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03-11-24-R
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03-11-24-R
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Contractor's Application for Payment No. 1 <br />Application to 12/31/2023 Application Date: 12/31/2023 <br />Period: <br />To (Owner): City of Arden Hills <br />From Peterson Companies, Inc. <br />Via (Engineer): HR Green <br />(Contractor): <br />Project: Arden Manor Park Floral Park <br />Contract: <br />Owner's <br />Contractor's 23120 <br />Project No: <br />Project No: <br />Chance Order Summary <br />Approved Change Orders <br />Number <br />Additions <br />Deductions <br />Change Order 01 <br />$115,649.89 <br />TOTALS <br />NET CHANGE BY <br />CHANGE ORDERS <br />$115,649.89 <br />-$115,649.89 <br />Contractor's Certification <br />The undersigned Contractor certifies, to the best of its knowledge, the following: <br />(1) All previous progress payments received from Owner on account of Work done under the Contract have been <br />applied on account to discharge Contractor's legitimate obligations incurred in connection with the Work <br />covered by prior Applications for Payment; <br />(2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by <br />this Application for Payment, will pass to Owner at time of payment free and clear of all Liens, security <br />interests, and encumbrances (except such as are covered by a bond acceptable to Owner indemnifying Owner <br />against any such Liens, security interest, or encumbrances); and <br />Contractor Signature <br />By: Date: 12/31/2023 <br />L ORIGINAL CONTRACT PRICE................................................................... <br />$ $816,523.35 <br />t. Net change by Change Orders......................................................................... <br />$-$115,649.89 <br />L Current Contract Price (Line 1 f 2)................................................................ <br />$ $700,873.46 <br />t. TOTAL COMPLETED AND STORED TO DATE <br />(Column F total on Progress Estimates).......................................................... <br />$ $690,004.09 <br />i. RETAINAGE: <br />a. 5% X $690,004.09 Work Completed............ <br />$ $34,500.20 <br />b. 5% X Stored Material .............. <br />$ <br />c. Total Retainage (Line 5.a + Line 5.b)................................... <br />$ $34,500.20 <br />5. AMOUNT ELIGIBLE TO DATE (Line 4 - Line 5.c).................................... <br />$ $655,503.89 <br />7. LESS PREVIOUS PAYMENTS (Line 6 from prior Application) ............... <br />$ <br />3. AMOUNT DUE THIS APPLICATION.......................................................... <br />$ $655,503.89 <br />1. BALANCE TO FINISH, PLUS RETAINAGE <br />(Column G total on Progress Estimates + Line 5.c above) ............................. <br />$ $45,369.57 <br />Payment of. $ $655,503.89 <br />(Line 8 or other - attach explanation of the <br />other amount) <br />is recommended by: 41 y"'� <br />3/1 /2024 <br />(Engineer) <br />(Date) <br />Payment of: $ $655,503.89 <br />(Line 8 or other - attach explanation of the <br />other amount) <br />is approved by: <br />(Owner) <br />(Date) <br />Approved by: <br />Funding or Financing Entity (if applicable) <br />(Date) <br />
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