HomeMy WebLinkAbout9.d. City Hall Payment Requeste
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APPLICATION FOR PAYMENT
(UNIT PRICE CONTRACT)
NO. 2
Owner: ROSEMOUNT,
MINNESOTA Owner's Project No.
1986-9
Engineer's Project No.
87036
LOCATION COUNTRY HILLS ADDITION
Contractor
American Contracting Corp Contract Date 1-22`87
11661 Eagle St. N.W. Contract Amount $177,614.86
Coon
Rapids, MN 55433
Contract for TRUNK UTILITY IMPROVEMENTS FOR COUNTRY
HILLS ADDITION
Application
Date
For Period Ending
April 21, 1987
APPLICATION FOR PAYMENT
CONTRACT QUANTITY
UNIT
DESCRIPTION
UNIT QUANTITY TO DATE
PRICE TOTAL
0256.408 8-
PVC, 14' TO
16'
DEEP
L.F. 80 100
$15.33 $ 1,533.00
0256.410 10"
PVC,
8' TO
10'
DEEP
L.F. 160 222
13.28 $ 2,948.16
0256.410 10"
PVC,
10' TO
12'
DEEP
L.F. 400 374
13.62 $ S. 093.98
Page 1 of
5
SHORT-ELLIOTT-HENDRICKSON, INC.
c
a
*S
98?
APPLICATION FOR
PAYMENT -
Continued
CONTRACT
QUANTITY
UNIT
DESCRIPTION
UNIT
QUANTITY
TO DATE
PRICE
TOTAL
0256.410
10" PVC,
12' TO ;
14' DEEP
L.F.
245
230
$14.48
$ 3,330. 0
0256.410
10" PVC,
14' TO
16' DEEP
L.F.
145
102
15.59
$ 1,590.18
0256.610
10" DIP,
14' TO
16' DEEP
L.F.
35
31
22.68
$ 703.08
0256.610
10" DIP,
16' TO
18' DEEP
L.F.
55
58
27.29
$ 1,582. 2
0256.610
10" DIP,
18' TO
20' DEEP
L.F.
50
49
29.37
$ 1,439,13
0256.610
10" DIP,
20' TO
22' DEEP
L.F.
50
52
31.79
$ 1,653. 8
0256.610
10" DIP,
22' TO
24' DEEP
L.P.
170
170
34.60
$ 5,882. 0
0256.610
10" DIP,
24' TO
26' DEEP
L.F.
45
40
37.81
$ 1,512. 0
0256.610
10" DIP,
26' TO
28' DEEP
L.F.
20
27
41.27
$ 1,114.29
0256.701
STANDARD
MANHOLE,
8' DEEP
EACH
5
5
778.10
$ 3,890.50
0256.702
EXCESS DEPTH,
STANDARD
MANHOLE
L.F.
40
37.8
52.60
$ 1,988. 8
0256.706
MANHOLE DROP
SECTION
L.F.
8
7.2
210.95
$_1,51$:$4
0256.806
8" X 10"
MANHOLE
STUB
EACH
1
2
170.56
$ 341.12
0256.901
CONNECT TO EXISTING
MANHOLE
EACH
1
0
494.60
$ 0.00
Page 2 of 5 SHORT-ELLIOTT-HENDRICKSON, INC.
CF OK,S
z
1 98?
to
APPLICATION FOR
PAYMENT -
Continued
CONTRACT
QUANTITY UNIT
DESCRIPTION
UNIT
QUANTITY
TO DATE
PRICE
TOTAL
0256.908
8" DIP FORCEMAIN
L.F.
1,400
942
$15.63
$ 14,723.46
0257.407
6" DIP HYDRANT
LEAD, CL. 52
L.F.
40
39.5
17.84
$ 704.68
0257.408
8" DIP WATERMAIN,
CL. 52
L.F.-
60
48
19.84
$ 952.32
0257.416
16" DIP WATERMAIN,
CL. 52
L.F.
1,550
1,475
27.33
$40,311.75
0257.606
6" RS GATE VALVE
AND BOX
EACH
2
2
290.60
$ 581.20
0257.608
8" RS GATE VALVE
AND BOX
EACH
1
0
395.80
$ 0.00
0257.617
16" BUTTERFLY VALVE
AND BOX
EACH
1
0
1,283.80
$ 0.00
0257.630
D.I. FITTINGS
LB.
