Laserfiche WebLink
APPUCATION AND CERTIFICATE FOR PAYMENT <br />TO OWNER: City ot Pequot Lakea PROJECT: 2106 Wactewater Treahnsnt APPLICATION NO.: 1 <br />4638 Couity Roed 11 FeciNty ImprovemeMe PERIOD TO: AprN 22, 2016 <br />PeQuot Lakes, MN 56472 � PROJECT 1�.: 0130B0059.000 <br />&UB6TANTIAI CONTRACT DATE: August 1, 2016 <br />CONTRACTOR: Borden E�sveGnp Ine. ENGINEER: Widseth Smith Noking FINAL CONTRACT DATE: Aupust 31, 2016 <br />13170 Borden Road 7408 indwtrial Pxk Rcad <br />Msrcifleld, MN 56465 Badsr, MN 56425 <br />CONTACT: Coraba Borden 21&7658346 CONTAGT: Tim Houb 218-316-3646 <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Applicatlon is mede �or peyment, as etawn 6ebw, in conrxd'an wNh lAe Contrsct <br />1. ORIGINAI CONTRACT SUM ......................................... <br />2. Nel chenge by Chenge Ordere .................................... <br />3. CONTRACT SUM TO DATE (L'me 1+ �ine 2) ............... <br />4. TOTAL COMPLETED & STORED TO DATE ................... <br />5. RETAINAGE: <br />A. 5% oi Compkted to Date <br />B. 5% of Storsd Meteriels <br />Total Retainsps <br />6. TOTAL EARNED LESS RETAINAGE ............................. <br />IUro 4 bp Lina 5 Totd) <br />7. IESS PREVIOUS CERTIFICATES FOR PAYNIENT......... <br />�1.ine 8 trom prwr peymer� <br />B. CURRENT PAYMENT DUE.......„..._»...._...._......».....» <br />9. BAIANCE TO FINISH, INCLUDING RETAINAGE ............. <br />�Line 3 bss lina 81 <br />aese,�oa.00 <br />50.00 <br />5�8,704.00 <br />s�az,2�e.so <br />53.550.10 <br />53�063.83 <br />56,613.93 <br />s��,c�.s� <br />50.00 <br />s�ss,ea4.s� <br />a�a3,o�.a3 <br />CHANGE ORDER 8UMAAARY <br />Total chanpes approved in previouc morrths <br />by Owner: COs <br />Total approved this moMh: <br />TOTALS: <br />� �.11':• . <br />50.00 <br />� � ��� <br />50.00 <br />The underapned CoMredot cerdtiea thet to tlie beel o17ie ContracbYS imowk�e, informstlon, arni <br />befe}, Ihe Work oovered by this Appllosdon for Peymsnt hss been oompbOM in accordance with the <br />Co�trscl Oocumenta, MM sl amounts have bean peid by the Contr�tor br Work wfiich pravious <br />Cartilfcatee lor PeymsM ware fsswd erW psymsnts recelvstl trom tha Ovmer, end tllat curtent <br />payme�t shown heren s row due. <br />CONTRACTOR: Bor�n Excavatlny hic. <br />BY: �l/IU-f'�%%`��/�G�I.C.V� <br />o.a: y�� ��/ �o <br />ENGINEER'8 CERTIFICATE FOR PAYMENT <br />In accordencs wNh the Co�tract OocumsnW, besed on oirslle observapbns and the dala wmprisinp <br />tAis apptlutlon, IM E�qqineer certMles Oo the Ownor thet Do the best ot lhs Enpinaer's knowledae, <br />IMOrmetbn, antl belkt, the Work hea propress�d es Indiceted, the queiry ot Work ie n�cordarice <br />In accoMenoe wIM the Contract Documenh, and the GoMrector la entipetl lo payment of the <br />ahova CurteM Paymanl Dua. <br />ENOINEER: /Widsath 8mHh NdHnp <br />/ �//yy� ��'/% <br />BY: r //��3�� � C . � %�'�"�PJ <br />Timdhy M. Houb <br />NET CHANGES by Change Order: 50.00 <br />oe�: Aprii 26, 2016 <br />J:101JOB-City of Pequot LekssW13080058-W WTF Corqtructbn Phaas10130BOD58.W0�YJVVTF Conetruction PhacelPaymeotc-C�snpa Orders�(PPE No 1.zkK�6ummary Pape <br />