HomeMy WebLinkAbout4.f. Application for Payment #2, West Ridge 2nd Addition Street & UtilitiesY
CITY OF ROSEMOUNT
t
APPLICATION FOR PAYMENT
NO. Z.
CITY PROJECT NO: /67 SEH FILE NO: 87/Z3
PROJECT: %e-3-t KC74 t Zto / et4o..'
CONTRACTOR: b*014x., CoA Cir CONTRACT DATE
x/66/ E-*44e St My APPLICATION DATE: 87
C006-
C00K 90444- 01N. SS433 FOR PERIOD ENDING:
Total Contract Amount $ Z9S688 Total Amount Earned $ /62-1 04Z 87
Material Suitably Stored on Site,
Not Incorporated into Work $
— r—
Contract Change Order No. Percent Complete $
Contract Change Order No. Percent Complete $
Contract Change Order No. Percent Complete $
GROSS AMOUNT DUE ........... .... ... $ /6Zj d 9Z 87
LESS S$ RETAINAGE .. ....... . $ S/OZ !4
AMOUNT DUE TO DATE ............ $ 16315%'40 73
LESS PREVIOUS APPLICATIONS ........... $ 11+1733 °S
AMOUNT DUE THIS APPLICATION ........... $ 3911 Z'07 60
APPROVED:
Richard M. Ne ,
City Engineer/D3rector of Public Works
PAGE 1 OF 4 SHORT—ELLIOTT—HENDRICKSON, INC.
C�l� l
Rt ELLSuiT Nc,�.; P.ICItSON, INC,
APPLICATION FOR PAYMENT
------- ------ --�----------
( UNIT PRICE CONTRACT)
SEP 24 1987
NO. --
—
SL PAUL
OWNER:
ROSEMOUNT, MINNESOTA
OWNER'S PROJECT NO. 167
ENGINEER'S
PROJECT NO. 87123
LOCATION:
ROSEMOUNT, MINNESOTA
-------------------------------
----------------
CONTRACTOR
AMERICAN CONTRACTING
CORP.
CONTRACT
DATE
11661 EAGLE ST. N.W.
--------
CONTRACT.AMOUNT
-------------------------
$245,688.94
-
COON RAPIDS, MN 55433
-------------------------------
-----------------------
CONTR. FOR
STREET AND UTILITY
CONSTRUCTION — WEST
RIDGE SECOND ADDITION
APPLIC.DATE
--------------------
-------- ---- --- -- ---
b2L_
.... Stem r 23 1987 ___--
_
PERIOD END.____
Se tember 22 19$7
APPLICATION FOR
PAYMENT
CONTRACT
QUANTITY UNIT
DESCRIPTION
UNIT
QUANTITY
TO DATE PRICE TOTAL
I.
-----------------------------------------------------
SANITARY SEWER
0256.408
8" PVC, 10' —12' DEEP
— L.F.
1302
1658 13.69 $-2.698.02
0256.408
8" FVC, 12' -14' DEEP
L.F.
551
42Z 14.37 $ 6,1 J5.99
0256.408
8" PVC, 14'-16'DEEP
L.F.
268
p 15.22 $ Q.00
0256.604
8" DIP 10'-12' DEEP
L.F.
18
1R 19.09 $ 343-62
0256.604
8" DIP 12'-14' DEEP
L.F.
36
36 19.77 $ 711.72
0256.701
STANDARD MANHOLE,
EACH
9
9 829.20 $ 7.,462.$0
8' DEEP
0256.702
EXCESS DEPTH STANDARD
L.F.
35
0 58.72 $� .0(�
MANHOLE
PAGE 1 OF 4 SHORT—ELLIOTT—HENDRICKSON, INC.
PAGE 2 OF 4 SHORT-ELLIOTT-HENDRICKSON, INC.
0256.801
8" BY 4" PVC WYE
EACH
53
53
29.20
$ 1,547.60
0256.802
10" X 4" DIP SEWER
EACH
1
1
503.55
S
503.55
CONNECTION
0256.803
4" PVC SERVICE
L.F.
2300
2,2 ld 3
3.84
$ _13.,.618-11
0256.805
4" DIP RISER
L.F.
30
22.9
81.16
$
1.858.56
0256.900
CONNECT TO EXISTING DROP
EACH
3
3
647.40
$____1,242,20—
1,242.20STRUCTURE
STRUCTURE
II.
WATERMAIN
0257.406
- ----------------
6" DIP WATERMAIN, CL 52
L.F.
1980
-2 13 4
10.79
$
28,198.59
0257.606
6" R.S.GATE VALVE & BOX
EACH
4
4
286.60
$
1,146.40
0257.630
FITTINGS LESS THAN 12"
LB.
900
786
1.35
$
1,061.10
0257.640
FIRE HYDRANT
EACH
8
8
983.20
$
7,865.60
0257.710
1" COPPER SERVICE
L.F.
