9.3 Larsen Parkway Final Payment - DeChantal Excavating

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Contractor's Application for Payment Owner: City of Pequot Lakes Owner's Project No.: N/A Engineer: Widseth Engineer's Project No.: 2020-11495 Contractor: DeChantal Excavating,LLC Contractor's Project No.: N/A Project: 2021 Larsen Parkway Street and Utilities Improvement Project Contract: N/A Application No.: 5-Final Application Date: 1/23/2023 Application Period: From 12/29/2021 to 1/25/2023 1. Original Contract Price $ 370,240.15 , 2. Net change by Change Orders $ 6,169.02 3. Current Contract Price(Line 1+Line 2) $ 376,409.17 4. Total Work completed and materials stored to date (Sum of Column G Lump Sum Total and Column J Unit Price Total) $ 378,524.59 5. Retainage a. 0.0% X ; $ 378,524.59 Work Completed $ - b. 0% X $ - Stored Materials c. Total Retainage(Line 5.a+Line 5.b) 6. Amount eligible to date(Line 4-Line 5.c) $ 378,524.59 7. Less previous payments(Line 6 from prior application) dismaka;: 8. Amount due this application $ 9 463.11 9. Balance to finish,Including retainage(Line 3-Line 4) • Contractor's Certification See memo in the following pages -- The undersigned Contractor certifies,to the best of its knowledge,the following: (1)All previous progress payments received from Owner on account of Work done under the Contract have been applied on account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for Payment; (2)Title to all Work,materials and equipment incorporated In said Work,or otherwise listed In or covered by this Application for Payment,will pass to Owner at time of payment free and dear of all liens,security interests,and encumbrances(except such as are covered by a bond acceptable to Owner Indemnifying Owner against any such liens,security interest,or encumbrances);and (3)All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. Contractor: DeChantal Excavating,LLC Signature: v ® Date: /025 023 Recommended y Engineer Approved by Owner By: 2:1;4/79 f"r• auk By: Title: Timothy M.Houle-Project Manager Title: Date: 1/25/2023 Date: Approved by Funding Agency By: NA By: Title: Title: Date: Date: EJCDC C-620 Contractor's Application for Payment (c)2018 National Society of Professional Engineers for EJCDC. All rights reserved.