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9.h 2017 Seal Coat Contractors Request for Paymen... h:\scnd\n13113369\1_corres\c_to others\mayor and city council_rjg^2017 seal coat contractors request for payment no 2 & final.docx December 12, 2017 Honorable Mayor and City Council 14727 209th St N Scandia, MN 55973 RE: Contractor’s Request for Payment No. 2 & Final 2017 Seal Coat Project Dear Mayor and Council: Enclosed please find Contractor’s Request for Payment No. 2 & Final for Pearson Bros., Inc. for the services they provided on the above referenced project. The contractor has completed the seal coat in accordance with plans and specifications. We recommend the Council approves the Contractor’s Request for Payment No. 2 & Final and pay $7,329.10 to Pearson Bros., Inc. for the work performed. The request includes payment of their retainage. IC-134s and lien waivers are enclosed for final closeout. Please call me at 612-597-7140 if you have any questions or concerns regarding this Contractor’s payment request. Sincerely, Ryan J. Goodman, P.E. City Engineer Enclosure: Contractor’s Pay Request for Payment No. 2 & Final, IC-134s, Lien Waivers CONTRACTOR'S PARTIAL PAY REQUEST DISTRIBUTION: 2017 Seal Coat Project CONTRACTOR (1) City of Scandia, MN OWNER (1) BMI PROJECT NO. N13.113369 ENGINEER (1) BONDING CO. (1) TOTAL AMOUNT BID $104,704.00 TOTAL, COMPLETED WORK TO DATE $96,885.60 TOTAL, STORED MATERIALS TO DATE $0.00 DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 TOTAL, COMPLETED WORK & STORED MATERIALS $96,885.60 RETAINED PERCENTAGE (0%)$0.00 TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS)$0.00 NET AMOUNT DUE TO CONTRACTOR TO DATE $96,885.60 TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $89,556.50 PAY CONTRACTOR AS ESTIMATE NO.2 & Final $7,329.10 Certificate for Final Payment I hereby certify that, to the best of my knowledge and belief, all items quantities and prices of work and material shown on this Estimate are correct and that all work has been performed in full accordance with the terms and conditions of the Contract for this project between the Owner and the undersigned Contractor, and as amended by any authorized changes, and that the foregoing is a true and correct statement of the amount for the Final Estimate, that the provisions of M. S. 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. 11079 Lamont Ave NE Hanover, MN 55341 By Name Title Date CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: ENGINEER: BOLTON & MENK, INC., 2035 COUNTY RD D EAST MAPLEWOOD, MN 55109 By , CITY ENGINEER Date APPROVED FOR PAYMENT: OWNER:City of Scandia, MN By Name Title Date Partial Pay Estimate No.:2 & Final2017 Seal Coat ProjectCity of Scandia, MNBMI PROJECT NO. N13.113369WORK COMPLETED THROUGH NOVEMBER 7, 2017ITEM UNITESTIMATEDESTIMATEDESTIMATEDESTIMATEDESTIMATEDNO.ITEMPRICEQUANTITYAMOUNTQUANTITYAMOUNTQUANTITYAMOUNT1MOBILIZATION$6,000.001LS$6,000.00LS$0.001LS$6,000.002TRAFFIC CONTROL$5,100.001LS$5,100.00LS$0.001LS$5,100.003BITUMINOUS MATERIAL FOR SEAL COAT$3.0024300GAL$72,900.00GAL$0.0022690GAL$68,070.004SEAL COAT AGGREGATE, FA-2 (MOD) - TRAP ROCK$20.00900TN$18,000.00TN$0.00755TN$15,100.0054" DOUBLE SOLID LINE YELLOW - PAINT$0.406760LF$2,704.00LF$0.006539LF$2,615.60TOTAL AMOUNT:TOTAL AMOUNT:$104,704.00$0.00$96,885.60AS BIDPREVIOUS ESTIMATECOMPLETED TO DATEESTIMATED 1lVAIVE~ AND R~L~ASE C!F LIEN VIlH~R~AS; the undersigned, l~e~r~~~,. ~v1p. i~~„~C,~, ,has furnished to (vendor} ~ C • the fnllawing product: ~'~,s .. z. ~contrac~or) said pursuant to 801./invoiceJ~ick~t numb~r(s} [~172y L.