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HomeMy WebLinkAbout4.k. Application for Payment - Valley Oak Addition Phase IV • • C�.� OF ROS�O'11�T � ` � pA,��tiT APYL'IC�'Ti�N � NO• --�-�'" , ' -��� . S'�� �I�E N�' . .t��,f,�� � _�.,,,1^• ..� �� � t ; � t�-a��- 1"� (' �- Cx,�Y pRO�E�� N�� _ O� � [�d a) w � �,� $9 � � � ��'� TRACT QAT�• g C} �ROJ�CT% C4N �� "`�y K NuTso� pATE� t�. � T�.ON �� f�p AF CA � Cpr1TRACTOR� 1,�._1 G►+�t �VC�I.�S �i� pLi E�10� E�1`i'DINC'� �) �R F�� p E �yy s�33 U{��s�t4� � pZ � � �s3�.�- �, pn►ount �arned � � t�� � D ��Ta�al .�-►--'�-�"� . ..�-r. °�, ontra°� ��unt $ S�-te. T�tal C $tore�' ot� . $ SUitablY t4 �or�c omp1Qte s M o�in�r�P�rated �� No• �� pexGQnt C lete �----'" S N t �omp � � Chan9� Qr�e pe�'c�'n �oc�tr ac No, ____._, � �Qmple'�e ,.---�'-- t Chang� Ord�►� ,�green �� SZ 4 Cont�a� r NQ' --�''"` • , $� Gon�ra�� Ct'an9g �rde �E . . ' � � . . ' S� � . . , . GR�SS AMOVNT p � • , . • • ' ' $� S RET�IN�GE • • • $ • ' ' ' � "' . . . LES� Du� TD pATE • + � • $� . • • � AMpUN'� L;CP►T�O1'IS • ' ' � � � � • S� VIO�S APP , . . • �ESS FR� EtIS A�'pL�'CA'TI4N ' P�pUtyT DUE T ..,_�-• M . / /� / � � !�°' � �/� ��( �� g � � / ' f G Wotk� ` 1,i �.�-- � �, .C<..-�,�'� �ti.'� o Pub' r�t�` icr►a'�a M� 0 J��r�'��o= �itY En��'ne � . . . • _APPLICATION_FOR_PAYM�NT_ j� �i', �-,� T`-,� � �r � ��. .�I.J a lf �� �� . (UNIT PRICE CUNTRACT j S��f1Rt ELL10tT IIF�;;1�It;Ktit)� 1�t,. No,--1 --- .�UL. N�! Tr►�,,� �. ..,_�... ,-----, . : , ��� OWNER: CxTY QF ROSEMOUNT QWMER'S PR03�CT NO. ------------- �--------------------- �.96 , ENGINEER'S FROJECT NO. '------ -'89161' LOCATION: VALLEY OAK ADDN - PMAS� IV ----^--^^^- ---- CONTftACTOR RICNARD KIV�TSClt�T _CONTRACT DATE --------------------- 6/21/$9 --------- --------------------- ---- � 2Q1 TRAVLRL3 TRa►IL, SUITE 5 CpNTRAGT AMOUNT $i71,073.0U ----------------- ---------------- HURNSVILt,E, MN 55337 -------------------- ---------- CONTR. FOR VALLEY OAK ADDN, PHASE IV, ROSEMOVNT, MN APPI,IC.DATE 7/19/89 �------------------------------------------------- ------- PEI�IQD END. �/19/89 ��------------ r � �r�- � , APPLICATIOM FOR PAYMENT D�SCRTPTIpN CONTRACT QUAMTITY UNIT UNIT QUAMTITY TO DATE PRICE TfJTAL ------------------------ .,____-_-___,.__..__-------___..;�_,.....----;,----- SECTION l, - SANITARY SEWER U266.40$ 8" PVC, $' -10' DE�P �,.F. 56 221 8.5Q S 1,�'7$. 50 Q256.4Q8 $" PVC,, 10' -I;2' qEEF �,.F. .�QS 458 4.32 S 4,268. 56 ..