2400
Z354
4.36
$
10,263.44
0257.730
1" CORPORATION
EACH
53
54
30.01
$
1,620-54
0257.740
1"- CURB STOP
EACH
53
54
55.17
$
2,979.18
0257.903
CONNECT TO EXISTING
EACH
3
3
301.60
$
904.80
WATERMAIN
III.
STORM SEWER
0258.412
-----
12" RCP STORM SEWER,
L. F.
152
149
20.47
$
CL. V
_,31050.03
0258.415
15" RCP STORM SEWER,
L.F.
513
514
20.76
$
10,670.64
CL. V
0258.421
21" RCP STORM SEWER,
L.F.
616
616
22.92
$
14,118.72
CL. IV
0258.424
24" RCP STORM SEWER,
L.F.
242
241
33.33
S
8,032.53
CL. IV
0258.515
15" APRON W/TRASH GUARD
EACH
1
1
557.20
$
557.20
10258.524
24" APRON W/TRASH GUARD
EACH
1
1
910.60
$
910.60
0258.603
MANHOLE, TYPE B
L.F.
42
38
87.68
$
3,331.84
0258, 604
MANHOLE, TYPE C
L.F.
20
17
163.10
$
2,772.70
0258.606
MANHOLE, TYPE E
L.F.
28
25
278.44
$
6,961.00
PAGE 2 OF 4 SHORT-ELLIOTT-HENDRICKSON, INC.
0258.704
CATCH BASIN, TYPE X
L.F.
20
15
131..31
$
1,969.65
0258.705
CATCH BASIN, TYPE Y
L.F.
9
7
151.95
$
1,063.65
0258.801
R 1733 MH CASTING FOR
EACH
6
6_
115.00
s------690.00
STORM SEWER
0258.808
R 3067 CB CASTING
EACH
8
8 _
176.00
$
1,408.00
0258.920
RANDOM RIPRAP,CL.IV
C.Y.
7
7
92.07
$44.49
W/GEOTEXTILE FILTER
IV.
STREETS
2105.521
_,
GRANULAR BORROW (L.V.)C.Y.
1000
0
3.87
$
0.00
2111.501
TEST ROLLING
RD.STA
26
0
5.00
$
0.00
2112.501
SUHGRADE PREPARATION
RD.STA
26
0
75.00
$
0.00
2211.503
AGG. BASE PLACED CLASS 5
C.Y.
1800
0
9.00
$
0.00
2341.504
BITUMINOUS MATERIAL FOR
TON
100
0
58.39
$
0.00
MIXTURE
2341.508
WEARING COURSE MIXTURE
TON
990
0
10.60
$
0.00
2341.510
BINDER COURSE MIXTURE
TON
790
0
10.60
$
0.00
2357.502
BITUMINOUS MATERIAL FOR
GAL.
600
0
1.00
$
0.00
TACK COAT
2504.602
ADJUST GATE VALVE BOX
EACH
6
0
95.00
$
0.00
2506.522
ADJUST FRAME AND RING
EACH
26
0
95.00
$
0.00
CASTING
2521.501
4" CONCRETE WALK
S.F.
6500
0
1,37
$
0.00
2531.501
CONCRETE CURB & GUTTER,
L.F.
5500
0
4.16
$
0.00
DESIGN D418
2554.501
PERMANENT BARRICADES
L.F.
32
0
43.34
$
0.00
PAGE 3 OF
4 SHORT-ELLIOTT-HENDRICKSON,
INC.
APPLICATION FOR PAYMENT- Continued
Total*Contract Amount $ 245,688.0 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
$ 162.042.87
GROSS AMOUNT DUE ................$ 16.7 Q&2 87
LESS5 % RETAINAGE......... $ 8,102.14
AMOUNT DUE TO DATE.............. $ 153,940.73
LESS PREVIOUS APPLICATIONS... $ 114733.05 v�
CONTRACTOR'S AFFIDAVIT AMOUNT DUE THIS APPLICATION.... $ 39.207.68
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 September 23 19 87 American -Contracting Corporation
Con actor
By ,
Name n gTi le
COUNTY OF Anoka ) SS
STATE OF Minnesota )
Before me on this 23rd day of September 19 87 personally appeared
William 0. Ho bal known to me, who being duTy sworn, did depose
and say that he is the President of the Contractor above mentioned;
(Office)
that he exec ax p+44mtion for Payment and Affidavit on behalf of said Contractor;
and tha o JbbftHstAt& Rt% c tained therein are true, corr t a complete.
z
NOTARY PUBLIC - MINNESOTA —
My Commi Expi�A CO
.
Mycommiwonexpires 8. � M991 (Notary Pu
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.
SNORT E=LT E RICIS"
, C.
Date By
T
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