Ceilings (CO #4) $2,249.20 $2,249.20 $2,249.20 100.00% $112.46 1 Acoustical Ceilings (CO #5) ($5,000.00) ($5,000.00) ($5,000.00) 100.00% ($250.00) 1 Acoustical Ceilings (CO #6) $2,286.75 $2,286.75 $2,286.75 100.00% $114.34 1 Acoustical Ceilings (CO #7) ($3,000.00) ($3,000.00) ($3,000.00) 100.00% - ($150.00) PAYMENT TOTALS I $147,905.951 $142,373.45 $5,532.501 1 $147,905.951 100.00%1 i $7,395.30 Page 1 of 1 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 Project: Elk River Multi -Purpose Facility and Lion John Weicht Park 1. ORIGINAL CONTRACT AMOUNT $33,901.00 2. NET CHANGE BY CHANGE ORDERS $0.00 3. CONTRACT SUM TO DATE $33,901.00 4. TOTAL COMPLETED AND STORED TO DATE $33,901.00 (Column G) 5. RETAINAGE 5.00%of Completed Work $1,695.05 (Columns D + E) 5.00% of Stored Materials - (Columns F) Total Retainage $1,695.05 (Line 5a + Line 5b OR Sum of Column 1) 6. TOTAL EARNED LESS RETAINAGE $32,205.95 (Line 4 less Line 5 Total) 7. LESS PRIOR CERTIFICATES FOR PAYMENT $21,429.53 (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $10,776.42 9. BALANCE TO FINISH, INCLUDING RETAINAGE $1,695.05 (Line 3 less Line 6) 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.: 2 Period To: 08/31/20 Application Date: 08/18/20 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: 08/25/20 State Of: County Of: Subscribed and sworn to before me this Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT day of In accordance with the Contract Documents, based on the on -site observations and the data compromising this application, the Architect certifies to the owner that to the best of the Architects knowledge, information and belief the Work under the Architect's Contract has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $10,776.42 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/18/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Becker Arena Products, Inc. PROJECT NO.: 19520-0033 E F G H A B C D 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) I + E) D OR E) DATE 1 1 Lions Park Batting Cage Turf $9,140.00 $6,635.64 $2,504.36 $9,140.00 100.00% $457.00 2 Varsity Locker Room Rubber $24,761.00 $15,921.76 $8,839.24 $24,761.00 100.00% $1,238.05 Flooring PAYMENT TOTALS $33,901.00 $22,557.40 $11,343.601 $33,901.001 100.00% $1,695.05 Page 1 of 1 o\I§n� �± / )2}@2'f/$ $�oroA �o n ems aN®$2 \�q 0 k § §03r) /°IRa a\z am3 r o gRE hj /m >A§ 8 3\ a z z > m q 0 > - 2� c o m z @ r> < m- E Q > -n j Ln R z - zn z ± § ` /§ � /) LA 0 / § ks 2 y@�B T m # 0 2 Q a - 9 p m r rl 2 « § 8 8 @ R "n. � ��® � k � O o § m 0 > =f CL C b uj k |� \l 7CD �� 0 § 2 � ƒ/ � k co L CA 'a 0 � Lo o q $ e b 7 G } itg 2 q > § ( m k m \ 7 CL \ \ CD/ \ q § 9 3 j CZ-0 \\ m - . k,\ - . © q > m \ § P 8 > 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 Period To: 08/31/20 Golden Valley, MN 55427 From: SUNRISE PAINTING Application Date: 08/13/20 805 TOWER DRIVE Project No.: 19520-0033 MEDINA, MN 55340 Contract Date: 07/23/19 Contract For: 195200033-099105 - Painting Commitment: 195200033-099105 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) $412,750.00 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 $77,406.00 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 $490,156.00 payment shown herein is now due. $490,156.00 CONTRACTOR: By: Kim Larson Date: 08/13/20 State Of. $24,507.80 County Of: Subscribed and sworn to before