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HomeMy WebLinkAbout4.m. Payment #7 and Final, O'Leary's Hills 5th Addition, City Project #232 i �� CITY OF ROSEMOUNT EXECUTIVE SUMMARY FOR ACTION CITY COUNCIL MEETING DATE: September 6, 1994 AGENDA ITEM: Payment #7 & Final, O'Leary's Hills 5th AGENDA SECTION: Addition, City Project #232 Consenfi Agenda PREPARED BY: Bud Osmundson ��� AGENDA ryQ.E City Engineer/Public Works Director ! ( � # �.�. � ATTACHMENTS: Payment Voucher #7 & Final APPROVED BY: This item requests the seventh and final payment to Arcon Construction Co. in the amount of $29,113.83 for City Project #232, O'Leary`s Hilfs 5th Addition. The total original contract amount was 5537,666.26. With this final payment, the total construction contract amount is $549,053.58 or about 510,000 more than the original bid. This is due to the fact that a substantial amount of old existing storm pipe was replaced to improve flow capacity. With this final payment, a two year warranty period begins (until September 6, 1996) on the streets and utilities. The City also accepts these facilities for perpetual maintenance. Attached is a copy of the pay voucher for your information. Staff recommends approval of this seventh payment request. RECOMMENDED ACTION: MOTION TO APPROVE PAYMENT #7 TO ARCON CONSTRUCTION CO. IN THE AMOUNT OF 529,113.83 FOR O'LEARY'S HILLS 5TH ADDITION STREET AND UTILITY IMPROVEMENTS, CITY PROJECT #232 AND THE CITY ACCEPTS THE STREETS AND UTIUTIES FOR PERPETUAL MAINTENANCE. COUNCIL ACTION: 6 .� MEMORANDUM - �ST.PAUL,MN ❑ MINNEAPOUS.MN L� ST.CLOUD:MN � CHIPPEWA FALLS,WI ❑ MADISON, WI TO: Bud Osmundson,P.E.,City Engineer FROM: David F. Simons,P.E. DATE: August 23, 1994 RE: Rosemount,Minnesota O'Leary's Hills 5th Addition City Project No. 232 SEH No:A-ROSEM2410.01 Enclosed is Application for Payment No.7(Final)for the above referenced project. The amount due is$29,113.83. All work has now been completed on the project,and the final quantities have been determined. We recommend that the City approve the final payment,but hold the contractor's check until all close out documents have been submitted. The contractor has been notified of the required close out documents. Note that the total amount earned of$549,053.58 exceeds the contracf amount by about$10,000. This is due to the storm sewer replacement work that was added to the project last summer. As you may recall,approximately$40,000 worth of storm sewer work was added near Wachter Pond. The existing 42 inch CMP was replaced with a 60 inch CNIl'to improve flow capacity. Savings in other parts of the project(about$30,000) offset most of the extra cost. Please call me at 490-2066 if you have any questions. tlo Attachment - � CITY OF ROSEMOUNT I� APPLICATION