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HomeMy WebLinkAbout6.h. Application for Payment #3, Valley Oak Addition Phase III Improvements, City Project #180 . t i . � . . � : j � �; . � . � . . . . . . '�,.. � .. � . . . � . � • �� J{�. �\/�r I (�. �• . .� � .��.. . . . . ...�^� . ��I" . cimv o� Ros�.raov�v�r `; -, z �►p�r,rc�►rzou �oR c����rv�r - � ` . No. 3 _ � . � � ,�, ' ,. �; � '' �� �s: '. Ci.'i'Y E'P.OJ�CT NO: / ��-------- SEli F`If�E t1O: � � �3I P R OJ I:CT: U ca..�1 e4 �c�.,l� /�zGd r� o�,. �i _ _ _1� � — a s� � f�v� —r ,�: • (:ONTRIIC't'�R: (aS¢r ►+ v� loh. -�-----�--5=�' _-��__ Cd, corrmnnc:�r r�n•rr.: S �g -- --- �1_ _ / _ 380t lJc.Pow-f._Avc.l�. nr�r�i,icnrior� r�n•r�:: } __�p�S., /N�t! _�S4�Z_ _ r•or� r�r•.r�rc�n rrae�Trrc;: '('��t:r� 1 ('��r�i.r��c:t n►nc�tar�t: ; �UB� �QO �9 '{'c�t.it 1lmcaiint f::�rsi��r1 '; �0�,7/�, fe t�i,�t:eri �31 >uitably Stor�cj on Sitc�, Psc.7t t.i�c.oL-��rai:�d irito W�z-k �; f ?93 �-�.o � t c'��i�tr����t: Ct�anc�� (�rd�r No. _ _ i'er.r.r�ni: t.`c�m��l ��tr� j �'„i�t.r.��-t. t'I�;�r�<�� Qrdc�r No. f'��� <:eni: t`t>nf{il ��t�, t'�����.r��c t ('har�c�c� Ord�r No. �_ t'F'r'c�n t C:omp i c�t.e ;,, GR(?SS Ah�(7t1CJ'I' 1)(11: . . . . . . . f��� C�U9 �� . . . . . . . . . . . . ., � LESS � $ 12t;T11I NAf;E�. �� :1 ------ . . . . . . . . . . . . . . . . . �, .: Z S U �7 !. �M�Urr�r nUr� �ro n�mr . . . . . . . . . . . . . . . � ��.75�3 9� ; - � , � i �� r�t;SS PR�VIOtIs nr�r�i,rc�n�ric�r�; . . . . . . . . . . . . SS, 96763 � '� 1�MOUNT 1)411•: 'i'fi I `,� h['f'L t�'1�'i'1 UN . . . . . . . . . . . (. :; �3, � �� Z--g , �l�I'('f l f�!): . 1 4 . � � \, -� � �//� �G �/ � (cI�3 �v �'i 1 I �� I, It 1 � � ► � � � �' � �� t a c h a r.c� h1. f : i�----------- - _ i (:i ty t:r�c�i noer/ i rectQr c�f f��ab l. .i c W�rk� � , • � " APPLICA'I'ION FOE2 PAYMENT " � (UNiT PRTCE CONTRACT) ' �' NO. 3 ¢; ��,; � � � � � � <�.,'. ..---- ------------ ____:_ _.-----`__�___ OWNER: I20SEMOUNT, MINNESOTA OWNER'S PROJECT NO. 1�30 � 1+ ENGINEER'S PROJECT NO. H '� ' 88131 a� LOCATIQN: ROSEMOUNT, MINNESOTA --'--+l--------- 1 CONTRACTOR MOSER_CONSTRUCTION_CO�__`- __-CONTRACT DATE ` -------------------- ` CONTRACT AMQUNT $108, 140.49 CONTR. FQR ___VALLEY_OAK_ADDITION_'_pNASE III - ROSEMOUNT, MINNESOTA APPLIC.DATE ------------------ ------------- ------- -- -_--__.�114L�s_------ FERIOD END. ------ ------.