HomeMy WebLinkAbout4.h. Approve Application for Payment #1. Jaycee Park Phase I Grading & Utilities ` • �
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CITY OF ROSEMQUN"T
APPLICATION FOR PAYl�NT
NO. �_
CITY PROJECT NO: , g g SEH FILE NO: �g Z'],s'
PROJECT: J �c.e ��+-�'� " pha,te J.- vta-d�� a �7t'{ �OhSTrU�oh.
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CONTRACTOR: �►ow�� Cr�:S .Zwc CQNTRA,CT DATE: s��b�Pj9
�/�7 '�4 /�'ea.ric,lr f}Ve„ APPLICATION DATE: � Z 89
�--a-Ke v►t�-e, �11/U sS0 44. FOR PERIOD ENDING: S�.�/��9
Total Contract Amount $ 99, 6Z7 9--.� Tptal Amount Earned $ '�'t� 9p—
Matezial Suitably Stored on Site,
Not Incorporated into Work S
Contract Change Order No. Percent Complete $
Contract Change Order No. Percent Complete $
Contract Ghange Order No. � Pereent Complete $
GROSS AMOUNT DUE . . . . . . . . . . . . . . . . . . . . . S�U J �
LESS � $ RETAINAGE . . . . . . . . S Z�-�, �
. . . . . . . . . . .
AMOUNT DUE TO DATE . . . . . . . . . . . . . . . . . . . . $ 7S S�'�j �
LESS PREVIOUS APPLICATIONS . . . . . . . . . . . . $ Q
AMOUNT DUE THIS APPLICATION . . . . . . . . . . . $ TS�'a �
1�/�r D• `
� � G�z �q
l
Richard M. 3.,
City Engine / irector of Public Works �;��Fl��
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APPLICATION FOR PAYMENT - . -- -- _ , _ �
(UNIT PRICE CONTRACT) - - -- ; � , , ,
NO.--1---- s'!''j r' �
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. . . . . . . .. . . . � ., . . . ...l•. . . .
OWNER: CITY OF ROSEMOUNT OWNER'S PROJECT NO. 198, 1989-6
ENGINEER'S PROJECT NO. 88221
LOCATION: ROSEMOUNT, MINNESOTA
CONTRACTOR HROWN AND CRIS, INC. CONTRACT DATE
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19740 KENRICK AVENUE CONTRACT AMOUNT $99, 627.90
LAKEVILLE, MINNESOTA 55044
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CONTR. FOR JAYCEFs PARK - PHASE I
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AFPLIC.DATE June 2 1989
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PERIOD END.
__Ma� 31�_1989_�______�____
APPLICATION FOR PAYMENT
CCENTRACT QUANTITY UNIT
DESCRIPTION UNIT QUANTITY T� DATE PRICE TOTAL
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SECTION I — SANITARY SEWER
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0256.406 6" PVC, 0'-8' DEEP L.F. 318 11.00 $
0256.406 6" PVC, 8'-10' DEEP L.F. 276 11.00 $
0256.406 6" PVC, 10'-12" DEEP L.F, 70 11.00 $
0256.701 STD MANHOLE, $' DEEP EACH 2 $60.00 $
0256.702 EXCESS DEPTH STD MH L.F. 1 50.00 $
025b.900 CUT INTO EXISTING MH EAGH 1 325.00 $
FAGE 1 OF 4 SHORT—ELLI�TT—HENDRICKSON, INC.
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SECTION II - WATERMAIN
0257.404 4" DIP WATERMAIN, CL 52 L.F. 50 12.75 $
0257.604 4" RS GATE VALVE & BOX EACH 1 272.OQ $
0257.406 6" DIP WATERMAIN, CL 52 L.F. 760 13.75 $
0257.410 10" DIP WATERMAIN, CL 52 L.F. 420 1$.75 S
0257.606 6" RS GATE VALVE & $OX EACH 2 312.00 $
0257.630 FITTINGS LESS THAN 12" LB. 4Q0 0.01 $
0257. 640 FIRE HYDRANT EACH 1 1135.D0 $
0257.710 1° COPPER SERVICE L.F. 105 6.95 $
0257.730 1" CORPORATION EACH 2 65.OQ $
0257.740 1" CURH STOP EACH 2 100.00 $
Q257.903 CONNECT TO EXISTZNG WM EACFI 1 325.00 $
SECTION III - STORM SEWER
0258.412 12" RCP STORM SEW CL IVT L.F. 131 18.15 $
0258.700 DRY WELL L.S. 1, 1550.00 S
0258.704 CATCHBASIN, TYPE X L.F. 5 94.0o s
Q258.705 CATCHHASIN, TYPE Y L.F. 5 1I4.00 $
0258.808 R 3067 CB CASTING EACH 3 25Q.00 $
0258.809 R 2501 ,CB CASTING EAGH 1 200.0� $
0258.932 CUT INTO EXISTING MH EACH .� 1 325,00 $ '
SECTION IV - GRADING
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2101.502 CLEARING TRE�S 5 � 4 40.00 S i60.00
2101 .507 GRUHHING TREES 5 4 40.00 $ 160.00
2104. 501 RMV CONC CURB & GUTTER L.F. 40 2.00 $
2104. 501 RMV INPLACE 6" GAS LINE L.F. 100 3.00 S
21Q5. 501 C(}MMON EXCAVATION C.Y. 102Q0 3,000 1.50 $ 4,500.0�
2105. 535 SALVAGED TOPSOIL C.Y. 3950 1.00 $
PAGE 2 OF 4 SHORT-ELLIOTT-HENDRICKSON, INC.