me this $24,507.80 $465,648.20 $437,623.20 $28,025.00 $24,507.80 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $98,269.00 $20,863.00 Total approved this month $0.00 $0.00 TOTALS 1 $98,269.00 $20,863.00 NET CHANGES by Change Orders $77,406.00 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 $28,025.00 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 8 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/13/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 SUNRISE PAINTING PROJECT NO.: 19520-0033 �A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM NUM DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS ' PRESENTLY STORED NOT IN COMPLETED AND STORED TO % (G + C) BALANCE TO FINISH C - G) RETAINAGE (IF VARIABLE RATE) ION (D APPLICATION THIS PERIOD D OR E) DATE E 1 PAINTING $407,750.00 $378,250.00 $29,500.00 $407,750.00 100.00% $20,387.50 2 BOND $5,000.00 $5,000.00 $5,000.00 100.00% $250.00 1 Painting (CO #1) $10,000.00 $10,000.00 - $10,000.00 100.00% $500.00 1 Painting (CO #3) ($9,000.00) ($9,000.00) - ($9,000.00) 100.00% ($450.00) 2 Prime + Paint Joists (CO #2) $63,800.00 $63,800.00 - $63,800.00 100.00% $3,190.00 1 Painting (CO #4) ($1,863.00) ($1,863.00) - ($1,863.00) 100,00% ($93.15) 1 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% - $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) PAYMENT TOTALS $490,156.001 $460,656.00 $29,500.001 1 $490,156.00 100.00% - $24,507.80 Page 1 of 1 APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: Thyssenkrupp Elevator Corp - SSC 7481 N.W 66 Street Miami, FL 33166 Contract For: 195200033-142005 - Elevators 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.: 3 Period To: 08/31/20 Application Date: 08/21/20 Project No.: 19520-0033 Contract Date: 07/23/19 Commitment: 195200033-142005 $79,500.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by the Application for Payment has been completed in accordance with the ($7,800.00) 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 $71,700.00 payment shown herein is now due. $71,700.00 CONTRACTOR: By: Kimberly Mayfield Date: 08/21/20 State Of: $3,585.00 County Of: Subscribed and sworn to before me this $3,585.00 $68,115.00 $66,381.25 $1,733.75 $3,585.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $0.00 $9,625.00 Total approved this month $1,825.00 $0.00 TOTALS $1,825.00 $9,625.00 NET CHANGES by Change Orders ($7,800.00) 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 $1,733.75 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 3 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/21/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Thyssenkrupp Elevator Corp - SSC PROJECT NO.: 19520-0033 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED NUM DESCRIPTION OF WORK VALUE FROM PREVIOUS PRESENTLY STORED NOT IN COMPLETED % AND STORED TO (G - C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) APPLICATION (D THIS PERIOD D OR E) DATE + E) 1 j Engineering/Pre-Production $39,750.00 $39,750.00 $39,750.00 100.00% $1,987.50 2 Material $19,875.00 $19,875.00 $19,875.00 100.00% $993.75 3 Labor $19,875.00 $19,875.00 $19,875.00 100.00% $993.75 1 Elevators (CO #1) ($9,625.00) ($9,625.00) ($9,625.00) 100.00% ($481.25) 1 Elevators (CO #2) $1,825.00 $1,825.00 $1,825.00 100.00% S91.25 PAYMENT TOTALS $71,700.00 $69,875.00 $1,825.00 $71,700.00 100.00% $3,585.00 