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APPLICATION AND CERTIFICATE FOR PAYMENT <br /> TO OWNER: City of Pequot Lakes PROJECT: 2106 Wastewater Treatment APPLICATION NO.: 3 <br /> 4638 County Road 11 Facility Improvements PERIOD TO: June 24,2016 <br /> Pequot Lakes,MN 56472 PROJECT NO.: 013080059.000 <br /> SUBSTANTIAL CONTRACT DATE: August 1,2016 <br /> CONTRACTOR: Borden Excavating Inc. ENGINEER: Widseth Smith Notting FINAL CONTRACT DATE: August 31,2016 <br /> 13110 Borden Road 7408 Industrial Park Road <br /> Merrifield,MN 56465 Baxter,MN 56425 <br /> CONTACT: Coralea Borden 218-7658346 CONTACT: Tim Houk 218316-3646 <br /> CONTRACTOR'S APPLICATION FOR PAYMENT <br /> Application is made for payment,as shown below,in connection with the Contract The undersigned Contractor certifies that to the best of the Contractor's knowledge,information,and <br /> belief,the Work covered by this Application for Payment has been completed In accordance with the <br /> 1. ORIGINAL CONTRACT SUM......................................... $868,704.00 Contract Documents,that all amounts have been paid by the Contractor for Work which previous <br /> 2. Net change by Change Orders.................................... $0.00 Certificates for Payment were issued and payments received from the Owner,and Met current <br /> 3. CONTRACT SUM TO DATE(Urne 1+Line 2)............... $868,704.00 payment shown herein is now due. <br /> 4. TOTAL COMPLETED 8 STORED TO DATE................... $749,121.00 <br /> 5. RETAINAGE: CONTRACTOR: Borden Excavating Inc. <br /> A. 5%of Completed to Date $37,456.05 i <br /> B. 5%of Stored Materials $0.00 <br /> Total Retainage $37,456.05 By: 14"4 _ //e4,4 <br /> 6. TOTAL EARNED LESS RETAINAGE............................. $711,664,95 <br /> (Line 4less Line 5 Total) Date: <br /> 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT......... $578,250.68 <br /> (Line 6 from prior payment) <br /> 8. CURRENT PAYMENT DUE.»». .»»....».......»...»......».. $133,414.27 ENGINEER'S CERTIFICATE FOR PAYMENT <br /> 9. BALANCE TO FINISH,INCLUDING RETAINAGE............. $157,039.05 In accordance with the Contract Documents,based on o"ite observations and the data comprising <br /> (Line 3 less Line 6) the application,the Engineer certifies to the Owner that to the best of the Engineer's knowledge, <br /> information,and belief,the Work has progressed as indicated,the quality of Work is in accordance <br /> in accordance with the Contract Documents,and the Contractor is entitled to payment of the <br /> CHANGE ORDER SUMMARY ADDITION$ DEDUCTIONS above Current Payment Due. <br /> Total changes approved in previous months ENGINEER: Widseth Smith Notting <br /> by Owner: COs / <br /> Total approved this month: <br /> By: <br /> TOTALS: $0.00 $0.00 Timothy M.Houle <br /> NET CHANGES by Change Order: $0.00 <br /> Date: June 28, 2016 <br /> JAD130B-City of Pequot La1kes\0130B0059-WWTF Construction Phase\0130B0059.000-VJWTF Construction Phase\Payments-Charge Orders\[PPE No 3.xlsx}Summary Page <br />