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Application for Payment No.3 <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. Engineer's Project No. <br /> Date of this Invoice: 30-Aug-12 <br /> Invoice Work Period: 8/1/12 through 8/31/12 <br /> 1) 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: $278,320.00 <br /> 5) Retainage(per Agreement): <br /> 0.00% of completed work $13,916.00 <br /> 0.00% of stored material: $0.00 <br /> Total retainage: $13,916.00 <br /> 6) Total Completed and stored to date less retainage(4-5) $264,404.00 <br /> 7) Less Previous Application for Payments: $199,367.00 <br /> 8) DUE THIS APPLICATION $65,037.00 <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 discharge CONTRACTOR's legitimate obligations <br /> incurred in connection with Work covered by prior Applications for Payment numbered 1 through 3 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: 4-Sep-12 <br /> �neyr�onst (etion,Inc.(Contractor) <br /> B <br /> State of `'�;� I`Ytnejo f�- County of �_V, )I r, <br /> Subscribed and sworn to before me this 4f� da of <br /> SU AtN <br /> ON Notary Public (,t C t�--14 ' ��`` ' NOyn .My Commission Expires: , i t <,.:r%y Commis1,2Q14 <br /> Payment of the above AMOUNT DUE THIS APPLICATION is recommended. <br /> Owner: City of Arden Hills Engineer: Elfering&Associates <br /> By: By: <br /> Date: Date: <br />