�11�C�__�----- , APPLICATIflN FQR PAYMENT DESCRIPTION CONTRACT QUANTITY UNIT UNIT QUANTITY TO dATE PRICE TOTAL . I. `SANITARY SEWER '�------------------------------------- --------- ------------ 0256.408 8" PVC, 10'-12' DEEP , L.F. G72 77G 12.QO � 9,312.00 0256.701 ST11Nb1�RD MN, 8' nEEP E�CIi 4 _��i__ 900.0� S_�..3..:�i��..S��. 0256.702 EXCESS DEPTN ST'D MH L.F. j5 � --_.].1__.� 55.�0 �---G�3_G..�.U_ 0256.801 8" X 4" PVC i�`YE EACH 14 1_4__ 20.00 $ ----:_2ii:tl.Q�_ 0256.803 4" PVC SERVICE L.F. 950 ---1-8-1-;3--- 5.?5 $�.5.,t324 Z5_ 0256.900 CONNECT TO EX SEWER EACH 1 � �oo.00 s_��a.00_ II. WATERM�#IN 0257.4Q$ 6" DIP WATERMAIN, CL. 52 L. F. 17.n - --._.Z1G _ ___ 13.Qt} $ ___,;,�)3t_i_Ut�_ PAGE 1 OF 4 SHORT-Ei,T,I�TT-fiENDRICKSt�N, IN('. t , ti � � 0257. 606 6" R.S. GATE VALVE & BO�{ EACH 2 � � 360.00 $__-____ZZQ..�U_ �5° 0257. 630 FITTINGS LESS TNAN 12" L$. 100 136 ' __V� 1 . 50 S 204.Ot) 0257. 640 FIRE HYDRANT E�1CH 1 1 1000.00 $ 1,000.UQ ; 0257.710 1" COPPER SERVICE L.F. 12.50 137�3 7.00 $`-- f),64G.t)p 4 0257.730 1" CORPORATION STOP EACH 27 -' ._�- i 27_ 35.00 $ 9�5.�0 , ��. 0257.740 I" CURB STOP AND 8dX EACH v!_' T � 27 27 75.00 $ Z,025.00 0257.903 CONNECT TO EX WATERMAIN EACN ^ 2 �_ ioo.ao s ZOU.00 III. STORM SEWER 0258.412^ 12" RCP STORM SEWER, CL. V L.F. 588 _ ,g3._� 15. 50 �---�-._12LSD_ . 025$.427 27" RCP STORM SEWER, CL. I I L.F. 262 269� 25.Q0 S G,525.00 025$.603 MANHOLE, TYPE B L.F� �0 F3.2 12D.00 S 9$4.0� 0258.605 MANNQLE, TYPE D �,.F. 5 5,5 120.00 $ GG0.00 0258.704 CATCN HASIN, TYPE X L.F. 15 11 S 10(?.�� $ 1 .1 S0.OQ 0258.705 CATCH BASIN, TYPfi Y L.F. 15 � 10 � 120.00 $_ 1.272.00 0258.SO1 R 1642 WH MN CASTING EAC�i 3 ;3 110.00 � 33� 00 0258.808 R 3Q67 CH CASTING EACH � _ 7: 200.00 $._1,.9.Q0�4:0_ 02�8•9�2 CONNECT TQ EX MANNOLE EACH z �_ 200.oa s. ---_�oa.oo_ IV. STREETS � 2105. 501 COMMON EXCAVATION C.Y. 500 ��2(L�L 1 . 50 $__-Z�.t�..�6_U_ 2101.521 GRANULAR BORROW (L.V. ) C.Y. 500 '�` 2E_4ll 2.00 $__.-_y2..92_ 2111. 501 TEST ROLLING R.S. 13 19.G 10.QO S 146.OU 2211. 503 AGG. BASE PLACED CLASS 5 C.Y. --- - -- - __ 825 _�3t�.�._��� 4.OQ S_ 7,_�49�3� 2112.501 SUBGRADE PREPARATION R.S. 13 .14�fi 100.00 S _�..�Q..4_Q 2341.504 BIT. MATERTAL FQR MIX TpT( �Q.5 `�LI14 14 6.00 S__�Z,_4�:L�fi�_ 2341. 508 WEARING COURSE MIXTURE TON 436 433_GZ 9.75 $_----4,2J_Z_?_2 2341. 510 BINDER COURSE MIXTURE 'TON 436 4�i.-43 9.75 $._____..4,.a40..d�_ PRGE 2 OF 4 SHORT-ELLIpTT-HENDIRICKSOt�I, INC. . � � � 2357. 5Q2 BIT. MAT FOR TACK COAT GAL. 265 . "l?_{1 1 .pp S 2"1_t1.