FOR PAYMENT I NO. 7 (FINAL) CITY PROJECT NO: 232 SEH FILE NO: A-ROSEM2410.01 PROjECT: O'LEARY'S HILLS 5TH ADDTTION CONTRACTOR: Arcon Construction Co.,Inc. CONTRACT DATE: 11-4-92 903 East Forest Avenue APPLICATION DATE: 8-19-94 Mora,MN 55051 FOR PERIOD ENDING: 8-19-94 Total Contract Amount$ 537,666.26 Total Amount Earned $ 549,053.58 Material Suitably Stored on Site, Not Incorporated into Work $ Contract Change Order No. _ Percent Complete $ Contract Change Order No. _ Percent Complete $ Contract Change Order No. _ Percent Complete $ GROSS AMOUNT DUE . . . . . . . . . . . . . . . . . . . . . . . : . $ 549,053.58 LESS 0%ItETAINAGE . . . . . . . . . . . . . . . . . . . . . . $ 0.00 AMOUNT DUE TO DATE . . . . . . . . . . . . . . . . . . . . . . . . $ 549,053.58 LESS PREVIOUS APPLICA'TION . . .. . . . . . . . . . . . . . . . . $ 519,939.75 AMOiJNT DUE THIS APPLICATION . . . . . . . . . . .. . . . $ 29,113.83 APPROVED: . ��� �-�-- Bud Osmundson City Engineer/Director of Public Works .i0�8/23/94 Oi:52 $612 679 22�� ARCON CONST. C0. C�002 . � . OB/li•/94 14:41 �g12 6i9 2244 ARCON CoNST. Co. l�002 APPLICATION FOR PAYMEN'P (UNIT PRICE CQ1�t�P'RACT) NO_ F�IiTAL , �WNER: ROSEM�UNT, MINNESaTA OWNER'S PROJECT NO_ �32 ------------------------------------ ENGINEER'S PROJECT NO. 924Z0 ' �OCATION: O'LEARY'S HILLS STi� �DDITION ' :ONTRACTOR ARCON CONSTRUCTION CO. , INC_ CONTRACT DATE ----------------------------- 903 EAST FOREST AVE. CO1�T'�1�.ACT AMOUNT 553?,666.ZB MORA, MN 5505I :ONTR_ FOR O'LEARY' S HILLS STH ADDIT20N - UTILITY � STREET COAiSTRVCi`ION .P1�I,IC.DATE 'ERIOD END. ----------------------...... APPLICATION FOR PAYMENT �����/���Ar��►��MV.►������_ . . .. . CONTRACT 4Up.1�ITS2'Y UNIT nESCR2PTION UN2T QUANTITY TO DA�E " PRICE TOTAL {�1'SDULE A - SAi+FITARY SEWER �207.403 AEMOVE SA'�tITARF SEWER"` L.F. 60 sa 6.00 350_00 �20?.410 REMOVE MH DROP SECTZON L.F. �.3 5.3 50_0o a�s.oa �222.3.01 CRUSHED fiOCK PIPE , FOUi�tOATION . TON 50 �.00 �Z22_103 GRANUZAR PIPE FOUNDATION TON 5d 5.00 _ °222.307 FtEP7�ACEMENT SACKFILL TON � 100 5-�a 2'73.112 $"PVC SEWER,10'-15 t DEEP L_F. 371 ++8� 15.08 7.298.'I2 1273.I13 8"PVC SEWER, 15�-ZO' DEEP L.F. 949 , 836 . 15.38 12,857.68 'AGE 1 OF 8 SHORT-ELLIOTT-HENDRICKSON, iNC. 48/2�/94 07:52 $B12 679 22�4 ARCON COA'ST. C0. 1�003 . , o8i17/84 14:41 $B12 8i9 224� .4RCoN COPIST. Co. �oo� ' 3273_213 10"PVC SWR,15' -20' D£EP L.F. 210 202 30.27 6,114.5� �273_214 1Q"PVC SWR,20' -25' DEEP L.F. 187 195 30.27 5.,9�2.fi5 }273_215 lU"PVC SWR,25'-30' DEEP E,.F_ 38 38 �.�? 1,154.26 3 f 39. 08 ]273_225 10"DIP SWR,25' -30' DEEP , L_F. 84 gu 37_37 '_ ��y.�.,,6g. aa�3_so�. r�xoxa�, iof n�p �cx 7 7 �.i�o_oa e.zqa_oo )273.51i EXCESS MANHOLE nEpTH L.F_ fi4 52.50 55.60 2_glg.Op ?Z?3.6Z2 8" X 4" PVC WYE EACFI 3i 31 37.00 1.1�7_00 )273.