HomeMy WebLinkAbout4.d. Request for Payment #2, West Ridge 2nd Addition, Streets & UtilitiesCITY OF ROSEMOUNT
APPLICATION FOR PAYMENT
NO.
CITY PROJECT NO: % % SEH FILE NO: 571Z 3
PROJECT: (sEf2S qe.
CONTRACTOR: r�cw�. t_�a�'P: Co rho. CONTRACT DATE: 8/+/87
//661 raga, Sf. 11)14j APPLICATION DATE: ! �1 Z$' /87
C001, � s %nli/. SS433 FOR PERIOD ENDING �l �ZS Z07
Total Contract Amount $ ZIS, 6683—+ Total Amount Earned S Z.3S, A2 9 47
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 ......................
$ 235, 839.
LESS$
S�.RETAINAGE
/'t 791 ' 98
...................
AMOUNT DUE TO DATE ....................
$ ZZ-fi-017.
LESS PREVIOUS APPLICATIONS ............
$ �s3}x,73
AMOUNT DUE THIS APPLICATION ...........
$ 7076
A P90VE
ichard M. H jt,
City Engineer irector of Public Works
APPLICATION FOR PAYMENT
-------------------------
(UNIT PRICE CONTRACT)
NO. 3
OWNER:
ROSEMOUNT, MINNESOTA
OWNER'S PROJECT NO.
167
ENGINEER'S
PROJECT
NO.
-
87123
LOCATION:
ROSEMOUNT, MINNESOTA
-------------------------------
----------------
CONTRACTOR
AMERICAN CONTRACTING CORP.
CONTRACT
DATE
--------------------------
- ---------------
-------------------------
---
11661
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
November 25 1987
PERIOD END.
.......November-25 1987
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
16 8
13.69
$ 69802
0256.408
8" PVC, 12'-14'DEEP
L.F.
551
—427
14.37
$ 6135x9
0256.408
8" PVC, 141-16'DEEP
L.F.
268
9
15.22
$
0256.604
8" DIP 10'-12' DEEP
L.F.
18
18
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
$ 7462.80
8' DEEP
0256.702
EXCESS DEPTH STANDARD
L.F.
35
0
58.72
$
MANHOLE
PAGE 1 OF 4 SHORT-ELLIOTT-HENDRICKSON, INC.
i
0256.801
8" BY 4" PVC WYE
EACH
53
53
29.20
$ 1547.60
0256.802
10" X 4" DIP SEWER
EACH
1
_1
503.55
$ 5113.55
CONNECTION
0256.803
4" PVC SERVICE
L.F.
2300
2244.3
3.84
$ 8618.12
0256.805
4" DIP RISER
L.F.
30
22.9
81.16
$ 1858.57
0256.900
CONNECT TO EXISTING DROP
EACH
3
3
647.40
$ 1942.20
STRUCTURE
II.
WATERMAIN
0257.406
6" DIP WATERMAIN, CL 52
L.F.
1980
2613.4
10.79
$ 28198.59
0257.606
6" R . S . GATE VALVE & BOX
EACH
4
4
286.60
$ 1146.40
0257.630
FITTINGS LESS THAN 12"-
L@.
900
7.86
1.35
$ 10fi1.10
0257.640
FIRE HYDRANT
EACH
8
8
983.20
$ 7865.60
0257.710
1" COPPER SERVICE
L.F.
2400
2354
4.36
$ 10263.44
0257.730
1" CORPORATION
EACH
53
54
30.01
$ 1620.54
0257.740
1" CURB STOP
EACH
53
54
55.17
$ 2979.18
0257.903
CONNECT TO EXISTING
EACH
3
3
301.60
$ 904.80
WATERMAIN
ISI.
STORM SEWER
0258.412
-------------------------
12" RCP STORM SEWER,
L.F.
152
149
20.47
$ 3050.03
CL. V
0258.415
15" RCP STORM SEWER,
L.F.
513
514
20.76
$ 10670.64
CL. V
0258.421
21" RCP STORM SEWER,
L.F.
616
616
22.92
$ 14118.72
CL. IV
0258.424
24" RCP STORM SEWER,
L.F.
