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Home My WebLink About4.d. Application for Payment #3, Jay Simon's Addition & 130th StreetCURK' ' s 9 $� 02 CITY OF ROSEMOUNT APPLICATION FOR PAYMENT NO. s CITY PROJECT NO: 4-f4 SEH FILE NO: 6,T) 97 PROJECT: /3044- St # S/• oKs c(w CONTRACTOR: 1l t 1%;"U1 Aac(k*Zj CONTRACT DATE ZE5LC" Ckdow S APPLICATION DATE: / 111413. MAI Z SS_107 FOR PERIOD ENDING: Total Contract Amount $ &$ &96 Total Amount Earned $ Material Suitably Stored on Site, Not Incorporated into Work Contract Change Order No. Percent Complete $ Contract Change Order No. Percent Complete $ Contract Change Order No. Percent Complete $ GROSS AMOUNT DUE ... .......0... ..... $ LESS $ RETAINAGE ................... $ 66 � AMOUNT DUE TO DATE .................... $ /67,46C " �- LESS PREVIOUS APPLICATIONS ............ S $ %f�3�,71?-+ AMOUNT DUE THIS APPLICATION ........... $ My APPROVED:' Richard M. Hefti, City Engineer/Director ofPublicWorks ucrn� APPLICATION FOR PAYMENT (UNIT PRICE CONTRACT) S�PAUV NO. 3 Owner: ROSEMOUNT, MINNESOTA Owner's Project No. 1985-4 & 1985-4A Engineer's Project No. 85197 LOCATION JAY SIMON'S ADDITION AREA Contractor Bituminous Roadways, Inc. Contract Date 2825 Cedar Avenue South Contract Amount $182,696.40 e Minneapolis, MN 55407 Contract for STREET CONSTRUCTION ON 130TH ST. & THE JAY SIMON'S Pa Application Date 12/14/86 ucrn� APPLICATION FOR PAYMENT (UNIT PRICE CONTRACT) S�PAUV NO. 3 Owner: ROSEMOUNT, MINNESOTA Owner's Project No. 1985-4 & 1985-4A Engineer's Project No. 85197 LOCATION JAY SIMON'S ADDITION AREA Contractor Bituminous Roadways, Inc. Contract Date 2825 Cedar Avenue South Contract Amount $182,696.40 e Minneapolis, MN 55407 Contract for STREET CONSTRUCTION ON 130TH ST. & THE JAY SIMON'S ADDN. Application Date 12/14/86 For Period Ending 12/01/86 APPLICATION FOR PAYMENT CONTRACT QUANTITY UNIT DESCRIPTION UNIT QUANTITY TO DATE PRICE TOTAL 0563.601 TRAFFIC CONTROL DEVICES L.S. 1 1 $1,200.00 $ 1,200.00 2021.501 MOBILIZATION L.S. 1 1 1,018.00 $ 1,018.00 2101.501 CLEARING ACRE 4 4 880.00 $ 3,520.00 GRUBBING ACRE 4 4 880.00 3,520.00 Page -1 of 5 SHORT-ELLIOTT-HENDRICKSON, INC. Ncumm 198?. � 2_ APPLICATION FOR PAYMENT - Continued CONTRACT QUANTITY UNIT DESCRIPTION UNIT QUANTITY TO DATE PRICE TOTAL 2104.521 SALVAGE CM PIPE CULVERT L.F. 705 224 $4.00 $ 896.00 2105.501 COMMON EXCAVATION 7542 (p) C.Y. 7,542 1.70 $ 12.821.40 2105.521 GRANULAR BORROW yyao ,►uTl ZZ, loo (C. V.) C.Y. 800 5748 5.00 $ 2105.535 SALVAGED TOPSOIL (L. V.) C.Y. 1,434 1434. 3.25: $ 4,660.50 2111.501 TEST ROLLING RD. STA. 70 70 5.00 $__0.00 2112.501 SUBGRADE PREP. R.S. 70 70 68.00 $ 4.760.00 2116.501 CORE EXCAVATION C.Y. 500 740 3.00 $-_2-.220.00 2116.503 AGGREGATE BACKFILL C.Y. 500 740 5.65 $ 4,181.40 2211.503 AGGREGATE BASE PLACED, CLASS 5 C.Y. 2,150 2150 9.45 $ 20,317.50 2221.503 AGGREGATE SHOULDERING ~" PLACED, CLASS 2 C.Y. 1,150 1150 14.85 $ 1747.50 2341.504 BITUMINOUSMATERIAL �yq L FOR MIXTURE TON 140 152.7 148.00 $ 2341.508 WEARING COURSE MIXTURE TON* 2,300 2776.14 10.30 $ . 