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Attachment B <br />Contractor's Application for Payment <br />Owner: City of Arden Hills Owner's Project No.: PW-24-0100 <br />Engineer: Bolton & Menk, Inc. Engineer's Project No.: OT1.130168 <br />Contractor: S.M. Hentges & Sons, Inc. Agency's Project No.: <br />Project: 2024 PMP Street & Utility Improvements <br />Contract: 2024 PMP Street & Utility Improvements <br />Application No.: 4 Application Date: 8/30/2024 <br />Application Period: From 8/2/2024 to 8/30/2024 <br />1. Original Contract Price $ 2,238,418.15 <br />2. Net change by Change Orders $ 40,903.03 <br />3. Current Contract Price (Line 1 + Line 2) $ 2,279,321.18 <br />4. Total Work completed and materials stored to date <br />(Sum of Column G Lump Sum Total and Column J Unit Price Total) $ 2,037,556.90 <br />5. Retainage <br />a. 5% X $ 2,037,556.90 Work Completed $ 101,877.85 <br />b. X $ - Stored Materials $ - <br />c. Total Retainage (Line 5.a + Line 5.b) $ 101,877.85 <br />6. Amount eligible to date (Line 4 - Line 5.c) $ 1,935,679.05 <br />7. Less previous payments $ 1,254,668.44 <br />8. Amount due this application $ 681,010.61 <br />9. Balance to finish, including retainage (Line 3 - Line 4) $ 241,764.28 <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 applied on <br />account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for <br />Payment; <br />(2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by this Application <br />for Payment, will pass to Owner at time of payment free and clear of all liens, security interests, and encumbrances (except <br />such as are covered by a bond acceptable to Owner indemnifying Owner against any such liens, security interest, or <br />encumbrances); and <br />(3) All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective. <br />Contractor: SM Hentges & Son's, Inc. <br />Signaturr:�,)A�1- Date: 9/5/2024 <br />Name: Patrick McMichael Title: Project Manager <br />Recommended by Engineer Approved by Owner <br />By: By: <br />Name: Ryan Peterson Name: <br />Title: Project Manager Title: <br />Date: 09.04.2024 Date: <br />