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Application for Payment No. 1 <br />To: The City of Arden Hills, MN <br />From: Magney Construction, Inc., 1401 Park Road, Chanhassen, MN 55317 <br />Contract: <br />Project: Lift Station 1& 12 Modifications <br />Owners Contract No. _ <br />Date of this Invoice: <br />Invoice Work Period: <br />Engineer's ProjectNo. <br />lj Original Contract Price: $291,620.00 <br />2) Net Change by Change Order/Written Amendments (-/+) $0.00 <br />3) Curent Contract Price (1+2): $291,620.00 <br />4) Total Completed and stored to date: $67,400.00 <br />5) Retainage (per Agreement): <br />% of completed work $3,370.00 <br />0.00°/a of stored material: <br />Total retainage: <br />6) Total Completed and stored to date less retainage (4-5) <br />7) Less Previous Application for Payments: <br />8) DUE THIS APPLICATION <br />$0.00 <br />$3,370.00 <br />$64,030.00 <br />$0.00 <br />$64,030.00 <br />Accompaning Documentation: <br />CONTRACTOR'S Certification: <br />The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of work <br />done under the Contract referred to above have been applied on account to dischazge CONTRACTOR'S legitimate obligations <br />incurred in connection with Work covered by prior Applications for Payment numbered 1 through 1 inclusive; (2) title of all <br />work, materials and equipment incorporated in said Work otherwise listed in or covered by this Application for Payment will <br />pass to OWNER at time of payment free and clear of all Liens, security interest or encumbrance (expect such as are recovered <br />by a Bond acceptable to OWNER indemnifying OWNER against any such Lien, security interest or encumbrance); and (3) <br />all Work covered by this Application for Payment is in accordance by the Contract Documents and not defective. <br />Dated: 3-Ju1-12 , , <br />I� <br />Inc. (Contractor) <br />State of � j �'�,�'��5� (�- County of �t� �U� � <br />Subscribed and sworn to before me this � day of �, 2012. <br />Notary Public �C� �"���� ��' <br />My Commission Expires: f��'� �� <br />Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br />Owner: <br />By: <br />Date: <br />Si1SAN KAY MASOiV / <br />NOTARY PUBLIC <br />MINNESOTA <br />i Gommission Expires Jan.31, 2014 <br />of Arden Hills Engineer: Elfering & Associates <br />By: � <br />Date: ( Z„ <br />