�0 2504.602 ADJUST GATE VALVE BOX EACH '� `� � � � � � � � � � � �3t1�.a(3 $ � t Gt1.�t}t� � _._ _ E;� 2506. 522 1\DJUST FRAME AND RING EACH 6 ? lOQ.00 $ 7d�.(10 CAS T I NG -- ,': � � � } -� 2531. 5{�1 CONCRETE CURB & GUTTER,� L.�. � 275t1 1��5 � 5. 2�0 S ���► 31�.�� __. .;�� DESIGN D418 — -- 2554.501 PERMANENT BARRICADES L.F. 32 _ _ 2Q.00 $ V. LIGHTING ---- 1;� 2545. 552 --FEED POINT EACH 2 - 6�Q.00 $ - 2545. 511 LIGHTING UNIT, TYPE A EACH 1 � ^ _ 1450.t70 $ � _ ._ � .. ... 2545.511 LIGfiTING UNIT, TYPE B EACH 3 _ 1fi55. 33 $ 2545. 532 UNDERGROUND CONDUCTOR L.F. 720 V —�SLL 2.2C1 5�1...4:3SL�S�� � . . . . . A _ � . � � . � .. ... . � � . . � . � . . . . .. � . � . � � . . . � . � . �. . . P'AGE 3 OF � S�iURT-ELLIOTT-#fiENDRICKSON, INC. . • , HPPL I CAT ION F�R PaYMEPII� - Cont i r,u2�1 Total Contract Flmount $ 108 . 49 total Amount Ea�d $ - ___ 10,3,_71 G, 1 fi �Material Suitably Stored on Site, Not Incaporated into Work � 1.�Z93.ZO Contract Change Qrder No. Percent_Gomplete $ Contract Change Order No. Rercent Camplete �_ ~ �" $ ; Contract Change Order No. Percent Complete $ �'� �� � i� � � � � � � � ��rtoss nMo�uNr ouE. . . . � � �.�. . .�. . . $ �_�s ��aog.:�a � � � ___ .�...____ LESS 5 � RETAIN�iGE. . . . . . . . $ ,�2,p.47 ANIQUNT DUE fi ` 0 DATE. . . . . . . . . . . $ 9y 7.�8.91 �--r --- IESS PREVIOUS APPl�iCATIONS. . . . . $--� „ 9G7.G3 �__.___._ CON7RACTOR'S AFFIDAViT A�UNT OUE T111S /�PpLICATION. . . . $ �3��y� ��II The undersigned' Contractor herebyswears uncter penatty of perjury tt�at (1) a11 previous progress. ' payments received from the Owner on account of work performed under tMe contract referred to above have be�n applied by the undersigned to discharge in fu13 all obligations of the under- signed incurred in connection with work cdvered by prior Apptications fvr Payment under said contract, material and equipment incorporated in said Project or vtherwise listed in or cavered)by1this Application for Payment are fre� and clear of all liens, claims, security interests and encumbrances. Dated �S�-,�T � �� � 19 � . Moser Construction Contractor `^'- :By , �l' � ��IC'`'"e-L_... ��> �c'J i t- r Name and Title�- COUNTY OF �����- ) SS STATE OF _ •�2.�-�t ) Before me on th i s �` � �9 �,.�� � �"�l day vf S�- 1.-�; personal lY anpeared Y)•:! � � � '�4" s �'�, nown to me, w o being cTuTy sworn, did de ose and say that he is the :y �v,�rf of the Contractor above mentioned; ' �ffice � that he executed the a ve a �---•• . .. .