09.d3 2024 Crack Filling and Seal Coat Project - Contractor's Request for Payment No 3 and Final
14727 209 th St. N., Scandia, Minnesota 55073
Phone (651) 433 -2274 Fax (651) 433 -5112 http://www.ci tyof scandia .com
October 15, 2024
Honorable Mayor and City Council
City of Scandia
14727 209th Street N.
Scandia, MN 55073-8503
Re: Contractor’s Request for Payment No. 3 and Final
2024 Crack Filling and Seal Coat Project
Dear Mayor and Council:
Enclosed please find Contractor’s Request for Payment No. 3 and Final, for the 2024 Crack Filling
and Seal Coat Project. We recommend the council approve the Contractor’s Request for Payment
No. 3 and Final and pay $38,398.20 to Pearson Bros. Inc. This amount includes work required
to seal coat the roads in this year’s project. This request includes withholding 0% retainage.
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. 3 and Final, and Final Documents
Contractor's Application for Payment
Owner:
Engineer:
Contractor:
Project:
Contract:
Application No.:3 and Final Application Date:9/6/2024___.:......,:_
Application Period:From 8/10/2024 to 9/6/2024
City of Scandia
Bolton &Menk,Inc.
Pearson Bros.,Inc.
2024 Crack Filling and Seal Coat Project
owner's Project No.:ON1.133753
Engineer's Project No.:-----------Agency's Project lo.'
1.Original Contract Price
2.Net change by Change Orders
3.Current Contract Price (Line 1+Line 2)
4.Total Work completed and materials stored to date
(Sum of Column G Lump Sum Total and Column J Unit Price Total)
5.Retainage
°K $396,292.91 Work Completed
b.X $-Stored Materials
c.Total Retainage (Line S.a +Line 5.b)
6.Amount eligible to date (Line 4-Line 5.c)
7.Less previous payments
8.Amount due this application
9.Balance to finish,including retainage (Line 3 -Line 4)
$419,363.00
$--
$419,363.00
$396,292.91
$-
$--
$-
$396,292.91
$357,894.71
$38,398.20
$23,070.09
Contractor's Certification
The undersigned Contractor certifies,to the best of its knowledge,the following:
(1)AII 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.5.290.92 have been complied with and that all claims against me by reason of the Contract have been
paid or satisfactorily secured.
Contractor:Pearson Bros.,Inc.
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Nome:}AA.Ee.?A N0a
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Approved by City of Scandia
Name:
Title:
Date:9/2<2
By:
Name:
Title:
Date:7 7
EJCDC C-620 Contractor's Application for Payment
(c)2018 National Society of Professional Engineers for EJCDC.All rights reserved.
Contractor Affidavit Submitted
Thank you, your Contractor Affidavit has been approved.
Confirmation Summary
Confirmation Number:1-205-215-456
Submitted Date and Time:12-Sep-2024 11:29:12 AM
Legal Name:PEARSON BROS INC
Federal Employer ID:41-1751395
User Who Submitted:mhallich
Type of Request Submitted:Contractor Affidavit
Affidavit Summary
Affidavit Number:267833344
Minnesota ID:1232027
Project Owner:CITY OF SCANDIA
Project Number:0N1.133753
Project Begin Date:10-Jul-2024
Project End Date:28-Aug-2024
Project Location:SCANDIA
Project Amount:$396,292.91
Subcontractor Summary
Name ID Affidavit Number
SIR LINES-A-LOT INC 3509324 993644544
MP ASPHALT MAINTENANCE LLC 5330725 111398912
Important Messages
A copy of this page must be provided to the contractor or government agency that hired you.
Contact Us
If you need further assistance, contact our Withholding Tax Division at 651-282-9999, (toll-free) 800-657-3594, or (email)
withholding.tax@state.mn.us. Business hours are Monday through Friday 8:00 a.m. to 4:30 p.m. Central Time.
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Contractor Affidavit Submitted
Thank you, your Contractor Affidavit has been approved.