�12 14" X �" PVC WYE EACH � 4 +� 72.00 288.00 ?273_OI.1 �' pVC SERVICE PIPE L.F. I3v0 1,��+8 5.74 8.311_52 _ �273.0l5 h R pvc Rzs� PIPS L.F. 319 ��s 5_�4 �_���.az 1273_531 CONi�tECT TO EXisTZHG r� sACH 1 1 360_00 36o.ao :CHEDULE 8 - WAT£RMAIN 725�.O�1 AGG. $AS� 1;�STOKATION IN.-S. 297 821 �.80 656.8Q 325g.031 BI�`. SURFACE RESTORATION IN.-5. 14Q ulz 6.30 2,589.3D )266.].Ob 6" DIP int.rL , CL. 52 L.F_ 1450 I,�+a 11,31 �s,2sS.�o ?2b6_30$ 8" DIP W.M_ , CL. 52 L.F- 902 1.00�F � 13.46 13.513.E34 )266.211 fi" GATF: VALVB A1�tD 80X �ACH 9 8 2E33.�O 2,26�t-.00 )256.212 S" GATE VALVE AND BaX ERCH 3 w.5_.--. -._. 378.00 1t890_oo � isss o�s a6�•�s� )265_181 DYP FiTTINGS LS. 1600 ��.s?' - 1.71 2,149�t?� )266.331 HYDR.ANT EAGH � � 1134.00 �+.S2o.ao � 7266.322 sALVACED HYDRANT EAcH i �. 240,oo �+�a.oa )256.411 I" CAPPER SSRVICE PIPE L.F. 1620 1,540 7.04 11,5�5_60 1265.421 1" CORPORATZON STOP EACH 35 35 35.00 2,225.00 )266.431 1" CURB STOP AND BOX EACH 35 35 67.50 2,362_50 )266.53.1 16" X 8,� PRESSURE TAP WI8" GATE VALVE AND BOX EACH 1 1 1340_00 1,300.00 _ )26fi.fill INSULATION SD.FT. 25b 255 1.00 256_oQ )266.531 CONNECT TO iNPLACE T�VM EACH 2 2 3.20.00 2�a.00: �AGE Z OF 8 SHORT-ELLIOTT-HENDRICKSON, INC. .�-8/23/9� 07:52 $612 6i9 22�� ARCON CONST. C0. C�004 OBl17/84 14:42 ''$'63,2 679 2244 r1RCOPI CONST. C0. I�]00� >CHEDULE C - STREETS ---------------------------___��_---- )150.51Q M�BILIZATION L.S. 1 ' 1 870�.00 8,700_OQ ' }157.201 TRAFFIC CONTROL L_S. 1 1_ 1500-00 1 QO_00 )ZQ7_QOl REMOVE CONC C � G L.F. 40 29 _ ' 4.QO i i�.00 l213.005 ROQC CONST. EI�TTRANCE EACH 3 3fl0.00 )222.501 Cot�tON EXCAYATI�N tLV) C.Y. � i000 2,_ 211 1.5D 3,+�a6.5o )222.6�1 GFt�,NULF►R BORROW (LV} C.Y. Z000 2._ 2�� 3-�0 8.032.50 - }222.701 TEST �ROLLING . R_S. 21 �.6 ZO_00 15.00 )2Z2.801 3U8GR�DE PREP?�RATI�N R.S_ 21 1S.12- 100.QO 1_5z2.00 }223.$03 �GG. BASE PLACED, CL. 5 C.Y. 1212 1_��_7 13.50 =c;.3C?_a0 �251_108 TYPE 41 WEARING COURSE MIXTURE TON 5$0 6r8 19_80 9.�.,27_6_�0 )251.110 TYPE 3I BASE COVRSE MI�TURE TON 580 5�� I8.80 zo_7s�.ao )252.201 COi�IC. CURB ANfl GUTTER L.F. .444. 0 rt�275 5-75 2�t.,5$1.25 1253.001 �" C�NCRETF WALK S.F. 1'!?0 �,752 1.55 2,715_60 )253_002 6" CONCRETE WALK S.F. 12� 120 1_90 228.00 ?254_702 B IT. MAT. FOR TACK C4AT GAL. 410 415 I.OQ +�15.00 )259_041 AGG_ BASE RESTORATION IN.-S. 222 316 O.80 2�2•8a �- )2S9.OlI BIT_ SURSACE RESTORATION IN.-S. lli 158 6.30 9�5.++0 )260.701 ADJUST FRAME S� RING CASTING EACH 15 _ �5__ 150.DO _�'�1 50.00 _ )250.703 AD�LTST V��E BOX EACH 7 7-- 100_00 70d.00 328�#.703 PERM3�NENT BARRICADES L.F. 32 �;+_ Z�_a0 �,�.�1,20 32.84.70Z STREET NAME SIGN � EACH 3 3. 2Z5.00 6T5.00 )293.00}1 SEEDING ACRS 1.2 1<2 280.00 33fi.