Page 1 of 1 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 $25,659.00 $282,144.00 $282,144.00 N/A N/A $0.00 $282,144.00 $266,399.97 $15,744.03 $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $23,337.00 $0.00 Total approved this month $2,322.00 $0.00 TOTALS 1 $25,659.00 $0.00 NET CHANGES by Change Orders $25,659.00 Application No.: 12 Period To: 08/31/20 Application Date: 08/25/20 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: 08/25/20 State Of: County Of: Subscribed and sworn to before me this Notary Public: My commission expires: ARCHITECTS CERTIFICATE FOR PAYMENT day of In accordance with the Contract Documents, based on the on -site observations and the data compromising this application, the Architect certifies to the owner that to the best of the Architects knowledge, information and belief the Work under the Architect's Contract has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $15,744.03 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 12 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/25/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Summit Companies PROJECT NO.: 19520-0033 A B C D E _ F l_ G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK NUM SCHEDULED VALUE FROM PREVIOUS PRESENTLY STORED (NOT IN COMPLETED AND STORED TO % (G + C) BALANCE TO RETAINAGE (IF FINISH (C - G) VARIABLE RATE) APPLICATION (D THIS PERIOD D OR E) DATE + E) 1 Labor $87,885.00 $87,885.00 $87,885.00 100.00% 2 Material $111,200.00 $111,200.00 $111,200.00 100.00% 3 Design $31,200.00 $31,200.00 - $31,200.00 100.00% 4 Fabrication $20,200.00 $20,200.00 $20,200.00 100.00% 5 Bonds $6,000.00 $6,000.00 - $6,000.00 100.00% - 1 Fire Protection (CO #1) $11,955.00 $11,955.00 - $11,955.00 100.00% 1 Fire Protection (CO #2) $5,952.00 $5,952.00 - $5,952.00 100.00% 1 Fire Protection (CO #3) $3,955.00 $3,955.00 - $3,955.00 100.00% 1 Fire Protection (CO #4) $1,475.00 $1,475.00 - $1,475.00 100.00% - 1 Fire Protection (CO #5) $2,322.00 $2,322.00 - $2,322.00 100.00% - PAYMENT TOTALS $282,144.00 $279,822.00 $2,322.00 $282,144.00 i 100.00% - Page 1 of 1 APPLICATION FOR PAYMENT To: RJM Construction, LLC. 830 Boone Avenue North Golden Valley, MN 55427 From: WEIDNER MECHANICAL 29 WILSON AVENUE NE PO BOX 1087 ST CLOUD, MN 56304 Contract For: 195200033-220105 - Plumbing 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.: 13 Period To: 08/31/20 Application Date: 08/19/20 Project No.: 19520-0033 Contract Date: 08/23/19 Commitment: 195200033-220105 $1,206,000.00 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 $110,101.00 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 $1,316,101.00 payment shown herein is now due. $1,316,101.00 CONTRACTOR: By: Karen Schenk Date: 08/19/20 State Of. $65,805.05 County Of: Subscribed and sworn to before me this $65,805.05 $1,250,295.95 $1,208,183.40 $42,112.55 $65,805.05 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $104,708.00 $5,183.00 Total approved this month $10,576.00 $0.00 TOTALS 1 $115,284.00 $5,183.00 NET CHANGES by Change Orders $110,101.00 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 $42,112.55 (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 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 1 2 3 4 5 6 7 8 9 10 11 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 A B C EM DESCRIPTION OF WORK SCHEDULED UM VALUE 10.105 