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APPLICATION AND CERTIFICATE FOR PAYMENT <br /> TO OWNER: City of Pequot Lakes PROJECT: 2106 Wastewater Treatment APPLICATION NO.: 4 <br /> 4638 County Road 11 Facility Improvements PERIOD TO: July 22,2016 <br /> Pequot Lakes,MN 56472 PROJECT NO.: 0130B0059.000 <br /> SUBSTANTIAL CONTRACT DATE: August 1,2016 <br /> CONTRACTOR: Borden Excavating Inc. ENGINEER: Widseth Smith Nolting 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 218-765-8346 CONTACT: Tim Houle 218-316-3646 <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 Contractors 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 that current <br /> 3. CONTRACT SUM TO DATE(Line 1+Line 2)............... $868,704.00 payment shown herein is now due. <br /> 4. TOTAL COMPLETED&STORED TO DATE................... $838,704.00 <br /> 5. RETAINAGE: CONTRACTOR: Borden Excavating Inc. <br /> A. 5%of Completed to Date $41,935.20 <br /> B. 5%of Stored Materials $0.00 <br /> Total Retainage $41,935.20 By: <br /> 6. TOTAL EARNED LESS RETAINAGE............................. $796,768.80 <br /> (Line 4 less Line 5 Total) Date: <br /> 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT......... $711,664.95 <br /> (Line 6 from prior payment) <br /> 8. CURRENT PAYMENT DUE............................................. $85,103.85 ENGINEER'S CERTIFICATE FOR PAYMENT <br /> 9. BALANCE TO FINISH,INCLUDING RETAINAGE............. $71,935.20 In accordance with the Contract Documents,based on on-site observations and the data comprising <br /> (Line 3 less Line 6) this application,the Engineer certifies to the Owner that to the best of the Engineers 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 ADDITIONS DEDUCTIONS above Current Payment Due. <br /> Total changes approved in previous months ENGINEER: Widseth Smith Nolting <br /> by Owner: COs <br /> Total approved this month: <br /> B : <br /> TOTALS: $0.00 $0.00 Timothy M.Houle <br /> NET CHANGES by Change Order: $0.00 <br /> Date: July 27, 2016 <br /> J:W130&City of Pequot LakeM013080059-WWTF Construction PhaseW130B0059.000-WWiF Construction Phase'Payments-Change Ordersl(PPE No 4.xLsu]Summary Page <br />