�,...�.Q.,,.,�pp,�,�� tion for Payment and Affidavi t on bel�al f of said Contractar; " and th�t aifio� ��,�`,��,��������ained therein are true, correct and compiete. My Com t; r��' EX�f�r, ���l!i� �, ,p�.::;�Th ) • .- . _ -._ , , ,. . „ � �15�1 .� p �'S � !t i lf ' ,'( , , : � fi � �L-a-,.....-. 7! � _ ._. t � i ., � �' f ��d�JC1. 1��. 11G? �(�Y''-- .� ' ) r[,�G ! !�='p 4_..�.�..�. , .._. � ,,....�..<,,..�....,,,.i � Notary Publ ic The undersigned has checked the Contractar's Application for Payment shown above. A part of this Application is the Contractor's Affidavit stating that all previous payments to him under this Contract have been applied by him to discharge in full all of his obligatians in connection with the work covered by all prior Applications for Payment. In accordance with the Contract, the undersigned approves payment to the Contractor of the Amount Due. Date / I'�Z �jg SH(�RT FLtr ft T HEN ICKSQ , }��1 . By r7� ��,,, ���'t,'I Pa9� `� of 4 � �'�'"" __ __ _ --. .--- - J��� .�UDd �UPPLY C� . _ .c::��o���i��"ouPi.ic,a,-� , r MPANY '�� �� J.��.�_ . wNO�ESs�E , � ��� � � � :: �.,.a�. P.O. BOX 33069 t e�crw�c�� � � EIECTRfCAL .r' s+,�,�Es 401 93rd Av�.N.W. DxSFAIeUTOAS r: Coon Rapids, Minn. 55433 � � . � � . S�2'78O'ZZ7O . . . � � � � ALL CCAIMS AND RETURN � . �,; � �� FOUNCtED t972 f+�DS MUST BE ACCOM- 3.: � . � � . � � P�NtEO 8Y TNIS�NVOtCE. . � �� .' . , � � . � � � . . � . . . . � � . . .. . . . o - . . � S � --� ..:� L - ___ -. . . H r. . _ D - � _. . -. .• ,_ - � ---•�� =..�.. . _ - p _ ._'_ : =>�`.c s - - :r: T _ . — . :`; _ - - .. - _ %`�,.., � oL � oL _ . , ' _ � � _ iNV010E GiATE lNYOICE NQ. PAGE NO. � '% .-. _ :--. r. ', t- � - _ -.,. _-, . _ - CUSTOMfR aLPHA • - -'_ ..- . � � CWSTOMER ORaER NO. . ''_ � JOB NO. WHSE SAIESNtAN TERMS; • ` � � � � _ _ Dw Cats And Cash Qiscoi;mt - � - . _ _ _ N Applicabls Ate Listed Sebw •r.•,., SAl.ES TICKET NO. , _ . :. : , ' "' NIINlM41N 8�11NG S 10.� ',. . SMIP VIA OATE SHIPPED OiRD€R DATE - � ' �„ . � _ _ _ .. _- -- �' j ' � . ���. � - - � - - � . . � � � . � SERYIC£CHARGE � . - . O. - .. .> '=.y-- i`.. y _^ . - _ A00£D ON?AST � �lUANT1TY .��� I . .� . - � ':_ - -•- � - � ".- �0 �DUE ACCOUNTS . U � i � -` '•- _ '�:'•,, .._. . . . '. tNt »60 T-SMiPPED —1 CAT.NO. . - . OESCRtPTtON CO PRICE UWT AMOUNT :: .- ' ' L�C! � � . . . ' � .. ._''�.. '' � ��„s.