~ ~J? ~4._.(~z i 4IZ~~i..~... t-I ! ~ 25~. fic~r ~~e during the Zt~1'7 construction season for use in the consxru~ctian of (Y~~ r~ a project belonging to ~.~ and design:~ted (name mu icipali~y; coun~ky ar stake) (pr~~~ct name/num~ae.~~ l~O1N 7HEREFaRE, ~R ~,r~ ~ , ,~.~ ~~~T ~L.rC. ,for In cons d~r~tio;n Qf (►vendor) ~~ l~~s~ ~ _ ~ ~qa. ~nq ,and other good 'and valuable considera~Cioh, the r~c~ipt wh:~r~~~F I~ h~r,~F~y acknawl~d~~e.d, d~(es) f~ereby waive and release any and ill Inns, or right to claim of lien, on the p:roject~and premise, under ar~y law, corrim~n or sta~u~C~ry, on a~~vun~C ~~ labor or materla{s, ar both, heretofore or hereafter furnished key to or for the (ver~d~ acc~ur~~ a~ said Gantractarfor the project. Giuen under my handy tl7[S " ~~ ,day of_ ~, tlC,t'Y1.~2.f' . ZO (~u~harized sign ure on behalf +~f vendor) Y~i1012~17 ~"I:58 &F1+ F~oQ~~l~l~t1 From:1~~i'012~~7 ~~~#~a3 P.0G2lQb2 vv~~~r~~ ~~a ~~~.~as~ ~ ~,~~v 1~VH~R~A , the ur~der~t~ned, r~ ~ r ~~s furnished ~ka~ ~v~r~~dorj ~.~~I r • 6 ~C.._ - - -- ya~ th+~ folt+vwi~g pr~d~~t~ ~"'~ ~~~ "~""~~ ~'~ {~on~ra~r~ ~~ld pur~uar~~t to ~Ol~inv+~ ~e/ticket nurrtb~r~s~ ~~l~f. ~ ~ ~ . ~G~ ~ ~c~ ~ 4~".~ t~ ___ f+~r~ use ~dur3c~~ ~h~ ~~~`~ ~c~ns~ru~ti~n ~~~~r~n fc~~ use in the ~~a~~tru~tic~r~ of - {y~ar~ . .a pr~j~ct lv~n~irr;~ to and: d~sigr►~t~d ~nar~e m ici~ali~y. ~ou~ty or ~tat~►y"' Y ~~ .. . . .. . {pr+~j~c~ n~m~/number) N~311t1 TM R~fi~ ~~, '~ fir in e~r~sid~r~tfon o~ ~~ [past ~ a~r~ c~th~r gnod ar~+d v~luabl~ ~r~tt~~d~r~~ic~n, ~~t~ r~~~ipt rn~h~r~+~f ~~ ~~r~~~ ~~~n~~n±'t~~g~d, ~~(~~j h~r~~y ►nr~iv~ aid r~~~~~~ ~~y aid all: liens, ~r ri,~h~k xc~ c1 €m of lien, en the project and ~rr~mis~s, under any ~a~, ~~mm~~ ~r st~~+~~v~r~ ~r~ ~~c~~~it ~~ labor err ~na~~ri~l~, car bo~h~ h~retofac~ yr h~r~~fter ~~rnisl~eci by ~r ~~a car far tMe ~~~~u~~ +~~ s~ic~ ~~~~~~~t~s~ ~~r ~h~ ~~'vj~ct. ~#u~r~ ender rrr~y hand, tt~i~ ~`~' ~~y c~~ l'~~/~ ~~ ~'' . ~t~.~.~ ' .., ~auth~rized sign~~ ~ can ~ (f of v~e~d~r) 1 Jacob Guzik Subject:FW: Your Recent Contractor Affidavit Request Contractor Affidavit Completed Thank you, your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 1-812-604-096 Submitted Date and Time: 11-Dec-2017 12:37:06 PM Legal Name: PEARSON BROS INC Federal Employer ID: 41-1751395 User W ho Submitted: mhallich Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 805707776 Minnesota ID: 1232027 Project Owner: CITY OF SCANDIA Project Number: 4246 Project Begin Date: 11-Dec-2017 Project End Date: 11-Dec-2017 Project Location: CITY OF SCANDIA Project Amount: $96,883.00 Subcontractor Summary Name ID Affidavit Number AAA STRIPING SERVICE CO. 6290097 1262952448 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 8:00 a.m. - 4:30 p.m. Monday - Friday. 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