�1fl )293.002 SEED, MIXTURE 600 LB. 88 88 _ 2-25 198.00 1293.005 SC?DDING, TYFE� LAWN S.Y. 1735 1_pQ0 1.Z8 1.280.00: �}293.011 MULCH MATERIAL, TYPE I TON 2.3 2.8 105.00 ' 29�_00 _ �AGE 3 OF $ SHORT-E'LLIOTT-HENDRICKSflN, INC_ OB/23/94 07:53 $612 679 224� ARCON CONST. C0. 1�005 � 06�1�7�9a ia:42 '�g12 ai9 2Za4 �RcaN CONST_ co. C�ooS 293.019 DISC RNCFIORZI�TG AGRE 1_2 1_2 48.00 S7.6d 293.�23 woon FIBER BLAN'KETS, TYPE HV 5_Y. 2Qa +_ 1-2�3 ' 293.03Z COM. FERTII�IZER, ArtALYSIS 1Z-12-12 L8. 120 1�0 O.Z3 32_20 611.ZZ3 2" NONNlFsTttiLLIC CONDUIT L.F. 2d� 320_ 6.00 1.920.00- CHEDULE D - STORM SEWER PHASE I: ��LEARY'S HILLS STH ADDITION ----------------------------------- �''$7 D�Fs 17o4.5'a •153_501 TEPiPORARY F£,NCZNG . - L_F. 600. _,� 3_50 �6b-.�o" ��5 �213.OOI BALE t�IECK L•A�II 30 6� 5_OO s35.00 �213.�03 SILT FENCE, PREASSEP�LED L.F. ' 300 7 2.00 1�.Q0 �227.�07 GROU'I'ED RIPRAP CL. III C.Y. 7 7 _ 90.00 630.00 �227.513 GRANZJLAR FILTER C.Y. 4 +� 20.00 80.00 �Z59.QOl AGG. BASE RESTORATION IN.-S. 164 A�0 Q.80 _ 656_.00 �259.011 BIT. SURFACE RESTORA.TION IN.-5. $2 �10 6.30 2,583.Od 1Z72.001 12" ACP CB LF.?�D. CL. IV L.F. Z�9 19_7 � ZZ.54 �,�0.38 I272.002 15" RCP CS LEAD CL. III L.F. 119 250_50 23.04 3,fi97.32 1Z?2.013 18"RCP STORM SWRr CL III L.F. 21$ 2fl.$9 �2?2.015 21"RCP STORM SWR, CL IZI L_F_ 13Q l3z 22.74 3,001.68 �272.016 24"RCP STORM SWFt, C'L lll L.F. 3'1 24.29 3272_O1? 2?"RCP STORM SWR. CL IIZ L-F- 637 �37 31_10 19.81fl.Z0 3272.018 �?"RCP STORM SWR, CL IV L_F. �2b 526 37.v9 z9,5o� �272.019 27"RCP STORM SWR, CL v L.F_ 85 9$ 53.2fl 5,'213.60 1272.03? 2�" RCP APRON WITR�,SH GUARD EACH 1 _ 7�t}.00 �+�a•_aa �272.0�41 MANHOLE. TYPE � L.F. 3.8_4 a.E�_53 153_00 2.850_39 -_ �2?2.Q42 MI�NHOLE, TYPE C L.F. 22_2 2_,,.3_24 lSfl_QO 3_9G�F.32 Z72.�43 MANHOLE, TYPE D L.F. 18.9 S9.p1 176.OD �7�_ •Z72_Od5 MANHOLE, TYPE F L.F. 16 8.� 3'60.00 ' 3.052.88 �272.051 CATCH BASIN, TYPE '�L L_P_ �i3.6 32.80 1�6.�Q +� 808. .�8 - 'AGE 4 OF 8 SHORT-ELI,IOTT-HET�TDRICKSON, INC. 0-8/23/94 Oi:53 $612 679 22�� ARCON CONST. C0. C�006 . ~ OS/17/94 14:43 $612 878 2244 e1RC0t�! COI�IST'. C0. C�DOB �Z72.QSZ CATCH BASZN, TYPE Y L.F. 14_8 20.�t3 Z5Z.00 3��.05.36 �-- �272.Q53 CATCH SASIN, TYPE C-1 L.F. 18_2 17.9? 186.00 3.,342_4� �Z�2.061 NII3 CAST2NG, TYPE R-I64Z EACH 8 6 Z52-00 z =��eo °292.bOZ CATC.EI BAS=NT CASTING, TYPE R-306�V FACH 16 14 290.00 �,oso.ov �29Z.071 CONNECT TO INPLACE STORM SEWER BACH 1 1 360.00 3fi4.o0 +293.00,5 SaDDING, �rYPE LAVdN . S_Y. 2050 3,�5q 1.28 z,s56_oo �293.032 COM_ F�RTILIZ£R, ANALYSZS 12 12-12 LB. C� 30 0.23 6.s0 :CiiEDUI,E E - STORM SEW£R PHASE II: ►'LEARY'S HILLS FlITURE ADDITIONS �1�3.502 TEMPORARY FENCING• L.F. 500 I00 3.�0 35o.Q0 �209.40Z RfiMOVE STORM SEWER L_F_ 430 502 4_00 2,u�04_o0 �Z07_409 REMOVE STORM SWR STRUC. EAGH 2 2 200.