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5.h) Pay Req #2 Final• BOLTON8.MBNK, INC© Consulting Engineers & Surveyors 2035 County Road D East • Suite B • Maplewood, MN 55109-5314 Phone (651) 704-9970 • Fax (651) 704-9971 www.bolton-menk.com October 21, 2014 Honorable Mayor and City Council 14727 209'h Street N Scandia, MN 55073 RE: Contractor's Request for Payment No. 2 & Final 2014 Seal Coat Project Project No.: N15.107877 Dear Mayor and Council: Enclosed please find Contractor's Request for Payment No. 2 & Final for Allied Blacktop Company for the services they provided on the above referenced project. All work has been completed as required by the contract. The IC -134s and lien waivers have been enclosed. If the Council chooses to approve a payment for this project, it would be appropriate to approve Contractor's Request for Payment No. 2 & Final and pay $15,385.76 to Allied Blacktop Company for the work performed. The request includes payment of their retainage. Please call me at 612-597-7140 if you have any questions or concerns regarding this Contractor's payment request. Sincerely, BOLTON & MENK, INC. A-�` Ryan J. Goodman, P.E. City Engineer Enclosure: Contractor's Request for Payment No. 2 & Final, IC -134's and Lien Waivers DESIGNING FOR A BETTER TOMORROW Bolton & Menk is an equal opportunity employer CONTRACTOR'S PAY REQUEST DISTRIBUTION: 2014 SEAL COAT PROJECT CONTRACTOR (1) OWNER (1) CITY OF SCANDIA, MN ENGINEER (1) BMI PROJECT NO. N15.107877 BONDING CO. (1) TOTAL AMOUNT BID PLUS APPROVED CHANGE ORDERS $208,125.00 TOTAL, COMPLETED WORK TO DATE $205,405.20 TOTAL, STORED MATERIALS TO DATE $0.00 DEDUCTION FOR STORED MATERIALS USED IN WORK COMPLETED $0.00 TOTAL, COMPLETED WORK & STORED MATERIALS $205,405.20 RETAINED PERCENTAGE ( 0% ) $0.00 TOTAL AMOUNT OF OTHER PAYMENTS OR (DEDUCTIONS) $0.00 NET AMOUNT DUE TO CONTRACTOR TO DATE $205,405.20 TOTAL AMOUNT PAID ON PREVIOUS ESTIMATES $190,019.44 PAY CONTRACTOR AS ESTIMATE NO. 2 & Final $15,385.76 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: Allied Blacktop Company 10503 89th Ave N Maple Grove, MN 55369 By Name Title Date CHECKED AND APPROVED AS TO QUANTITIES AND AMOUNT: ENGINEER: BOLTON & MENK, INC.,2035 COUNTY ROAD D EAST, SUITE B, MAPLEWOOD, MN By CITY ENGINEER Date APPROVED FOR PAYMENT: OWNER: CITY OF SCANDIA, MN By Name Title Date Partial Pay Estimate No.: 2 & Final 2014 SEAL COAT PROJECT CITY OF SCANDIA, MN BMI PROJECT NO. N15.107877 WORK COMPLETED THROUGH OCTOBER 9, 2014 ITEM NO. ITEM UNIT PRICE AS BID PREVIOUS ESTIMATE COMPLETED TO DATE ESTIMATED QUANTITY ESTIMATED ESTIMATED AMOUNT QUANTITY ESTIMATED ESTIMATED AMOUNT QUANTITY ESTIMATED AMOUNT BASE BID: 1 MOBILIZATION $1,100.00 1 LS $1,100.00 0.50 LS $550.00 1.00 LS $1,100.00 2 TRAFFIC CONTROL $1,500.00 1 LS $1,500.00 0.50 LS $750.00 1.00 LS $1,500.00 3 BITUMINOUS MATERIAL FOR SEAL COAT $3.58 39250 GAL $140,515.00 38,800.00 GAL $138,904.00 38,800.00 GAL $138,904.00 4 SEAL COAT AGGREGATE, FA-2(MOD) - TRAP ROCK $33.00 1850 TN $61,050.00 1,812.62 TN $59,816.46 1,812.62 TN $59,816.46 ALTERNATE #2 6 4" DOUBLE SOLID LINE, YELLOW PAINT $0.18 22000 LF $3,960.001 LF $0.00 22,693.00 LF $4,084.74 TOTAL AMOUNT: 1 1 $208,125.00 1 $200,020.46 1 $205,405.20 https://www.mndor.state.mn.us/tp/eservices/ /Retrieve/0/b-/j_fGrNpx... MINNESOTA -REVENUE Contractor Affidavit Submitted Thank you, your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 1-813-032-576 Submitted Date and Time: 14 -Oct -2014 1:27:23 PM Legal Name: ALLIED BLACKTOP COMPANY Federal Employer ID: 41-0827871 User Who Submitted: N10503 Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: Account Number: Project Owner: Project Number: Project Begin Date: Project End Date: Project Location: Project Amount: 182353920 8606387 CITY OF SCANDIA N15.107877 04 -Aug -2014 03 -Sep -2014 VARIOUS ROADS AND STREETS $205,405.20 Subcontractor Summary Name ID Affidavit Number AAA STRIPING SERVICE CO 6290097 385843200 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 (Metro Area) 651-282-9999, (Greater Minnesota) 800-657-3594, (TTY Users) Call 711 for Minnesota Relay, or (email) Withholding.tax@state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. How to View and Print this Request You can see copies of your requests by going to the History Tab. Please print this confirmation pie for your records using the print or save functionality built into your browser. 