�,a,,, 0256.408 S" PVC, 12'-14' D�EP L.F. 414 241 10.66 S �r142.66T I Q256.408 S" PVC. 14'-16' DE�SP L.F. 1?3 191 12.36 $ 2,364.7fi 0256.40$ g" PVC, 16'-18' DEEF L.F. 139 __ 13.86 $"� Q256.701 STD. MN, 8' DEEP EACH 5 � 8D4.6Q $ �,827.6Q Q256.702 EXCESS DEPTH STD. MH L.F. 29 23. 45 4a. 6� � 1,140. 14 0256.801 8" X 4" PVC WYE EACH 26 2� 16.pq S 416.Op PAGE 1 OF 4 SNORT-ELLIOTT-Fi�NDRICKSC?N, ING, , ,: � � . . . . . � � � .. ..�.�., �,, � . . . . � . � 0256.�03 4" � PVC S�RVICB �,. F, 141p 1 , 336 �.q� 57,254. 48 � , .._�.�.,,.� . , , . ---------- ..�_ _. n256.E3t)5 4" YV(: RtSL:R t,. �. i3t1 ._..... .......�1. �• 5;� $ 34`3.71 _. . U�5�r.9UO C4)NN TO EXIS'i'ING SEWER EACt1 � 2 1$2.50 S �65.00 . SECTION II - WATERMAIN . y 0257.406 6" DIP WM, CL. 52 L. F. 17�5 1,658 10.35 $�.7�16Q. 30 Q257.408 8" DIP WM, CL. 52 L.F. 41Q 390 � 13.41 $ 5, 229.9Q 0257.6q6 6" R.S. GATE VALVE & BOX EACH 3 2 298.00 $ 596.00 Q25?. 6i2 12" RS GATE VALVE & BOX �ACfi 1 1 7C18.p0 S 70g.pQ 0257.630 FITTINGS LESS TNAN 12" L8. 76p 1, 338 l . fi9 $�261.� Q257.640 FIRE HYDRANT EACFI 4 4 $99.OQ $3, �96.QQ q2�7.710 1" COPPER SERVICB L. F. �;d3U 1. 305 6,36 $�49.AO 0257.730 1" CORPORATION EACf! 26 ��.a� S _...,.�6� �.�d 6 4.88_. Q257.?AO 1" CURB STOP EACN 26 26 59.81 $�.555.Q6 0257.801 6" QN 16" PRESSURE TAP EACN 1 1 G 998.0� s_�9$8:-OZ�%��.1•� 025?.903 CUNNBCT TO EXI$TING WM EACN 5 _ 5 I59.S0 $ 849.00 B�CTION III - STORM S�WBR � , .,,.,,�r�_.. , 0258.427 2�" RCP STdRM BEWER. L. F. 72Q 709 22.2? $15.T$9.43 CL III - 025$.603 MANHOLE, TYPB H L.F. 28 22• 22 ($.b8 � 1.526.p7 0256.705 CATCH BASIN, TYPE Y L.F. 5 3. 38 105.60 $ 356.93 0258.8p1 R-1733 M�i CASTING EACN 3 3 139.00 $T 417.00 0258.SQ8 R-3�67 CB CASTING EACN 1 1 211.00 $ 211.p0 �258.930 CONN TQ EXTG STpRM SEWER EACN 2 2 255.50 S 511.00 SECTION IV - STREET CONSTRUCTION 2105. 501 COMMON EXCAVATION C.Y. 500 �. 52 $ 2I05.52i GRANULAR HORROW (LV) C.Y. 5UQ 2.49 $ 21,11 . 501 TEST ROLLING R.S. 14 15.�0 $ I'� Z112.501 SUBGRADE PREPARATION R.S. 14 75. 14 $ PAG� 2 O�' 4 .. `.�"�'. SHQRT-ELLIOTT-HENDRICKSON, INC. , • • .2211,5p3 AGG. BASE PI,ACED, CL 5 C.Y. 1080 7.92 $ " 2341.504 HIT MAT. FQR MIX TON 55 130.00 $ 2341.5Q8 WEAR�NG COURSE MIX TQN 50Q , g.35 g 2341 .51Q �INDER COURSE MIX TQN 500 9.35 $ 2357.502 BxT MAT. FOR TACK COAT GA�,. 29Q . :"�,�• i.�� � 2504.602 ADJUST GATE VALVE 80X EACM 4 �g.�0 $ 2506. 522 ADJ FRAME 6� RING CASTING EACN 4 162.67 $ 2531 .5Q1 GQNC CURB & GUTTER D�S L. F. 3210 �.94 � ---- ._ U41$ -- 2531 . 5Q? 7'' CONCRETE CRQSS GUTTER S.3t. 4Q 21 .�Q $ S�CTION V - LIGNTiN(3 25$5. �11 I,IG�ITING tINIT, TYPE A EACH 3 �,23r�.OQ $ 2545. 511 LIGliTING UNIT, TYPE B EACN 1 1455.OQ $ 2545. 