HomeMy WebLinkAbout4.l. Approve Application for Payment #2, Limerick Way Watermain • �'� 4 � � � . •.� � � . � . . � . . • � . . ... � . ��
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SFtORT-�ELLIpTT-HENDRICKSON, INC.
�ATE 4/2$/8 I
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FILE N�. __;��78 �
('REP. HY '
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CONSTRUCTION COST BREAKDOWN '
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PROJECT N0. 19� S. A. P. N0. ;
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CONTRACTOR _T R +� F.srracaai-ir� -- . '
.�.__. C4NTRACT AMOUNT _ $21 .261 00
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APFLICATION FOR PAYMENT N0. �
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APPLICATION DATE 4/28/89
FOR PERIOD ENUING 4/5/89 �
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TOTAL COMPLETED ,
CONTRACT $19.$04.$8
GHANGE QRDERS �
TOTAL —
LESS �_Z RETAINAGE ,
��9ti an —
TOTAL DUE
T0 DATE �19�78
--_._,_
LESS PRE�IOU3
PAYPIENT - $11 ,444.�,�6 -
PAYMENT DUE
THIS APPLICATION ;
�7.964_42
1
SHE�T � QF 1 SNEETS
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APPLICATION FOR PAYMENT
(UNIT PRICE CONTRACT)
NO. .
_�------
OWNER: ROSEM�UNT, MINNESOTA OWNER`S PROJECT NO. 193
ENGINEER'S PRCtJECT NO. $907$
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LOCATI�N: LIMERICK WAY
� CONTRACTOR T & S EXCAVATING, INC. CONTRACT DATE
2044 GHAMHERS STREET w � ^ CONTRACT AMOUNT $21, 261.00 '
ST. FAUL, MN 55i09 '------- -------- ----- - ------
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CONTR. FOR WATERMAIN C�NSTRUCTION - LIMERiCK WAY - ROSEMOUNT, MiNNESOTA
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APPLIC.DATE----4 28 $9
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PERIOD END, 4/5�89
APPLICATION FOR FAYMENT
CONTRACT QUANTITY UNIT
DESCRIPTIpN UNIT UANTITY TO DATE PRICE T�TAL
------------------------------------------Q--------------- -------- .. _--- --
� - ---- - --
0257.406 6" DIP WM, CL. 52 L.F. 20 14 16.Oa 224.00
0257.416 16" DIP WM, CL 52 L.F. 320 -�2Q 37.OtJ 1'1,840.00
0257.60b 6" RS GATE VALVE & BOX EACH 2 � 35C1.OQ 700.00
4257.617 16" B.F. VALVE & BOX EACH l � 1650.00 �� 5�p,.pp
025'7. 631 FITTINGS 12" & LARGER LB. 1,080 122�� 1.20 1 R470.00
025?.64Q F�RE HYDRANT EACH 2 2 1100.OC? 2,200.00
0257.71Q 2" COPPER SERVICE L.F. 5Q �..�� 1$.50 420L,88
PAGE 3 QF 3 SHORT-ELLIOTT-HENDRTCKSUN, INC.
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157.730 2" CORPORATIQN EACH 4 � 350.00 700,00
0257.740 2" CURB STOP & HOX EACH 4 2 165.00 3,�.Q0
f12,7. 9n3 CONNECT TO EXISTING • •
WATERMAIN EACH 1 1 27Q.flQ 270.QQ
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P��E 2 �F 3 SHORT-ELLIOTT-HENDRICKSON, INC.
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.al Contract Amount S 21.261. 00 Total Amount Earned 5 __19_Rn4_�g
�aterial Suitably Stored on Site, Not Incaporated into Work $
Cantract Change Order No. Fercent_Complete $
Cor�tract Change Order ^lo. Rercent Compl ete �
Contract Change Qrder t�o. Percent Complete g
GROSS AMOUNT DUE. . . . . . . .. . . . . . . � 19�$Q4.$8
I.ESS 2 % REi'AINAGE. . . . . .. , . $ 396.10
, AMQUNT DUE TO DATE. . . , . . . ., . . . . $_ 19,408.78
LESS PREVIOUS APPLICATIONS. . . . . $ 11,444.36
- AMQUNT DUE THIS APPIICATION. . , . $ 7,964.42
CONTRACTOR'S AFFtOAVIT
The undersigned Contractor hereby swears under penalty of perjury �hat (1) ail previous progress.
. payments received from the Owner on aceount vf work perfarmed under the contract referred to
above have been applied by the u�dersigned to discharge in full aTi abligations of the under- ``
signed incurred in conneetion with work covered by prior Applicatians for Payment under said
contract, , and (2j all
material and equipment incorporated in said Project or otherwise listed in or covered by this
Applieatian for Payment are free and clear of ali iiens, claims, security interests and
encumbrances.
Dated �`� , 19 ��. T & S Excavatin Inc.
Ca tr ct .
����
. By
. and Title
�OUNTY OF ) SS
�TATf 0� )
3efore me on thi 2� d�y of J ig '�
� � personaily appeared
known to me, w o being u y swarn, did depase
�nd say that he is the of the Cantr ctor above mentioned;
Off ce :
that he executed the above Application for Payment a id v' o eh lf of said Contractor;
and that ail of the s i , o ec n comptete.
II�NAEL D. T�UNIBS
My Comm i s s i o n Exp i res NpTARY pUBt,IC-MINpESaTA
��A�� Notary ubTic
�h oem�tae 94r.r w..2�.+�1+
The undQrsigned has checked the Contractor s pp ication for Payment shown above, A part of
this Application is the Contractor`s Affidavit stating that a11 previous payments to him
under this Contract have been applied by him to discharge in ful} all of his obligations in
connecti�n with the work covered by all prior Applications for Payment.
In accordance with the Contract, the undersigned approves payment to the Contractor of the
�mount Due.
SHORT L 07T NEN�I�ICKSO I ',
Qate 4128189 g� �
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