25 2501.511 12" CM PIPE CULVERT L.F. 450 128 13.90 $ 1,779.20 2501.511 15" R.C. PIPE CULVERT L.F. 625 630 20.85 $13,13 .50 2501.515 12" CM PIPE APRON EACH 30 4 65.00 $ 260.00 Page 2 of 5 A APPLICATION FOR PAYMENT —Continued F� 1987 0 2 CONTRACT QUANTITY UNIT DESCRIPTION UNIT QUANTITY TO DATE PRICE TOTAL 2501.515 15" R.C. PIPE APRON EACH 15 -36 $275.00 $ 4,400.00 2501.521 28-1/2" SPAN RCP CLASS III L.F. 36 36 38.00 $ 1,368.00 2501.525 28-1/2" SPAN RCP CLASS III APRONS EACH 2 2 365.00 $ 730.00 2501.571 INSTALL SALVAGED CM PIPE CULVERT L.F. 352 229 4.60 $--1.053.40 2506.509 CONSTRUCT CATCH BASIN, TYPE Z EACH 1 1 850.00 $ 850.00 2511.515 GEOTEXTILE FILTER, TYPE IV S.Y. 1,500 1879 1.50 $x,818.50 2511.515 RANDOM RIPRAP, CLASS II C.Y. 150 144.1 40.00 $ 5,764.00 2535, 501 BITUMINUS CURB L.F. 1,690 1615'' 2.95 $ 4,764.25 2554.501 PERMANENT BARRICADES L.P. 16 16 22.00 $ 352.00 2554.501 TRAFFIC BARRIER, DESIGN 8330 L.F. 555 600 5.85 $_-3,510 00 2554.501 TRAFFIC BARRIER,> DESIGN A8307 L.F. 654 638 9.85 $ 6.284.30 2554.523 TWISTED END TREATMENT EACH 2 2 420.00 $ 840.00 -. 2575.501 ROADSIDE SEEDING ACRE 4.7 160.00 $ 2575.502 SEED MIXTURE LBS. 355 2.30 $ Page 3 of 5 ' CLERK'S fltf 1 9 8 2 APPLICATION FOR PAYMENT - Continued DESCRIPTION CONTRACT QUANTITY UNIT UNIT QUANTITY TO DATE PRICE TOTAL 2575.505 SODDING S.Y. 140 3.15 2575.511 MULCH MATERIAL, TYPE 1 TON 9.4 175.00 $ 2575.519 DISC ANCHORING ACRE 4.7 42.00 $ Page 4 of 5 •APPLICATION FOR PAYMENT - ContinuedCLFRK'S 1987 _ , ` FILE .�1 qCofitract Amount $ 182 696.40 Total Am �8 ' Amount Earned $ , ate`rial Suitably Stored on Site, Not Incoporated into Work Contract Change Order No. Percent.Complete Contract Change Order No _ percent Complete Contract Change Order No. Percent Complete $ 98 GROSS AMOUNT DUE.. . ... $ 97, 331 LESS 5 % RETAINAGE......... $ ,8z AMOUNT DUE TO DATE.. $?, 465. LESS PREVIOUS APPLICATIONS..... $ 103,224.38 CONTRACTOR'S AFFIDAVIT AMOUNT DUE THIS APPLICATION.... $��' he undersigned Contractor hereby swears under penalty of perjury that (1) all previous payments received from the Owner o account of work performed under the contract referreo dtoess. 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, material and and (2) all. equipment incorporated in said Project or otherwiselisted in or covered by this Application for Payment are free and clear of all liens, claims, security interests and encumbrances Dated 19 __. BITUMINOUS ROADWAYS, INC, r 1tQ_0 n t r for iAn Name an Ti e COUNTY OF ) SS STATE OF ) Bef me on th' day of , 19 �L Q{ nown to me w personally ap and say that e, is he o beingul"y sworn, did of the Contractor above menti �Office that he executed the above Application for Payment andAffida,_ t on behalf of said eGr and that a'1l of the stat aiAk]''.1. i tru correct a co lets. ? Z 4Y Commission Expires: d FRf otary PubMy C' F. 20. logo he undersigned has checked the Contractor s pp cation for Payment shown above. A art of :his Application is the Contractor's Affidavit statin that all p him ender this Contract have been applied by him to discharge in full all payments in tnnection with the work covered by all prior Applications for Payment: n accordance with the Contract, the undersigned approves payment to the Contractor of the mount Due. ate % / Z� Pj? SHORT ELLIOTT HEN ICKS I C. By age 5 of 5