532 UNDERGROUNp CONDUCTOR t,.F. 8p0 2.OQ S 2545.552 FEED POINT EACN 2 1600.00 $ �. ..�_w. . . . PAGE 3 QF 4 SNORT-ELLIOTT-FIENURICKSON, INC. ' ' APP�ATION FQR PAYMENT - Gontinued � . Total Contract Anwunt � 17I,p73, 00 Total Amount Earaed ��� r''r , .,, $ _85�. �a23.U��r Material Suitably Stored qn Site, Not Incoporated into Work $ Contract Change Order IYo. Percent.Coinplete $ Contract Change Order �Io. � Percent Complete � . � Contract Change Order tJo. ���� Percent Com�lete ��_� E , f . GRpS� At�?UNT pUE. . . . . . , : :":':. $ ..$5:'S23:02 r_. ,' ' ,' .. .',.. IESS S � RETAINAGE. . . . . . . . . $ 4,276.15 ...., ..: �� ; --�: .. ; .. AMOUNT DUE TO DATE. . . . . . . . . . . . . $ �1; 246:87 LESS PREVIUUS ARPI.ICAtiONS. . . . . '$ - , . . ;;; . ,!,�•- AMQUMT pUE TNIS APPIIGATION. . . . $ �$�.,�46.87 CONTRACTOR'S AFFIDAVIT The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress. payments received €rom the Owner on account of work performed under the contract referred to above have been applied by the undersigned to discharge in full all obligations of the under- signed incurred in connection with work covered by prior Applications for Payment under said contract, _ and (2) all naterial and equipment incorporated in said Pro3ect or otherwise lfisted in or covered by this 4pplication for Payment are free and clear of all liens, claims, security fnterests and Dncumbrances. Dated `� -� � . 19�. RICEiARD �CNUTSON Contracto� ' � �'`� � / � BY ,��f '' > .:/� ���.F%� � , , ame and � tle :OUNTY OF ,�f� ,�� $s iTATE 0F 1 ��'��..,t',t —� 3efore �e_,on this � � � da Qf ,{c1 � iQ �r'f ' '/ � 7 it '� Tcnawn to me, PersonallY apPeared w�io be f ng�Tc uTy sworn, d i d depose �nd say that t�e is the �� ,•t .: /,•r -- af the Contractor above mentio�ed; ., . .. Of ice :hat he executed tMe abave Application for Payment and Affidavit vn behalf of said Contractar; ►nd that al] of the s���r�t������ t in re tru , carrect and �omplete. N .v ,; 1y Commission Expire �Pubpc-Mln .l� j , R ,�-f "epn Couny , � Mo ta ry ub c ` 'he undersigned has chec ed t e antrat or's cation for Payment shown above. A part of .his Application is the Contractor's Affidavit stating that all previous payments to him rnder this Cantract have been applied by him to discharge in full all of h1s obligatians in :onnection with tfie work cavered by ali prior Applications for Payment. n accordance with the Contract, the undersigned approves payment to the Contractor of the •,mount Rue. SHORT TT N QRIGK N NC. ►ate � ���� _ B Y age �+ �f 4