1 of 1 10/14/2014 1:27 PM Contractor Affidavit Submitted Thank you, your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 0-276-246-144 Submitted Date and Time: 14 -Oct -2014 12:39:21 PM Legal Name: AAA STRIPING SERVICE CO Federal Employer ID: User Who Submitted: Type of Request Submitted: Affidavit Summary Affidavit Number: Account Number: Project Owner: Project Number: Project Begin Date Project End Date: Project Location: Project Amount: Subcontractors: 41-0997871 Kelly Kasper Contractor Affidavit 385843200 6290097 CITY OF SCANDIA 2014 SEALCOATS 09 -Oct -2014 09 -Oct -2014 SCANDIA $3,857.81 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 (Metro Area) 651-282- 9999, (Greater Minnesota) 800-657-3594, (TTY Users) Call 711 for Minnesota Relay, or (email) Withholding.tax(a�state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. How to View and Print this Request You can see copies of your requests by going to the History Tab. This message and any attachments are solely for the intended recipient and may contain nonpublic / private data. If you are not the intended recipient, any disclosure, copying, use, or distribution of the information included in this message and any attachments is prohibited. If you have received this communication in error, please notify us and immediately and permanently delete this message and any attachments. Thank you. RECEIPT AND WAIVER OF MECHANICS LIEN RIGHTS The undersigned hereby acknowledges that payment has been received in full from Allied Blacktop Company, for 'striping services purchased from the undersigned delivered or furnished to (or performed at) City of Scandia, MN for 2014 Seal Coat Project and for value received hereby waives those rights which may have been acquired by the undersigned to file mechanics liens against said premises on account of the above described labor and/or materials delivered and furnished by the undersigned, to the extent only of the amount of the aforesaid payment: and the undersigned hereby expressly reserves the right to assert, without prejudice to it's heretofore existing priority, mechanics lien rights against said premises for labor and/or materials delivered and/or furnished to said premises payment for which is not included in the aforesaid payment. Dated this k4 , 2014. Title: (� AAA Striping Service Co. 12220 431d Street NE St. Michael, MN 55376 (763) 428-4322 10-13-14; 5=44AM;Dresser Trap Rock OCT-10-201WRI) 12;10 Allied Blacktop ;715 483 3219 # 1/ 1 (FRX)763 425 1046 P.002f002 RECEIPT AND WAIVER OF MECHANICS LIEN RIGHTS The undersigned hereby acknowledges that payment has been received in full from Allied Blacktop Company, for FA -2 Trap Rock purchased from the undersigned delivered or furnished to (or performed at) City of Scandia, MN and for value received hereby waives those rights which may have been acquired by the undersigned to fife mechanics liens against said premises on account of the above described labor and/or materials delivered and furnished by the undersigned, to the extent only of the amount of the aforesaid payment: and the undersigned hereby expressly reserves the right to assert, without prejudice to it's heretofore existing priority, mechanics lien rights against said premises for labor and/or materials delivered and/or furnished to said premises payment for which is not included in the aforesaid payment. Dated this119 `a • day of October, 2014 P.O. Box 517 Dresser, Wl 54009 (800) 537-3573 Date: 10/14/2014 Time: 3:59 PM To: 111117634251046 Page: 001 WAIVER AND RELEASE OF LIEN WHEREAS, the undersigned, Flint Hills Resources, LP, has furnished to fikL ("Contractor'), the following product: S"� Name oiContra'lur Name of Product sold pursuant to Contract number FAADMWPG3 , between the Enter Flint Hills Resources. LP Contract Number dates of �J and -" 't 16-20A for use in the construction of a project belonging to (the "Project"), and Name of Municipality, County, or State designated as 90grA G Project Number or Name NOW THEREFORE, Flint Hills Resources, LP, for and in consideration of at least $ $P%617-81 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 claim of lien, on the Project and premises, under any law, common or statutory, on account of labor or materials, or both, heretofore or hereafter furnished by Flint Hills Resources, LP, to or for the account of said Contractor for the Project. Given under my hand, this _ .4day of 0 -CA -0W , 201 Flint Hills Resources, LP rv!t A-� A -,_ Arnold Lenz Credit Director