3,000
1,775
1.54
$ 2,733. 0
0257.640
FIRE HYDRANT
EACH
2
2
1,058.60
$ 2,117.20
0257.901
CUT -IN AND CONNECT
TO INPLACE WM
EACH
1
0
1,185.60
$ 0.00
0259.605
AGGREGATE PIPfi
SUBGRADE BACKFILL
TON
1,000
0
.10
$. 0.00
0259.607
REPLACEMENT
BACKFILL
TON
2,000
0
.10
$ 0.00
0259.701
4" BITUMINOUS SURFACE
RESTORATION
S.Y.
200
0
15.00
$ 0.00
0259.703
8" AGGREGATE BASE
RESTORATION
S.Y.
200
0
8.00
$ 0.00
0259.705
12" AGGREGATE SHOULDERING
RESTORATION
S.Y.
100
0
10.00
$ 0.00
Page 3
of 5
SHORT-ELLIOTT-HENDRICKSON,
INC.
Page 4 of 5 SHORT-ELLIOTT-HENDRICKSON, INC.
�rE s
2
9
APPLICATION FOR
PAYMENT -
Continued
CONTRACT
QUANTITY
UNIT
DESCRIPTION
UNIT
QUANTITY
TO DATE
PRICE
TOTAL
1195.501
LIFT STATION
L.S.
1
0 $48,923.40
$ 0.00
1710.501
TRAFFIC CONTROL
DEVICES
L.S.
1
0
500.00
$ 0.00
2105.501
COMMON EXCAV.
C.Y.
440
0
2.50
$ 0.00
2105.521
GRANULAR BORROW
(LV)
C.Y.
200
0
4.50
$ 0.00
2118.501
AGGREGATE SURFACING,
CL. 2
TON
350
0
12.00
$ 0.00
2501.511
12" CM PIPE
CULVERT
L.F.
20
0
14.41
$ 0.00
2501.515
12" CM PIPE APRON
EACH
2
0
106.10
$ 0.00
2575.501
SEEDING
ACRE
3
0
400.00
$ 0.00
2575.502
SEED, MIXTURE 5
LB.
225
0
1.75
$ 0.00
2575.511
MULCH MATERIAL,
TYPE 1
TON
6
0
125.00
$ 0.00
2575.519
DISC ANCHORING
ACRE
3
0
50.00
$ 0.00
Page 4 of 5 SHORT-ELLIOTT-HENDRICKSON, INC.
APPLICATION FOR PAYMENT - Continued
Total Contract Amount $ 177,614.86 Total Amount Earned
Material 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
CLERKSFILE 1981 1
$ 98,245.37
$
GROSS AMOUNT DUE ............... $ 98,245.37
LESS L % RETAINAGE......... $ 4,912.27
AMOUNT DUE TO DATE......... $�-4-v
LESS PREVIOUS APPLICATIONS..... $ 32,069.23 ,/
CONTRACTOR'S AFFIDAVIT AMOUNT DUE THIS APPLICATION, - $ 61,263.87
The undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress.
payments received from 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
material and equipment incorporated in said Project or otherwise listed in or covered by this
Application for Payment are free and clear of all liens, claims, security interests and
encumbrances.
Dated April 21 , lg 87 , American Contracting Corp.
Contractor n
By
COUNTY OF Anoka ) SS
STATE OF Minnesota )
`-- U (Name and Title)
Koryne Horbal Secretary
Before me on this 21st day of ��_ 19 ' personally appeared
— --known to me, who being duly sworn, did depose
and say tat he is the sprrataryof the Contractor above mentioned;
(Office)
that he executed the above Application for Payment and Affidavit on behalf of said Contractor;
and that all x d therein are true, correct and complete.
JUDITH A. BURGGRAF
My Commissio19myCommission
rf%TrRr
CAINN
AN ce TY otary u
Expires May 28, 1991
The undersigned has~checked the Contractor'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 obligations 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 ±1 Z-, Z 87
Page 5 of 5
SHORT EL HE ICKS
By