10.d2 2023 Street Crack Filling and Seal Coat Project - Contractor's Request for Payment No 2nd and Final
14727 209th St. N. PO Box 128, Scandia, Minnesota 55073
Phone (651) 433 -2274 Fax (651) 433-5112 http://www.ci.scandia.mn.us
August 26, 2023
Honorable Mayor and City Council
City of Scandia
14727 209th Street N.
Scandia, MN 55073-8503
Re: Contractor’s Request for Payment No. 2nd and Final
2023 Crack Filling and Seal Coat Project
Dear Mayor and Council:
Enclosed please find Contractor’s Request for Payment No. 2 and Final, IC134
Withholding Affidavits, and Lien Waiver’s for the 2023 Crack Filling and Seal Coat
Project. We recommend the council approve the Contractor’s Request for Payment No. 1
and pay $13,276.48 to Allied Blacktop Company.
The contractor has successfully completed all work on the project and withholding has
been reduced to 0%.
Please call me at (612) 597-7140 if there are any questions or concerns regarding this
Contractor’s Payment request.
Sincerely,
Ryan J. Goodman, P.E.
City Engineer
Enclosures: Contractor’s Request for Payment No. 2nd and Final, IC134’s and Lien
Waivers
2 and Final
From
1.
2.
3.
4.
5.
a.X
b.X
c.
6.
7.
8.
9.
Name:Name:
4,275.65$
Date:
By:
Title:
By:
Title:
Approved by City of Scandia
The undersigned Contractor certifies, to the best of its knowledge, the following:
(1) All previous progress payments received from Owner on account of Work done under the Contract have been applied on
account to discharge Contractor's legitimate obligations incurred in connection with the Work covered by prior Applications for
Payment;
(2) Title to all Work, materials and equipment incorporated in said Work, or otherwise listed in or covered by this Application for
Payment, will pass to Owner at time of payment free and clear of all liens, security interests, and encumbrances (except such as
are covered by a bond acceptable to Owner indemnifying Owner against any such liens, security interest, or encumbrances);
and
(3) All the Work covered by this Application for Payment is in accordance with the Contract Documents and is not defective; and
(4) The provisions of M. S. 290.92 have been complied with and that all claims against me by reason of the Contract have been
Recommended by Bolton & Menk, Inc.
Name:
Allied Blacktop Company
Contractor's Certification
Amount due this application
Contractor:
Balance to finish, including retainage (Line 3 - Line 4)
Date:
Signature:
Work Completed
Stored Materials
Total Retainage (Line 5.a + Line 5.b)
Amount eligible to date (Line 4 - Line 5.c)
Less previous payments
$ 164,100.85
$ -
-$
-$
13,276.48$
150,824.37$
-$
164,100.85$
Contractor:
Engineer:
Project:
0N1.130046
Contractor's Application for Payment
Application No.:
City of Scandia
Allied Blacktop Company
Bolton & Menk, Inc.
2023 Crack Filling and Seal Coat Project
Owner's Project No.:
Engineer's Project No.:
Agency's Project No.:
Application Period:
Contract:
Owner:
8/8/2023
Application Date:8/9/2023
139,576.50$
28,800.00$ Net change by Change Orders
6/13/2023 to
Original Contract Price
164,100.85$
168,376.50$
Retainage
Current Contract Price (Line 1 + Line 2)
Total Work completed and materials stored to date
(Sum of Column G Lump Sum Total and Column J Unit Price Total)
Date:
Title:
EJCDC C-620 Contractor's Application for Payment
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.
Contractor's Application for Payment
Owner's Project No.:
Engineer's Project No.:
Agency's Project No.:
2 and Final From 06/13/23 to 08/08/23
A C D E F F1 F2 G H I J K L
Item Quantity Units
Unit Price
($)
Value of Bid Item
(C X E)
($)
Quantity Previous
Estimate
Value Previous
Estimate
Estimated
Quantity
Incorporated in
the Work
Value of Work
Completed to Date
(E X G)
($)
1 1.00 LS 10,000.00 10,000.00 0.80 8,000.00 1.00 10,000.00 10,000.00 100% -
2 1.00 LS 5,000.00 5,000.00 0.95 4,750.00 1.00 5,000.00 5,000.00 100% -
3 18,000.00 GAL 2.50 45,000.00 18,000.00 45,000.00 18,000.00 45,000.00 45,000.00 100% -
4 550.00 TN 105.00 57,750.00 550.00 57,750.00 550.00 57,750.00 57,750.00 100% -
5 7,500.00 LBS 2.50 18,750.00 7,500.00 18,750.00 7,500.00 18,750.00 18,750.00 100% -
6 5,250.00 LF 0.45 2,362.50 - - 5,173.00 2,327.85 2,327.85 99% 34.65
7 2.00 EA 165.00 330.00 - - 2.00 330.00 330.00 100% -
8 48.00 SF 8.00 384.00 - - 46.00 368.00 368.00 96% 16.00
139,576.50$ 134,250.00$ 139,525.85$ -$ 139,525.85$ 100% 50.65$
9 1.00 LS 1,250.00 1,250.00 0.95 1,187.50 1.00 1,250.00 1,250.00 100% -
10 4,690.00 GAL 2.50 11,725.00 3,103.00 7,757.50 3,103.00 7,757.50 7,757.50 66% 3,967.50
11 140.00 TN 105.00 14,700.00 140.00 14,700.00 140.00 14,700.00 14,700.00 100% -
12 450.00 LB 2.50 1,125.00 347.00 867.50 347.00 867.50 867.50 77% 257.50
28,800.00$ 24,512.50$ 24,575.00$ -$ 24,575.00$ 85% 4,225.00$
168,376.50$ 158,762.50$ 164,100.85$ -$ 164,100.85$ 97% 4,275.65$ TOTAL
CHANGE ORDER TOTAL
BASE BID + CHANGE ORDER NO. 1
SEAL COAT AGGREGATE, FA-2 (MOD)
BITUMINOUS MATERIAL FOR SEAL COAT
AGGREGATE FA-2 MODIFIED
ROUTE AND SEAL CRACKS
CHANGE ORDER
BASE BID TOTAL
Materials Currently
Stored (not in G)
($)
Work
Completed
and Materials
Stored to Date
(H + I)
($)
Contract Information
Bid Item
No.
BITUMINOUS MATERIAL FOR SEAL COAT
Engineer:
Contractor:
Project:
Contract:
DOUBLE YELLOW STRIPE
RAIL ROAD MESSAGE
Application Date:Application Period:Application No.:
Previous Estimate
08/09/23
B
BASE BID
% of
Value of
Item
(J / F)
(%)
Balance to Finish
(F - J)
($)
MOBILZATION
TRAFFIC CONTROL
Description
Work Completed
24" STOP BAR
TRAFFIC CONTROL
Progress Estimate - Unit Price Work
City of Scandia
Bolton & Menk, Inc.
Allied Blacktop Company
2023 Crack Filling and Seal Coat Project
Owner:
0N1.130046
ROUTE & SEAL
Unit Price
EJCDC C-620 Contractor's Application for Payment
(c) 2018 National Society of Professional Engineers for EJCDC. All rights reserved.1 of 1