E a • !
�5'75. 502 SEEDING LH. 770 4.00 S
2575.511 MULCH MATERIAL, TYPE I TON 1� 140.00 $
2575.519 DISC ANCHORING ACRE 5 40.00 $
2575.532 FERTILIZER LB. 15�40 0.15 $
0259.901 SILT FENCE � L.F. 2050 1.D0 $
2573.501 STRAW BALES EACH 10 5 4.00 $ 20.00
SECTION V - PARKING LOT GONSTRUCTION
2111.501 TEST ROLLING L.S. I 300.OQ $
2112.501 SUBGRADE PREPARATION L.S. 1 1300.00 $
2211. 503 AGG BASE PLACED CL 5 C.Y. SOQ 9.88 $
2331.504 BIT MATERIAL FOR MIXTURE TON 18 128.00 $
2331.514 BASE COURSE MIXTURE TON 390 11.40 $
2341. 504 BIT MATBRIAL FOR MIXTURE TON 25 12$.00 S
2341. 508 WEARiNG COURSE M�XTURE TON 39Q 12.40 $
2357. 502 BIT MAT FOR TACK COAT GAL 240 2.2Q $
2506. 522 ADJ FRAME & RING CASTING EACH 1 150.00 $ •
2531. 501 CONC CURH & GUTTER, L.F. 1670 5.50 $
DES H618
2531. 507 7" CONCRETE DRIVEWAY S.Y. 20 21.00 $
PAVEMENT
PAGE 3 OF 4 SHORT-ELLIOTT-HENDRICKSON, INC.
�PPLICATION FOR PAYMENT - Conti�d
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' Total Contract Amount 5_99 .627 . 90 Total Amount Earned $ 4,�'+0.��
Material Suitably Stored on Site, Not Incoporated into Work g o.00
Contract Change Order No. Percent.Compiete $ -
Contract Change Order �lo. percent Complete $ -
Contract Change Order No. Percent Complete g -
GROSS AMOUNT OUE, , , , , , , , , , , , , , b 4,840.�0
LESS 5 X RETAINAGE. . . . . .. . . � ?�2.no
AN�UNT DUE TO DATf. . . . . . . . . . . . . $ 41598.00
LESS PREVIOUS APPLICATIONS. . .. . $__ 0.00
AMOUNT DUE THIS APPLICATION. .. . $ �,598.oc�
CONTRACTOR'S AFFIDAVIT
he undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress.
payments received from the Owner on account of work performed under the contract referred to
above have been applied by the undersigned to discharge in full all obtigations of the u�der-
signed incurred •in connection with work covered by prior Applicatians for Payment under said
contract, and (2) a11
material and equipment incorporated in said Pro,�ect or otherwise listed in or covered by this
Application for Payment are free and clear of all liens, claims, security interests and
encumbrances.
Dated �'a-� � �' , 19 `j` . $rown and Cris Inc .
C a�r
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BY -'� --- i..F� c � ' �.. .
" me � d Title ,
COUNTY OF �i���; t_. ) SS J
�TATE OF � ��„� �� ti�c �� I ��. �
3efore me on this ,1,� �� 5��'
day of � `,�.� ti�C. 19 ,
. ��, �, ,' , �--. . persona l ty appea red
l � � y`- own to m e, w—T i o b e i n q u y s w o r n, d 1 d d e p o s e
in d say t hat he � th� �� C � i�' � of the Contractor above rnentioned;
ice
that he executed the above Application for Payment and Affidavit on behalf of safid Contractor;
and that all of the s true, correct and complete,
NMICY J.80YliM �
My Commission Expires: �� `r �cZ } �:'� _ '-, � ';,' � � ,` , � ;, �
MrOo�aw�enE�n.w��.tao�t Notsry i c .�
The undersigned has checked the ontractor s pp ication for Payment shown above. A part of
this Application is the Contractor's AffYdavit stating th�t dll previous payments to him
under this Contract have been applied by h9m to discharge in full all of his obligations in
connection with the work covered by all prior Appllcations for Payment.
In accordance with the Contract, the undersigned approves payn�nt to the Cantractor of the
Amount Due.
Oate �1��� SHORT T H RICKS4N I
By
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