•) y,,,�`:i_^a. . . . � n . . . Q — - �. .. �:, =.: + =:� �;..1� '� :i-c;__ e: - ';:� ' (t �' � t . # � G"'�+l�i:� � : 'I y '��y � � - ..�s _ _ . ,j.,� _ . _ _ i ,.-� � *^,:,1�r- ,,,. V t.+. .. . .., ;s� �,_.^ . l ..it � � � . '..��'-ti%-f-�,J....c-b;.�F�.t:^R:. . '-�.sr . . . . � . . . � � . � . � . � _ � . .. � .. � ' . "'r"' 3`fr`. . .. V' •4 . .. 4 � � � � . . � ' . . . . ' � � � c �--r. G. ��:-j:.;.�;.. �.L. � ol � � � � � . � � . . . � . � . . .. . . . . ' � � ' � .� � . . . � . . . � � . � �. . . /' � �. � � . � . � � � � . . . . � . . .('. .. � . . � . . . , � .� � . � . . � . . � � . . � � � � �. . . . � � . . . . � � t '�.�t�: . , . �. . . � . .. .. . .. . . � . � �� �- . . . . . .. . . . . . . � �... i � .� . .`�^��� . . . . . . . . . . . . � � . . �v�,,, / � -•,/<J f� �% ..j�✓ ..i_ . . . . . . . . . . . . .. �.. � ' . . � . . . . . . . � . . . . . � . . � . . . . � . � . . . . . . . . . �i.. . _ . . � � ta � . . . . . . . . . . . . � � . . . . . �� �. . . �CCOWIt 13 C:M@!7t . . . � . . . . � . . . .. � � . . . . � . . . �nvofce ts Pa�d Sv: _ Cash SL'8'CT,»i,,; � . _ _ . Deduct Oisaount S.'�I.�S T.�JC:I . _ ., ' : � . � 'abor w�an,aqoq,=f n+e accaun[r�as no�been o�f at man,nry arW R�e a�eamt rtaa to be xacetl tw cdMction.cdbsewn rae6 � � � � � '� arawea�ar�oods ren++u�t wrtrwu�eonsar+a Sarv�ce cnarqos«+ease aue aecwxs«u rx asaossea as aaoweo oy iaw. TRANSi�1RT.ii'tC�� � '*+wNrfactur8 the gOpCs�t 58tl8 anA makes n0 erpreg;warrantnea therBGrt.AbO � � ' . .. . . . . .� ^+erc.�+iaaury���me�s`or a oar:�cwar use. �'�'��+Y tlix�aima ad snpbaC�warrantps . . . . . . . . . . . � .. . . . . . ',�1111� ���il� � � .. . - � . . � . . . v � . .. � . . . � . � � . � � � . � � . .. . . . . . � � . � �� � CUS�C��.1�R QL'P�iC:.�'C r ��fl� JUDD SUPPLY COMPANY MEMBER ��`�`�--��,� yf � . wNO�ES�IE � � � P,O.BOX 33069 � � � � � � E�ECTR��CA� � �� � � � E��cr+hcu~ 401 93rd Ave.N.W. '� ' • o�stRteuToas :.t'• ""'�'�'Es Coon Rapids, Minn.55433 • 612-780-2270 au,ctauus aNa AErupN ;,>' • fOUNOEO 1972 GOCOS+.tI;ST BE ACCOM- � PANIED 3Y THIS IhVO10E � . . - � � . . . . .. : . . . . _ a ,,��, Sr � S � -� = � ..� p f' , .. f::l* :<.�I��^3_�,,•� � . � . � H •~ �`,.- --•��� -"�`�-�'= -.��— (t' . . _ .- � '. � . . . � ���Ii� ...•J �i�'1 .J•J i�..l . . . . p iylit— %t(' y+.. _ . . . . ' . _ � . Ts . _ . . - _ � � T � � ° L J -`� _ d...-y c! : . . <4:t^,..^'-a . `! i-s �a INVOICE OATE INVOICE NO. PAGE NO. " q ,,,,,. � ---^ - - _ ;� •'" >�'+�.,�.i� . _ _ r.: �``,u� � � � � . � :��/ Jv � IN-�1/ L�.. �.