Bond 10.109 Allowance 10.115 Pipe & Fittings 10.119 Drains & Carriers 10.123 Pumps & Tanks 10.127 Water Heaters 10.137 Plumbing Fixtures & Trim 10.139 Misc Plumbing 11.185 Labor - Plumbing 30.300 Digging/Backfill 30.325 Rentals 30.360 Pipe Covering Plumbing (CO #1) Plumbing (CO #2) Plumbing (CO #3) Plumbing (CO #4) Plumbing (CO #5) Plumbing (CO #6) Plumbing (CO #7) Plumbing (CO #8) Plumbing (CO #9) Plumbing (CO #10) Plumbing (CO #6) Plumbing (CO #11) i Plumbing (CO #12) Plumbing (CO #13) Plumbing (CO #14) PAYMENT TOTALS $10,333.00 $7,500.00 $235,689.00 $47,196.00 $5,400.00 $82,739.00 $79,004.00 $42,488.00 $560,753.00 $37,034.00 $13,000.00 $84,864.00 $7,430.00 ($2,203.00) ($2,980.00) $2,506.00 $10,815.00 $1,338.00 $15,209.00 $2,645.00 $10,615.00 $25,562.00 $2,041.00 $26,547.00 $1,943.00 $6,842.00 $771.00 $1,316,101.00 D E WORK COMPLETED FROM PREVIOUS APPLICATION (D THIS PERIOD + E) $10,333.00' $7,500.00 $235,000.001 $689.00 i $47,196.00' $5,400.00 $82,739.00 $79,004.00 $42,488.001 $554,600.00' $37,034.00 $13,000.00 $82,000.00 $7,430.00 ($2,203.00) ($2,980.00), $2,506.001 $10,815.00 1 $1,338.001 $15,209.00 $2,645.00 $10,615.001 $25,562.00 $2,041.00 $10,000.00 $1,271,772.00 $6,153.00 $2,864.00 $16,547.00 $1,943.00 $6,842.00 $771.00 $44,329.00 APPLICATION NO.: 13 APPLICATION DATE: 08/19/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 F G MATERIALS TOTAL PRESENTLY COMPLETED STORED (NOT IN AND STORED TO D OR E) DATE $10,333.00 $7,500.00 $235,689.00 $47,196.00 $5,400.00 $82,739.00 $79,004.00 H I % BALANCE TO RETAINAGE (IF (G + C) FINISH (C - G) VARIABLE RATE) 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% $516.65 $375.00 $11,764.45 $2,359.80 $270.00 $4,136.95 $3,950.20 $42,488.00 100.00% - $2,124.40 $560,753.00 100.00% - $28,037.65 $37,034.00 100.00% - $1,851.70 $13,000.00 100.00% - $650.00 $84,864.00 100.00% - $4,243.20 $7,430.00 100.00% - $371.50 ($2,203.00) 100.00% - ($110.15) ($2,980.00) 100.00% - ($149.00) $2,506.00 100.00% - $125.30 $10,815.00 100.00% - $540.75 $1,338.00 100.00% - $66.90 $15,209.00 100.00% - $760.45 $2,645.00 100.00% - $132.251 $10,615.00 100.00% - $530.75 $25,562.00 100.00% - $1,278.10 $2,041.00 100.00% - $102,05 $26,547.00 100.00% - $1,327.35 $1,943.00 100.00% - $97.15 $6,842.00 100.00% - $342.10 $771.00 100.00% $38.55 $1,316,101.00 100.00%1 $65,805.05 Page 1 of 2 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 13 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/19/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 WEIDNER MECHANICAL PROJECT NO.: 19520-0033 A B C TD E F G H I w WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM DESCRIPTION OF WORK VALUE STORED NOT IN AND STORED TO (G = C) FINISH (C - G) VARIABLE RATE) APPLICATION (D THIS PERIOD D OR E) DATE 1 Plumbing (CO #15) $1,020.001 $1,020.00 $1,020.00 100.00% $51.00 PAYMENT TOTALS $1,316,101.00 $1,271,772.00 $44,329.00 - $1,316,101.00 100.00% - $65,805.05 Page 2 of 2 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 Application No.: 12 Period To: 08/31/20 Application Date: 08/21/20 Project No.: 19520-0033 Contract Date: 07/30/19 Commitment: 195200033-233005 $1,776,000.00 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 $99,065.33 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 $1,875,065.33 payment shown herein is now due. $1,875,065.33 CONTRACTOR: By: Jeff Waletzko Date: 