�0 �1fi0-00 �2I.1:502 CLEARING TREE 3 3 100.00 300_00 �21 I.507 GRUSBING TREE 3 3 54.00 150_oD� �22Z.103. CRUSfiED ROCK PIPE FOUNDATION TON 50 8-OQ � r222_1Q3 GRAMTLAR PIPE FOUNDATION TON 50 5.00 �Z22.107 REPLACEMEI�IT SACKFZLL TON �OQ 5.00 1259.00I AGG. BASE RESTOR.A'rION IN_-S_ 3335 3t184 0.80 Z,,5�7_20 1259.011 BIT. S1IRFACE REST0IZATION I1+1.-S. I668 1.�92 6.30 10_023.60 s272.OZ4 18"RCP ST�RM SWR, CL IV L.F. 1Q l0 24_45 249.54 +272.018 27"RCP STORM SWR, CL IV L_F. 693 6g3 3Q•82 Z1_358.26_ �Z72.019 27"RCP ST�RM SWR, Cr� V L.F. 238 225 41.Z9 3,290.2b 272.OZ0 . 36"RCP STORNi SWR, CL IV L.F. 309 386 48.84 3:�,9u5-d� 272.021 36"RCP STORM SWR, CL V L.F. 4$6 u8f 61.7Q 29,986.2fl ___ 272-022 48"RCP STORM SWR, CL IV L.F. 4Z5 8g5 79.65 �1,28s.�5 272_042 M,ANI30LE, TYPE C L.F. 73_9 i11.9� 146_00 is,3�a3.2u AGE 5 OF 8 SHORT-ELLIOTT-HENDRICXSON, INC_ 08/23/9� 07:54 $612 6i9 22�� ARCON CONST. C0. �007 ' 06/1•7/94 1�:43 �B12 679 2244 ARCON CONST. C0. �007 , �Z?2.043 MANHOLE, TYPE D L.F. ' 92.5 32_9 I81.20 5,961.�8 y272.Q44 MANXQLE, TYPE E L.F. � 41.6 35.�2 295.00 SO,�g.gQ �272_055 CATCI� BASIN, TYpS J L.F. 19 18_58 86.00 �_�g�.gg 1272.061 L�i CASTING, TYPE R-1642 EAC�i 12 12 ZSZ.00 3,o2�t.00 5272.Ob2 CATCFi SASZN CASTZxG, 1'YPE R-3057v EACH 1 1 290.t10 zso_aa �272_0?2 CDNNECT TO I1+rPLACE tyII3 EACH 1 2 360.00 �2a_oo �293.001 -SEEDING ACAE 2.5 2_9 280.00 812_4� �293.002 SEED, MIXTURE 6�0 LB_ 1Z �� 2.Z5 2u.75 �293.004 SEED, MIXTURE I100 LB. 189 1$g 0.38 ��.g2 )293.a05 SODDING, TYPE LAWN S.Y. 2IlI 2,585 1._78 3,310_08 �Z93.011 i�UzCs rtATERIAL, TYPE I TON 5 5.8 305_Ot� bo9_ao )293_019 DISC ArrCxORING ACRE Z_5 2.� h8.OO z39.2o 1293.023 WOOD FIBER BLANKETS, TYPE HV S.Y_ 200 1.�8 }293.032 COM. FERTILIZ�SR, ANALYSIS Z2-Z2-12 LB. 294 3�� 0.23 �$-89 ;QdEDULE F - STORM SEWER PHASE III: �OUTH ROfSE PARK ADDI'TION }207.402 RErtQVE S�ORM 58WER L.F. 65 ?� 6.00 4�4.00 �2i3.Q03 SZLT FFNCE, pREASSEMBLED L.F. 7�0 �29 1.5� 5+�3.50 )222.10Z CRUSHF'sD RDCK PIFE F'OUNDAT ION TON 50 8.fJ 0 )222,103 GRANU'LAR P3PE FOVNDATION TQN 50 5.00 1222.1Q� REPLACEMENT BAC�FILL T�N 3590 2_281 2.50 5,90�_50 �227.509 GRotrT� P.IPRAP Cr�. r�z c.Y. 6 6 90.00 s�o.Qo �227.513 GRANULAR FILTER C.Y. 3 `�.. 20.00 �p_pp �27�.012 35"RCP STORM ST�iR, CL I�7 I�.F. 385 385 20.60 7,.331.00 ` .,Z72.014 I.8"RCP STORM SWR, CL IV L�.F. Z54 15+t 22.10 3 �0� 3.�0_ 'AGE 6 OF � SHORT`-EI,LIDTT-HENDRICKSQN, INC. 08/23/9� Oi:5� $612 679 22�� ARCON CONST. C0. f�008 �oi s,r:nq i4:�:1 G�S1'L f3T9 2144 ARCOI+1 CONST. C0. �OU8 �272•033 1$" RCP APRON w/Tx�SH GUA.RD EACH 1 1 570.00. 57a.00 _._.