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HomeMy WebLinkAbout6.e. Application for Payment #1, Shannon Oaks Street Improvements, City Project #185 � � , � �-"�.�� � e.. CITY OF ROSEMOUNT ,;:� �;�; APPLICATION FOR P1�YMENT ��. N�. � � , � • t � � , i �i ��� � � � � �� � � � � � � ��� I ' ci�z'y I'f2U.IL•"C'I� rro: /SS __� st:r� r�1 E,r: r��>: �3c�19 4- f'ftOJ I:C'C: ��t / / _. __ . ' a-+� +to►L. ll0..k�_S-�v Q¢.'�,__.�O+'�S l�'�c�U�+�.___-- ------- CONTRIICTOR: �j � (Gnt�ndtrl �`'�ad�va�,t �^t,CONTRIICT D11TE: ���Z� g'j�'j --- - --- _. ------ ----- ��ZS C2.�a.v ttVe_So. AP�LICI�TI�N D11T[s: _ I ! �9/c�� ,t,� / - --_. _... _. __ /"lal S_./�'�. _S��O�j� F'Oft PF,F2 IOD i•:Nt)i NG: y/ �9 1 i`�� 'I'uta l Cor�tract Amount S ��?� `�p v / o0 _._...-.--[.381 __" Total 11mf��int: f::�t�ii�rj S U � (� __ t�laterial Suitably Stored on Site, Not Incor�orated into Work s ' -----_--- --- -- Contract Change Order No. V, percent Camplet� S _.___ _.__ . _. Co��tract Change Order No. _ Percent C:ompletc� S Contract Ch�nge Order No. Percent Complet.c� s GROSS AMOUNT DUE . . . . . . . . . . . . . . . . . . . . S �91G °—"� ----.__ --- — _-- LESS o S$ RETAINAGE . . . . . . . . . . . . . . . . . . $ � '��5� � � _ _ . . . AMOUNT D _° UE TO DATE . . . . . . . . . . . . . . . . . . S �j 4 6�- :_S --- ` LESS PREVIOUS APPLIC�'1TI�NS . . . . . . . . . . . . $ - '" - ..,� AMOUNT DUE THIS APPLICATIUN . . . . . . . . . . . S � '�'6'¢- S� \1 ' 1 : _ .._.__ /�- t -1(t'PR �; , : r �; �---- _`" __ v. (� 3 c�(� ichard M. i . , � ' I'.� i _ '� � `C ►., , '1 �.1� , City Enginee Directar of Publfc Works , , � i i ` � � � , APPLICATION FOFt PAYMrN'1' (UNIT PRICE CONTRACT) � rro. � ----------- - . _ OWNER: CITY OF ROSEMOUNT . - -^--OWNEf2'S PROJECT NC). l f35 ENGINEEtt'S F�FZOJEC'i' NC�. ----'t3�19�1----- LOCATION: SHANNpN OAKS '� -----�---------- CONTRACTOR BITUMINOUS_ROADWAYS=_INC_ C�NTRACT DATE � ! ----- 2�325 CEDAR AVENUE SOUTH � � �� �----- __CONTR�iCT AMOUNT S 1`3 f, 3�31. . 50 ----------------- MINNEAPOLIS, MN 55407 -----�-�----'------'-`-- ------- C�NTR. FOR STREET CONSTRUCTION - SHANNON 011KS ----------- ------------------ APPLIC.DATE ----------------- --------__--_--------- 9/19/88 ---------- --------------- PE�tIOD END. 9/19�F38 APpLICATIQN FOR P1IYMENT DESCRIPTION CONTRIICT QUANTI'I'Y tJNZT LTNIT QUANTZTY TQ DATE PRICE 'I'O'I'AI, --------------- ------------------- 2021. 501 MOBILIZATION -^-�--- ----------�-----"`------- L.S. 1 �t�nfl.(�O $ __ ---_._ ___ _. 2101.502: . CLEARING -____.___�__ . TREE 1QO �5 2 i.0O � I,_375.00 2101 . 507 GRUBBING • TREE _._�._.- •'::•. • ' 100 62 25.�t? S i 550.00 - —�-- 2105. 501 COMMON EXCAVATION P O C.Y. 26950 630Q Q. 95 55,9�35.00 21Q5. 521 GRANULAR BORROW (CV) C.Y. 1000 --- ------ ___..__ 2. 5� S Z105. 535 SALVAGED TppSOIL (P) C.Y. 1850 --- 0.9 5 5 ?111 . 501 TEST ROLLZNG R.S. 2� + -------- ----- 50.OU S _ ____-------- '.112.501 SUBGRADE PREPARATION R.S. 28 •-------- 9 5.O C) S . ___. _--_____._ .116. 501 CORE EXCAVATION ' C.Y. 150Q 1 . 5� fi AGE 1 �1' 3 SFiOftT-Et,T�IpTT-IiENDRICKSQN, 7idC. , � # 2116.503 AGGREGATE HACKFILL C.Y, 15�C} 2, 5Q S " 2211, 593 71GG. SAS� �LACED, CL 5 C.Y. - �+_ --" __._ 3190 �. ?.�5 S 02],1.594 4" I1GG BASE FOR SIDEWIILK, S. F - _ 21760 � ._�_________� Q. i:G S 2341 . 504 F�I�'. M71T. POR MIXTUk2t' _.... ... ._.r____._ _ � T4N 13'I l 9 tl.UC) �` ' __.. __. --__ -- •�' 2341.5(}8 WGI�RING COURSE MIXTURE TQN ----- ----._--_ 1530 � 9.90 $ 2341 .519 BINDER COURSE MIXTURE TON 900 7. tl0 $ 2357. 502 BIT. MAT. FOR TRCK COAT GAL. ---- ------- ___ 4Q0 �:.� 1 .?,5 S 2501.511 15" RC PIPE CULVERT CL 5 L.F ^ V �25 1f3.0C� fi 25�2 . 