08/21/20 State Of: $93,753.27 County Of. Subscribed and sworn to before me this $93,753.27 $1,781,312.06 $1,745,696.56 $35,615.50 $93,753.27 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $115,127.33 $17,750.00 Total approved this month $1,688.00 $0.00 TOTALS 1 $116,815.33 $17,750.00 NET CHANGES by Change Orders $99,065.33 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 $35,615.50 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 12 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/21/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Sentra-Sota Sheet Metal Inc. PROJECT NO.: 19520-0033 A B C D E F G H I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ITEM DESCRIPTION OF WORK NUM Mobilization - Labor Mobilization - Material HVAC Demo - Labor HVAC Demo - Material 230593 Test and Balance 530700 Insulation 232300 Refrigeration Piping 250900 Controls 233000 Ductwork - Labor 233000 Ductwork - Material 233000 Misc Round - Labor 233000 Misc Round - Material 233000 Spiral Pipe - Labor 233000 Spiral Pipe - Material 233000 Fabric Duct - Labor 233000 Fabric Duct - Material 233423 Fans/Hoods - Labor 233423 Fans/Hoods - Material 233616 VAV Boxes - Labor 233616 VAV Boxes - Material 233713 Grilles/Registers - Labor 233713 Grilles/Registers - Material 236213 ACCU - Labor 236213 ACCU - Material 237400 Rooftop Units - Labor 237400 Rooftop Units - Material PAYMENT TOTALS WORK COMPLETED MATERIALS TOTAL SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF VALUE APPLICATION D TH15 PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) , VARIABLE RATE) $5,000.00 ( + E) D OR E) DATE $5,000.00 100.00% $5,000.00 $2,500.00 $2,500.00 $2,500.00 100.00% $15,000.00 $15,000.00 $15,000.00 100.00% $5,000.00 $5,000.00 $5,000.00 100.00% $22,000.00 $22,000.00 $22,000.00 100.00% $32,000.00 $32,000.00 - $32,000.00 100.00% $55,000.00 $55,000.00 - $55,000.00 100.00% $230,000.00 $216,878.00 $13,122.00 - $230,000.00 100.00% $75,000.00 $75,000.00 - $75,000.00 100.00% $23,300.00 $23,300.00 - $23,300.001 100.00% $8,000.00 $8,000.00 - $8,000.00 100.00% $4,500.00 $4,500.00 - - $4,500.00 100.00% $84,500.00 $84,500.00 - - $84,500.00 100.00% $45,000.00 $45,000.00 - - $45,000.00 100.00% $2,500.00 $2,500.00 - - $2,500.00 100.00% $4,000.00 $4,000.00 - - $4,000.00 100.00% $10,000.00 $10,000.00 - - $10,000.00 100.00% $22,000.00 $22,000.00 - - $22,000.00 100.00% $8,000.00 $8,000.00 - - $8,000.00 100.00% $24,000.00 $24,000.00 - - $24,000.00 100.00% $17,000.00 $17,000.00 - - $17,000.00 100.00% $30,000.00 $30,000.00 - - $30,000.00 100.00% $4,000.00 $4,000.00 - - $4,000.00 100.00% $80,000.00 $80,000.00 - - $80,000.00 100.00% $44,000.00 $44,000.00 - - $44,000.00 100.00% $445,500.00 $445,500.00 - - $445,500.00 100.00% $1,875,065.33 1 $1,837,575.33 $37,490.00 - $1,875,065.331 100.00% $250.00 $125.00 $750.00 $250.00 $1,100.00 $1,600.00 $2,750.00 $11,500.00 $3,750.00 $1,165.00 $400.00 $225.00 $4,225.00 $2,250.00 $125.00 $200.00 $500.00 $1,100.00 $400.00 $1,200.00 $850.00 $1,500.00 $200.00 $4,000.00 $2,200.00 $22,275.00 $93,753.27 Page 1 of 3 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Sentra-Sota Sheet Metal Inc. A B C D E WORK COMPLETED ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS NUM VALUE APPLICATION (D THIS PERIOD + E) — 27 238100 Packaged AC Units - $6,000.00 $6,000.00, Labor I 28 238100 Packaged AC Units - $25,000.00 $25,000.00 Material 29 238419 Desiccant Dehumid $40,000.00 $40,000.00 - Units - Labor 30 238419 Desiccant Dehumid $300,000.00 $300,000.00 - Units - Material 31 232100 Hydronic Piping $80,000.00 $80,000.00 - 32 Mobilization - Labor $1,000.00 $1,000.00 33 Mobilization - Material $500.00 $500.00 34 Ductwork - Labor $2,500.00 $2,500.00 35 Ductwork - Material $500.00 $500.00 36 Grilles/Registers - Labor $500.00 $500.00 37 Grilles/Registers - Material $200.00 $200.00' 38 Fans - Labor $1,000.00 $1,000.00 39 Fans -Material $1,000.00 $1,000.00 40 Permit $20,000.00 $20,000.00 1 HVAC (CO #1) $7,692.93 $7,692.93 1 HVAC (CO #2) $2,751.00 $2,751.00 1 HVAC (CO #3) $49,987.00 $49,987.00 1 HVAC (CO #4) ($17,750.00) ($17,750.00) 1 HVAC (CO #5) $7,784.00 $7,784.00 1 HVAC (CO #6) $4,485.00 $4,485.00 1 HVAC (CO #7) $3,750.00 $3,750.00 1 HVAC (CO #8) $12,276.00 $12,276.00 1 HVAC (CO #9) $9,166.00 $9,166.00 1 HVAC (CO #10) $8,718.00 $8,718.00 1 HVAC (CO #11) $2,673.40 $2,673.40 1 HVAC (CO #12) $5,164.00 $5,164.00 PAYMENT TOTALS $1,875,065.33 $1,837,575.33 $37,490.00 APPLICATION NO.: 12 APPLICATION DATE: 08/21/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 F G H MATERIALS TOTAL PRESENTLY COMPLETED STORED (NOT IN AND STORED TO D OR E) DATE $6,000.00 $25,000.00 - 1 $40,000.00 $300,000.00 % BALANCE TO RETAINAGE (IF (G + C) FINISH (C - G) VARIABLE RATE) 100.00% 100.00% 100.00% 100.00% $80,000.00 100.00% $1,000.00 100.00% $500.00 100.00% $2,500.00 100.00% $500.00 100.00% $500.00 100.00% $200.00 100.00% $1,000.00 100.00% $1,000.00 100.00% $20,000.00 100.00% $7,692.93 100.00% $2,751.00 100.00% $49,987.00 100.00% ($17,750.00) 100.00% $7,784.00 100.00% $4,485.00 100.00% $3,750.00 100.00% $12,276.00 100.00% $9,166.00 100.00% $8,718.00 100.00% $2,673.40 100.00% $5,164.00 100.00% $1,875,065.331 100.00% $300.00 $1,250.00 $2,000.00 $15,000.00 $4,000.00 $50.00 $25.00 $125.00 $25.00 $25.00 $10.00 $50.00 $50.00 $1,000.00 $384.65 $137.55 $2,499.35 ($887.50) $389.20 $224.25 $187.50 $613.80 $458.30 $435.90 $133.67 $258.20 $93,753.27 Page 2 of 3 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Sentra-Sota Sheet Metal Inc. APPLICATION NO.: 12 APPLICATION DATE: 08/21/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D IE F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF NUM DESCRIPTION OF WORK VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) + E) D OR E) DATE 1 HVAC (CO #13) $680.00 $680.00 $680.00 100.00% $34.00 1 HVAC (CO #14) $1,688.00 $1,688.00 $1,688.00 100.00% - $84.40 PAYMENT TOTALS $1,875,065.33 $1,837,575.33 $37,490.00 - $1,875,065.33 100.00%1 $93,753.27 Page 3 of 3 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 $99,529.23 $1,886,443.23 $1,886,443.23 $94,322.15 $94,322.15 $1,792,121.08 $1,769,139.15 $22,981.93 $94,322.15 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $135,160.65 $44,468.59 Total approved this month $8,837.17 $0.00 TOTALS $143,997.82 $44,468.59 NET CHANGES by Change Orders $99,529.23 Application No.: 12 Period To: 08/31/20 Application Date: 08/19/20 Project No.: 19520-0033 Contract Date: 08/01/19 Commitment: 195200033-260105 The undersigned Contractor certifies that to the best of the Contractors 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: 08/20/20 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 $22,981.93 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar Design Electric, Inc APPLICATION NO.: 12 APPLICATION DATE: 08/19/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A B C D E F G H ITEM DESCRIPTION OF WORK I SCHEDULED NUM VALUE 1 BOND/PERMIT $35,908.00 /MOBILIZATION 2 SITE WORK/UNDERGROUND $33,158.00 3 DEMOLITIONTrEMP WIRING $64,200.00 4M CONDUIT - MATERIAL $122,167.00 4L CONDUIT - LABOR $180,320.00 5M BOXES/WIRE/DEVICES - $110,400.00 MATERIAL 5L BOXES/WIRE/DEVICES - $67,200.00 LABOR 6M FIXTURES - MATERIAL $425,654.00 6L FIXTURES - LABOR $90,400.00 7M GEAR - MATERIAL $145,168.00 7L GEAR -LABOR $38,400.00 8M LOW VOLTAGE ROUGH -IN - $46,722.00 MATERIAL 8L LOW VOLTAGE ROUGH -IN - $73,120.00 LABOR 9M EQUIPMENT CONNECTIONS $68,400.00 - MATERIAL 9L EQUIPMENT CONNECTIONS $12,200.00 -LABOR 10M FIRE ALARM - MATERIAL $84,697.00 10L FIRE ALARM - LABOR $20,000.00 11M SOFTBALL FIELD - $153,200.00 MATERIAL 11 L SOFTBALL FIELD - LABOR $15,600.00 12 1 Electrical (CO #1) $945.49 PAYMENT TOTALS $1,886,443.23 WORK COMPLETED MATERIALS TOTAL FROM PREVIOUS PRESENTLY COMPLETED % APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G = C) + E) D OR E) DATE $35,908.001 - $35,908.00 100.00% $33,158.00 - $33,158.00 100.00% $64,200.00 - $64,200.00 100.00% $122,167.00 - - $122,167.00 100.00% $180,320.00 - - $180,320.00 100.00% $110,400.001 - - $110,400.00 100.00% $67,200.00 - $67,200.00 100.00% $425,654.00 - $425,654.00 100.00% $88,592.00 $1,808.00 - $90,400.00 100.00% $145,168.00 - $145,168.00 100.00% $38,400.00 - $38,400.00 100.00% $46,722.00 - $46,722.00 100.00% $73,120.00 - $73,120.00 100.00% $68,400.00 - $68,400.00 100.00% $12,200.00 $12,200.00 100.00% $83,003.06 $1,693.94 $84,697.00 100.00% $19,600.00 $400.00 - $20,000.00 100.00% $153,200.00 - - $153,200.00 100.00% $15,600.00 - $15,600.00 100.00% $945.49 $945.49 100.00% $1,862,251.731 $24,191.501 $1,886,443.23 100.00% BALANCE TO RETAINAGE (IF FINISH (C - G) VARIABLE RATE) $1,795.40 $1,657.90 $3,210.00 $6,108.35 $9,016.00 $5,520.00 $3,360.00 $21,282.70 $4,520.00 $7,258.40 $1,920.00 $2,336.10 $3,656.00 $3,420.00 $610.00 $4,234.85 $1,000.00 $7,660.00 $780.00 $47.27 $94,322.15 Page 1 of 2 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO.: 12 containing Contractor's signed Certification is attached. APPLICATION DATE: 08/19/20 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 08/31/20 Design Electric, Inc PROJECT NO.: 19520-0033 A B C F G H l I D E WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF FROM PREVIOUS NUM VALUE APPLICATION (D THIS PERIOD STORED (NOT IN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) + E) $1,340.58 - D OR E) DATE $1,340.58 100.00% $67.03 1 Electrical (CO #2) $1,340.58 1 Electrical (CO #3) $1,582.00 $1,582.00 - $1,582.00 100.00% $79.10 1 Electrical (CO #4) ($24,378.00) ($24,378.00) - ($24,378.00) 100.00% ($1,218.90) 1 Electrical (CO #5) ($12,693.73) ($12,693.73) - ($12,693.73) 100.00% ($634.69) 1 Electrical (CO #6) $396.52 $396.52 - $396.52 100.00% $19.83 1 Electrical (CO #7) $2,162.06 $2,162.06 - $2,162.06 100.00% $108.10 1 Electrical (CO #8) $7,694.97 $7,694.97 - $7,694.97 100.00% $384.75 1 Electrical (CO #10) $5,773.48 $5,773.48 1 - - $5,773.48 100.00% $288.67 2 Joist Work - Electrical (CO #9) $24,561.00 $24,561.00 - - $24,561.00 100.00% $1,228.05 1 Electrical (CO #7) $1,035.41 $1,035.41 - - $1,035.41 100.00% $51.77 1 Electrical (CO #7) $12,342.68 $12,342.68 