Confirmation Summary
Confirmation Number: 1-263-558-880
Submitted Date and Time: 11-Sep-2024 12:37:20 PM
Legal Name: MP ASPHALT MAINTENANCE LLC
Federal Employer ID: 82-3548843
User Who Submitted: mleaf2121
Type of Request Submitted: Contractor Affidavit
Affidavit Summary
Affidavit Number: 111398912
Minnesota ID: 5330725
Project Owner: CITY OF SCANDIA
Project Number: 2024 CRACK SEAL
Project Begin Date: 26-Jun-2024
Project End Date: 26-Jun-2024
Project Location: CITY OF SCANDIA
Project Amount: $9,249.75
Subcontractors: No Subcontractors
Important Messages
A copy of this page must be provided to the contractor or government agency that hired you.
Contact Us
If you need further assistance, contact our Withholding Tax Division at 651-282-9999, (toll-free) 800-657-3594, or
(email) withholding.tax@state.mn.us. Business hours are Monday through Friday 8:00 a.m. to 4:30 p.m. Central
Time.
How to View and Print this Request
You can see copies of your requests by going into your History.
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you are not the intended recipient, any disclosure, copying, use, or distribution of the information included in this
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immediately and permanently delete this message and any attachments. Thank you.
WAIVER AND RELEASE OF LIEN
WHEREAS, the undersigned,Mp Asohalt
Name of Manufacturer, Material man or Subcontractor
has furnished to MP Asphalt the following:
Name of Confactor
Crack sealins for use in construction of a
Kind of Material and Services Furnished
project belonging to Citv of Scand
, and
Name of Owner
designated as,zo24 street oroiect
Name of Prolect
NOW, THEREFORE, the undersigned,MP halt
Name of Manufacturer, Material man or Subccntractor
for and in consideration of S s9.249.75 , and other good and
valuable consideration, the receipt whereof is hereby acknowledged, do(es) hereby
waive and release any and all liens, or right to or claim of lien, on the above described
project and premises, under any law, common or statutory, on account of labor or
materials, or both, heretofore or hereafter furnished by the undersigned to or for the
account of said
MP asPhalt for said Project.
Nam€ of Contractor
Name of Manufacturer, Materiai man or Subcontractor
President,Partner or Owner, or, if signed bY than one offoregoing, accompanied by Power
.i
Given under my (our) hand(s) and seal(s)this !L-day of 20Il
{nf Ar{tr"W
By
by one of the foregoing in favor of the signer. (Use designation applicable)
of Attorney signed
WAIVER AND RELEASE OF LIEN
WHEREAS, the undersigned,
Name of Manufacturer, Material man or Subcontractor
has furnished to the following:
Name of Contractor
for use in construction of a
Kind of Material and Services Furnished
project belonging to , and Name of Owner
designated as, . Name of Project
NOW, THEREFORE, the undersigned, Name of Manufacturer, Material man or Subcontractor
for and in consideration of $ , and other good and valuable
consideration, the receipt whereof is hereby acknowledged, do(es) hereby waive and
release any and all liens, or right to or claim of lien, on the above described project and
premises, under any law, common or statutory, on account of labor or materials, or
both, heretofore or hereafter furnished by the undersigned to or for the account of said
for said project. Name of Contractor
Given under my (our) hand(s) and seal(s) this day of , 20 .
Name of Manufacturer, Material man or Subcontractor
By
President, Vice-President, Partner or Owner, or, if signed by other than one of foregoing, accompanied by Power of Attorney signed
by one of the foregoing in favor of the signer. (Use designation applicable)
Sir Lines-A-Lot, LLC
Pearson Bros, Inc
Pavement Markings
City of Scandia
2024 Sealcoat
Sir Lines-A-Lot, LLC
18,492.80
Pearson Bros, Inc
Sir Lines-A-Lot, LLC
13th September 24
Gina Goehring, Project Accounant Lead