515 15" RC FIPE� �1PRON -------- -----_____ - WITf211SFi GUARD E14Cfi `� ?.QO.Ut� $ 2511.541 RANDOM RIPRAP, CL I II C.Y. _--------- --- --- 12 _ 50.(?0 S 2511. 515 GEOTEXTILE FILTER + S.Y. ?.t3 7..00 S 2 5 21 . 511 2 __.__- ------, -_---- --------- " BITUMINOUS WALK S. F. 2.1760 ------ 0. ?,£3 S 2554. 501 PERMANENT HARRICADES L. F. � 16 31. . 7.5 S 2564.531 F & I SIGN PANELS, ----_--- ----___ TYPE C S.r- 45 14.'75 �$ 0564.603 4" WIDE SOLTD LINE, �--- YELLOW F�AINT L.F. 5�00 0. 1.9 $ 0564. 603 4" --`�-- WIDE SOLID LINE, ____ .----- WFiITE PAINT L.F. 115 0. 19 S 2575.501 R011DSIDE SEEDING 11CRE 4.0 295.QO $ -----__._. .___ 2575. 502 SEED MIXTURE 5 --- __.__._`--- L8S. ?.00 3.t?0 S 2575. 511 MULCH MATERIAL, TYPE 1 TON ' � 8 20�.00 $ 2575. 519 DISC ANCHORING � ACRE 4.Q _ 55.00 $ � ----._-- 11GL 2 OI' 3 SIIOF2'1'-1?LLIU7"I'-i11:N1)ItlCli:;(>N � LNt'. • • l��I CAT I0N FOR P,1Yi•fE��T - Con t i nuecl� . lt.;tal Contract llrnount $ ].3G, 381 .50 Total timount E�3r-ned Qf3,91t).t)tt ----_-- - _._ _ .- --------__.-- Material Suitably Stored on Site, Nat Incaporated into Work $ Contract Change Order No. Percent.Coit�plete ! ' ----__.__�— $ --__�. ----._. __------____.. Gontract Change t)r•der No, t'crcetit Com��letct ._____.._._._ � . _ ___ . _ . _ _ __ __- -. . Contract (;h��i�ye Urder tJo. _ Percent Complete _ ___�____ $ GROSS AMOUNT f)tJE. . . . . . . . . . . . . �Ft,'�it�.UU .__ CESS 5 � RETAIN/1GE. . . . . . . . . $ 44r�.50 AMOUNT OUE TO 0�4TE. . . . . . . . . . . . . $f3,9GA.5O T LESS f�REyiOUS ti{'C'LICAtIONi. . . . . � t� � CONTRACTOR'S AFFIQ/IVIT �h10UNT DUE TIIIS APf'1_IC!lTION. . . . $f;lqt�q_.,p i The undersigned Contractor hereby swears und�r penalty of per ur that i all �J payments received from the Owner on account of work performed under the contract�referred�to�s� abave have been applied by the undersigned ta discharge in full all ohligations of the under- signed incurred in connection with work covered by prior AppTicatio�s for Payment under said contract, material and equipment incorporated in said Project or otMerwise listed in or covered}by,this Application for Payment are free and clear af all iiens, claims, security interests and encumbrances. Ddted .;�,l,t 21, , 19 a�3 . Bituminous I2oaclw.-��s, Ii1C. a��n�en�.��an��t�n�.aF��n;�.ti�e�� Cot}�FaL�tol^ f �,� {(AfIIY 1. �,tEPlSC ( 1 "��. '� � :;r�ornnv i in;c�c r.�FUNEsorn gy � ✓ - '^ •^" i�,,�,urn �our��.� � , �- MY Cnrmm� �on 1 x,u t.tar ,�t LL'J3 ; Name a nd T i t E E'���', �., r;�'_� � ��� �9��.-r'�'i��7��r��` .�S COUN Y �� ti=31:oC� � STATE OF M�i,r,er;c�ra � Before me on this 2t day of ;���i,i�,�„ia„r� , ig f;s� E�ersonai �y a�peared ta�,�•���:,,, c�. �t.,t,—' ,,.�-,!---- kn�wn to me, w e being il v sworn, did depase and say that he is the vice �resider,t of the Contractor above ment�oned; Office that he executed the above Application for Payment and Affidavit on behalf of said Contractor; and that all of the statements contained therein are true, correct and complete. My Commission Expires: j�Ji�rr�i�.� ��,c� �'�'<;,�� -- �,�, � , ' � --_____` j. �c ' �1�i-=��-� `-K=— __ o a y Put�l ic� The undersigned has checked the Contractor's Application for Payment shown ab�ve. i1 part of this Application is the Contractar's Affidavit stating that a]1 previous payments t� ljini ander this Contract have been applied by him to discharge in full ali of fiis obli�,tior�s in :onnection with the work covered by all priar A{�plicatians for Payn»nt. 'n accordance witf� tt�e Contract, the undersic�necl ap�iroves �j�y►nent t� t:l�e C�iitr,irt.c�r ��f tlie ►maunt Due. �ate j�(`�? �� Sli()RT El r TT I�f i��ttit'Y'��+�r� ,,itar, � , �y __.._../_ : --'�'`=1 ����r j; � ___-_:�__ �g� 3 of 3