d - $12,342.68 100.00% $617.13 1 Electrical (CO #7) $1,170.60 $1,170.60 it - $1,170.60 100.00% $58.53 1 Electrical (CO #7) ($7,396.86) ($7,396.86) - ($7,396.86) 100.00% ($369.84) 1 Electrical (CO #11) $42,232.20 $42,232.20 - $42,232.20 100.00% $2,111.61 1 Electrical (CO #12) $12,952.00 $12,952.00 $12,952.00 100.00% $647.60 1 Electrical (CO #13) $1,677.13 $1,677.13 $1,677.13 100.00% $83.86 1 Electrical (CO #14) $9,491.86 $9,491.86 $9,491.86 100.00% $474.59 1 Electrical (CO #15) $1,044.26 $835.41 $208.85 $1,044.26 100.00% $52.21 1 Electrical (CO #15) $5,221.53 $4,177.23 $1,044.30 $5,221.53 100.00% $261.08 1 Electrical (CO #16) $3,536.88 $2,829.50 $707.38 $3,536.88 100.00% $176.84 1 Electrical (CO #17) $2,741.41 $2,741.41 $2,741.41 100.00% $137.07 1 Electrical (CO #18) $1,389.62 $1,389.62 $1,389.62 100.00% $69.48 1 Electrical (CO #19) $356.00 $356.00 $356.00 100.00% $17.80 1 Electrical (CO #19) $1,759.00 $1,759.00 $1,759.00 100.00% $87.95 1 Electrical (CO #20) $2,591.14 $2,591.14 $2,591.14 100.00% $129.56 PAYMENT TOTALS $1,886,443.23 $1,862,251.73 $24,191.501 $1,886,443.23 100.00% $94,322.15 Page 2 of 2 79, 0 P O -� < n a1 Lyl cr Q O ^' fl o N CD fii CD C CD v m CO) n m 0 Z U) -v z O 90 Z =mom Z m C O O o o a Z Y m r Z r o o o 0 6 69 W W W W�'Gq a _ CO CO 4 O in Boa M 0 0 0 CW 3 D o z m o =oOo 0 C�cn 0 = rnMCm mj mCD °1 CTi Z 4 �Z NZ m Q C 4 ,n m X � y C c m mCA mrn y m A a W O = v � v z m m � � O X m O x � � v < m a r O Z C— O Z O v Om O C> m Zi -ll Z > N) °° N v CD CD N o m 0 rry � O O CD Cl) -a'rn 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 Period To: 08/31/20 Golden Valley, MN 55427 From: Action Fence, Inc. Application Date: 08/13/20 PO Box 1065 Project No.: 19520-0033 Burnsville, MN 55016 Contract Date: 08/15/19 Contract For: 195200033-015610 - Temp. Fencing w/ Commitment: 195200033-015610 Standard Screening 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) $29,980.00 $1,325.00 $31,305.00 $31,305.00 $1,565.25 $1,565.25 $29,739.75 $26,958.15 $2,781.60 $1,565.25 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months $1,325.00 $0.00 Total approved this month $0.00 $0.00 TOTALS $1,325.00 $0.00 NET CHANGES by Change Orders 1$1,325.00 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: Carrie Cummins Date: 08/13/20 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 $2,781.60 (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 CONTINUATION SHEET APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed Certification is attached. In tabulations below, amounts are stated to the nearest dollar. Action Fence, Inc. APPLICATION NO.: 4 APPLICATION DATE: 08/13/20 PERIOD TO: 08/31/20 PROJECT NO.: 19520-0033 A— B - -C D i E T F G H WORK COMPLETED MATERIAL TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED % BALANCE TO RETAINAGE (IF DESCRIPTION OF WORK APPLICATION (D THIS PERIOD D OR E) DATE NUM VALUE STORED NOT IN AND STORED TO (G + C) FINISH (C - G) VARIABLE RATE) +E 1 Construction Fence $29,980.00 1 Temp. Fencing w/ Standard $450.00 Screening (CO #1) 1 Temp. Fencing w/ Standard $450.00 Screening (CO #2) 2 COVID-19 Testing/Safety (CO $425.00 #3) PAYMENT TOTALS $31,305.00 $27,052.00 $2,928.00 $29,980.00 100.00% $450.00 $450.00 100.00% $450.00 $450.00 100.00% $425.00; $425.00 100.00% $28,377.001 $2,928.00 - $31,305.001 100.00% $1,499.00 $22.50 $22.50 $21.25 $1,565.25 Page 1 of 1