�.r��. �Jt� ,. � . � . ' �, ...:. . � CUSTOMER ALPNA CUSTOMER OROEA NO. JOB NO. WHSE SALESMAN Y TERMS: ` ; � �<: �s ,- ' � Oue Date And CaaM Disca�nt a,,. ' � ._�. ,._- ' a ' :'.• ., �-.,,� !f Appticabis Are Listad Babw y ��` .' ;�t . '•1:�4� `�;i•.: i "r:E-',j MINIMUM8ILLSNG510.00 �. �- i's R r S.'il.ES TiCKET NO. SNlP VIA DATE SliiPP£D ORDER DATE ,•. �.t-� .� , � y : - - _ _ - - _ � _ _ SSRLiCECNARGE '�>�'' : . ,.., .��: -` -� ..-. - ' ='v.....�u L°�,/�4 � t -Y�.:�Yl . � �.._ � '�"�+...:_i��3 .,._. ��" '_.'r;` _ '��... Wp O�tJE ACCOUNTS �'�' � - . �, . � . � .. : . '... _. � . _� .- .:�. _' - '. OkOEa DUA �t� CAT.NO. OESCfttPTION CD Pl310E t3Ni7 AMAUNT �%� .� � i . - .'�i J.�-�i`.i�G1�S± � .7}"'�w.`�.��-.`..f'�.f��C ta�=.".�'�iti�.Y�� .\ii � ��..�C+`. lJ'.1�t'.. ��F � J. �iC^i }����'�. �'� . .. . . �. �.`,��..'6!'Sf L . �Iyi��r ���►li 'Y.:i�7� .1'% 7'� . :� L'•i.l "�� ;�+� �;,� ���p,�.R 2' . � . L �l 1+'rl�`.�'i. . Z� � f x i >' — + n L � ` � _ _ � �. . � _ ,,,� ` d � � �: 4�..r V��� f.�GY�"� C►�..,�t f.:�aw.�V T7�`� � �..L�r.�i ��'! '�F. w. ^+ ,t � ti.ii: _ �-..•r`�,Ci'�1 VrG :��!,.:�L'' '....�r-�'t �b1'f.Jta t'�`'3" w�+M;.:: � _ . �:J �. `t l. �Jv ".?F .,. . . �. w� S.�. � F5 , �. :. f.�.�.1..�' :'i� �.G�"!'Si�.� �I'•.il"'}7"� i'�1 �.�.E�f;i'jr ��._.. ...'.:'� :...1. :_.-'.C.. f��} f` t:� � G"J�"'(f.� C�T'j :: ,.'}'� } '� � #-;Fst�t�?i�#�##%fr#.Fitk-i��k#-.t=i-t �~�j �. . . . . � ?#;t-�'it-'� li"�ri:��t.�V��-� �..r:,�}: . � . � � . �"'a � �' � � 'i � ��#�#';^:e��##?t3F��f r�=r-:#�t:c w�-r '�a � _ _ � +�� i � ;, � � � � �.�. wf i --�, r , =��..:.r '� !j � �........;�... � � .�cr �---'L/,._.,t---' �;; . � . � . . � � � 1�` � . � . . . . \ � � . . . . � . . . � �. . . .�� . . . -� - •: �f vaur Aecounc is Cunent ' Cash �LB `OT�L: � I .� And The InvO�ce Is Paid 8Y7_. : . � DE2dUCt � . QiSCfltJttt jALG�j Tr1X: { ._ . �'..� �v!albwatl fw iaba a tlamages H th�account has not bman Pa�d at rt�tunty an0 the aeea�M has to�bs dxe0 fOr edbetioR co��ecbon tn�! TRA�'VS�oRTATiCN: � � � . . aa<sc w�u ba a�cwaa ta gooaa retvn�a wnhout cansenc Sarv+ce cr+�rges on Paat due aceowu w�1 bs assoasea as allowetl by:aw. . . . � . .. ��y aoes iwc man,taeaire ms goods it seus anc roskes�no e:press warranaes u,e.ean.Jutlo Suao�y ca+�any a�aclan+s ar irt+c`aa wartano.s � . �varranry�f inerchanrao�ry or ntnens tar a aartawar use.. qA Y ',!1 i !:' 1 I -.� � ' - . .. \ � . . . � � . . . . . . . . . �