— •272.Q41 MANHpLE, TYPE B L.F_ 37.I 3?.7 10Q_�0 �,,3,?85.08 �Z72.05I Mfi CASTING, TYPE R-1642 EACH , 3 3 252.00 ^�?55.00 2?Z_07I COlYNECl' TO INPLACE ' STORM SEWER EACFt - 1 1 360.00 360.OG �293.00I SEEDING ACRE Z.l 1 280.00 280_00 293.003 SEED, MIXTLFRE 800 LB. 170 170 Z-�5 280.So 293.0 Z]. MULCH.MATERIRL, TYPE 1 TON �4_2 2 'ZOS.00 210_00 �93.OI9 DISC ANCHORING ACRE 2.3 1 �8.00 u8_00 293_023 WOOD FIBER HLANKETS, TYPE HV - S.Y. 85Q0 ]._28 243_032 COM_ FERTILIZER, AI�iA. ANALYSIS 22-12-1� LB_ 212 �04 0_23 23.00 AGE 7 OF £3 SIiORT-ELLIOTT-T3ENDRICKSON� INC_ OB/23/94 07:54 $612 679 2244 ARCON CONST. C0. 1�009 APPL1CATiQN FOR PAYMENT-Con#inued . Sv�j oS3.Sf TOtal Contract Amount$ 537�665.26 Total Amount Eamed � r•' '"` "� Material Suitabiy Stared on Site, Not incorparated into Work $ Contract Ghange Order No_ Percent Compiete _ , _ $ --�-*g�'�'—�p, Contract Change Order No. Percent Complete $ Contract Change Order No_ Percent Complete � � " ...$ s-�,�-�:16 SQq�o535t GROSS AMOUNT DUE.....................• - �s LESS O % RE7AINAGE.........-•---....$ o.ao AMOUNT OUE TO OATE .....................$ , . ✓�`�,o�,�� • LESS PREV[�US APPLiCAT10N..........$ 519r939.�s v�' AMOUNT DUE THIS APPLiCATiC)N..___$ 3�-'sl z9,�t3.s3 Dy5 C4NTRACTOR'S AFFIDAVIT The undersigned Contractor hereby swears under penalty a# perjury that �1} aq previous progtess pay- ments recei�ed from the 4wner on account of wor#c performed under the contract referred #o above have beer� apptied by the undersigned to discharge in fuI! a!I obligations of the undersigned incurred in conneCt�on with work covered by prior Applications foc Payment ur�der said cvntract, and (2}ail rnateri- als and equipment incorporated in said Project or otherwlse listed in or c�vered by this Application for Payment are free and �l�ar of al[ liens, claims, security interests and encurnbrances. QBtBd Auaust 23 , ���. Arcon Construction Co_ , Inc. _ i{C'�ntractor} . By' ,�c, /��' — '— (Name and Title} GOUNIY OF xaaabec ) SS STATE CJF_ Minnesota } Before me on this z3 day of , Aa�g� , 19� persanai�y appeared Hici�ael nenker knawn to me, who being duly sworn, did depose and say that he is the sec=��/�����= of the Contractor above mentioned;that he � {Office) � execut�d the above Application for Payment and Affidavit o� behalf Qf said Contractor; and #hat alt af the statements contained therein are true, co�rect and complete_ „�,. ������� � � �V� ��� , ( �,.. ���� ��;���� My Commission Expires: �1-q-q� �`� {Nota ��s,u� YFie undersigned has checked the Contractar's Application for Payment shown above. A part of th=is Appiication is the Gontractor's Affidavit stating that al1 previaus payments ta him under this Contract have been applied by him to discharge in fuU aIl of his obtigations in connection with t�e wori�c cavered by a!t prior Applications for Payment. In accordance with the Contract, the undersigned approves payment ta the Contractor of the Amount Due. SHO LLb HE R[C ON, INC. Date g- �3 " � 4-- ey , .,��.�— Page 8 of 8