242
241
33.33
$ 8032453
CL. IV
0258.515
15" APRON W/TRASH GUARD
EACH
1
1
557.20
$ 557.20
0258.524
24" APRON W/TRASH GUARD
EACH
1
1
910.60
$ 910.60
0258.603
MANHOLE, TYPE B
L.F.
42
1R
87.68
$ 3331.84
0258.604
MANHOLE, TYPE C
L.F.
20
17
163.10
S 2772.70
0258.606
MANHOLE, TYPE E
L.F.
28
25
278.44
$ fi9fi 1 _00
PAGE 2 OF
4 SHORT-ELLIOTT-HENDRICKSON,
INC.
0258.704
CATCH BASIN, TYPE X
L.F.
20
15
131.31
$ 1969.65
0258.705
CATCH BASIN, TYPE Y
L.F.
9
7
151.95
$ 1063.65
0258.801
R 1733 MH CASTING FOR
EACH
6
6
115.00
$ 690.00
STORM SEWER
0258.808
R 3067 CB CASTING
EACH
8
8
176.00
$ 1408.00
0258.920
RANDOM RIPRAP,CL.IV
C.Y.
7
7
92.07
$ 6QQ_49
W/GEOTEXTILE FILTER
IV.
STREETS
2105.521
GRANULAR BORROW (L.V.)-_-C.Y.
1000
68
3.87
$ 263.15
2111.501
TEST ROLLING
RD.STA
26
29
5.00
$ 145.00
2112.501
SUBGRADE PREPARATION
RB.STA
26
29
75.00
$ 2175.00
2211.503
AGG. BASE PLACED CLASS 5
C.Y.
1800
1800
9.00
$ 16200.00
2341.504
BITUMINOUS MATERIAL FOR
TON
100
101.08
58.39
$ 5902.07
MIXTURE
2341.508
WEARING COURSE MIXTURE
TON
990
6_17 94
10.60
$ hrcn 17
2341.510
BINDER COURSE MIXTURE
TON
790
-76, 04
10.60
$ $0fi7 56
2357.502
BITUMINOUS MATERIAL FOR
GAL.
600
450
1.00
$
TACK COAT
450-00
2504.602
ADJUST GATE VALVE BOX
EACH
6
6
95.00
$ 570.00
2506.522
ADJUST FRAME AND RING
EACH
26
26
95.00
$ 2470.00
CASTING
2521.501
4" CONCRETE WALK
S.F.
6500
6042
1.37
$ 8277.54
2531.501
CONCRETE CURB & GUTTER,
L.F.
5500
5463
4.16
$22726.08
DESIGN D418
2554.501
PERMANENT BARRICADES
L.F.
32
0
43.34
$
PAGE 3 OF
4 SHORT-ELLIOTT-HENDRICKSON, INC.
s !
APPL ION FOR PAYMENT - Continued
Total Contract Amount
$ 245,688.94 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
GROSS AMOUNT DUE ............... $ 235,839.47
LESS 5 '% RETAINAGE......... $ 11,791.98
AMOUNT DUE TO DATE ............. $ 224,047.49
LESS PREVIOUS APPLICATIONS..... $ 153,940.73
CONTRACTOR'S AFFIDAVIT AMOUNT DUE THIS APPLICATION.... $ 70,106.76
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 Paymentunder 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 November 25, 1987 American Contracting Corporation
4" Name and -Titley
COUNTY OF Anoka SS
William 0 Horbal, President
)
STATE OF Minnesota )
Before me on this 25th day of Nomembec 19 a,�_ personally appeared
William 0. Horbal known to me, who being duly sworn, did depose
and say that he is the Presidpnt of the Contractor above mentioned;
Office
th v, plication for Payment and Affidavit on behalf of said Contractor;
an a o19VAARtJ 0qOTA
s contained therein are true, correct and co fete.
•° �� I NOTARY PIJPLIC - MINNfMym Xd
ssionr,�cpineetvMy Commission Expires May 28 J l Notary Public)
v vvvVWVVV0ANVVVVVVVVWVVVVWVVVVV X 16 b
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.
1,2-1-7 ! 8 % SHORT E TT H RICKSO
Date By
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