HomeMy WebLinkAbout4.m. Authorize Payment #5 for Shannon Oaks Street Construction, City Project #185, Conr. #1988-5 �� A/� �j�
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APPLICATION FOR PAYMENT cMt)�� _�.j.,,�r� ;��'.;��tC;iS0i�1. IfdC.
CITY OF ROSIIKOtJNT
APPLICATION FOR PAYMENT
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CITY PROJECT NO: �SS� SEN FILE NO: S�/�-¢
PROJECT: S�la.r.►�,c�. �a,.,k.S S'�"�',e��i..s"�c.-�.o�, Ccf'vT� /`Jc�j� j
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CONTRACTOR: _�/'�t�+K t ndcr i �oa.cjcr,a�s �,CONTRACT DATE: ��� �$
ZBZS C¢.�o�,� �/'e..So. APPLICATION DATB: 7I�2-�SS�
' mJd�S. .I�� S�-�O� FOR PERIOD ENDING: � �9
Total Contract Amount S �.�6,�8� `s-� Total Amount Earned S_ /6S/ ��Z¢�
Material Suitably Stored on Site,
Not Incorporated into Work �
Contract Change �rder No. � percent Compiete OU�o S_ ,�.�3� �
Contraot Change Order No. Percent Compiete S
Contract Change Order No. Percent Complete �
GROSS AMOUNT DUE . . . . . . . . . . . . . . . . . - • g � '�3� �Zp 70
LESS �$ RETAINAGE . . . . . . . . . . . . . . . . . . $ 8 �S,�i 04
AMOUNT DUE TC? DATE . . . . . . . . . . . . . . . . . . . $ �t�3gj �tS'�' 66
LESS PREVIOUS APPLICATIQNS . . . . . . . . . . . . S �S7�OZS �
AMOUNT DUE THIS AFFLICATION . . . . . . . . . . . $ z q-jg �
O D: �
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iGhara . H "i� ,
City Enginee � rector of Aublie Works
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2116.5Q3 AGGRCGATE HACKFILL C.Y. 15�4 ��U.6,Q 2.50 $ 7�g65.00
2211, 593 AGG. HASE PLACED. CL 5 C.Y, 3190 ��19Q.Q 7,75 $ 2�,722.50
0211.594 4" AGG BASE FOR SIDEWALK,S,F 2I760 24�543.0 d,l� $ 3,926.88
2341.504 HIT. MAT. FOR MIXTURE TON 13? 108.0�+ 140.00 $ 15,125.6Q
2341.508 WEARING COURSE MIXTURE TON 1530 1,4i7.93 9,gp $ 14,037.50
2341.519 BINDER COURSE MIXTURE TON 90U 845.66 7.$Q $ 6,596.14
--_,.,
2357.502 BIT. MAT. FOR TACK COAT GAL. 40C? 325.0 1,25 $ 406.25
2501.511 15" RC PIPE CULVERT CL 5 L.F 225 _l�p^Q I8.00 $ 2,340.00
2501.515 15" RC PIPE APRON
W/TRASH GUARD EACi�I 4 2.0 20Q.QQ S 400.OQ
2511.501 RANDOM RIPRAP, CL III C.Y. 12 6.0 5C1.00 $ 300.00
2511.515 GEOTEXTILE FILTER S.Y. 28 �4.0 2.OQ $ 28.00
2521.511 2" HITLJMINQUS WALK S.F. 21?60 �� ��g,p Q.28 $ 6,108.48
2554.501 PERMANENT BARRICADES L.F. 16 ��;.0 31•25 $ 500.OQ
2564.53I F & I SIGN PANELS,
TYPE C S.F. 45 42.45 14.75 $ 626.14
0564. 603 4" WIDE SOLID LINE,
�€ELLQW PAINT L.F. 5400 5,360.0 0,19 $ 7-�018.4�
Q564.603 4" WIDE SQLID LINE,
WHITE PAINT L.F. 115 115.0 Q.19 $ 21.85
2575.501 ROADSiDE SEEDS�NG ACRE 4.p g•o 295.0� S 2,3so.oa
2575. 5�2 SBED MIXTURB � I,pS. 200 27s.p 3.03 $ �25.��
2575.511 MtTLCH MATERI�L, TYPS 1 TON g 15.0 200.QO $. 3,040.00
2575.519 DISC ANCHORING ACRS 4.0 8.0 55.00 $ 4��.p0
PAGE 2 QF 3 SHORT-ELLIOTT-HENDRICK50N , INC.
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� AP�CATION FOR PAYMENT - Continued� �
Total Contract Amount � 136, 381 .SO Total Amount Earned $ 163,�s2.49
Material Suitably Stored on Site, Not Incoporated into Work $
Contract Change Order No. 1 Percent_Complete loo� $ �,33s.21
Cantract Change Order No. Percent Complete $ '
Cantract Change Order No. Percent Complete $
GROSS AMQUNT DUE. . .. . . . . . . .. . $ 1�3,120.�0
LESS 5 % RETAINAGE. . . .. .. . . $ 8,656.04
. AMOUNT DUE�TO DATE. . . . . . . . . . . . � 164,46�.ss
,.
L�SS PREIlIQUS APPLICATIDNS, . . . . $ 1s�,�25.4�
AMOUNT DUE TNIS APPLICA7i0N. .. . � 7?439•24
CQNTRACTOR'S AFFIDAVIT
The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress.
payments received from the Owner on aceount of work performed under the contract referred to
above have been applied by the undersigned to discharge in fu11 ail obligations of the under-
signed incurred in connection with work covered by prior Applications for Payment under said
contract, and (2) all
material and equipment incorporated in said Pro,�ect or otherwise listed in or covered by thts
Application for Payment are free and clear of all liens, claims: security fnterests and
encumbrances.
i�ated July 12, 1989 � lg . Bituminous Roadwa s Inc.
Can tor
By____� -� �':�' �__
Name and Title %
COUNTY OF Dakota � �S Norman C. Hagen Vice resident
STATE OF inneso a
3efore me on this 12tn day of �Julv , 19 �9 �@rSOiid�i,y dj�pfe����
Norman c� a'�en' nown to me, w o being c?uTy swvrn, did depose
�nd say that he is the of the Contractor abave �entioned;
ce
that he executed the above Apptication for Payment and Affidavit on behalf of said Contractor;
and that all of the statements contained therein are true, correct and con�lete.
My Commission Expires: � �}I . NSE ?���.�f'�j �1rf• �«�, :
��" � -.�.NOTARY ?U9lIC-MiflNESOTA NOt'1{I"�/ U `1 C
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a.,,;:;� �'�`;407t1 CQU W I(
The undersigned has ch���� -,mT' sion x;:;� s A1ar. G9. tr�� p�ication for Payment shown above. A part af
this Application is th� Contractar's Afftdavit stating that all previous payments to him
under this Contract have been appiied by fiim to discharge in full all of Mis obligations #n
connection with the work covered by ail prior Applications for Payment.
In accordance with the Cantract, the undersigned approves payment ta the Contractor of the
Arrrount Due.
� 1 �I �S� SHORT TT �RIC N INC.
Date By
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