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5.n) Contractors Request for Payment No 2 Final_2015 Seal Coat Project• 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 November 15, 2015 Honorable Mayor and City Council City of Scandia 14727 209th Street N Scandia, MN 55073 RE: Contractor's Request for Payment No. 2 & Final 2015 Seal Coat Project Project No.: N15.109471 Dear Mayor and Council: Enclosed please find Contractor's Request for Payment No. 2 & Final to Allied Blacktop Company for the services they provided on the above referenced project. All work has been completed as required by the Contract. IC- 134's and Lien Waiver have been enclosed for final closeout. The Contractor's Request for Payment is for the amount of $9,089.39. At this time we recommend the Council make a payment in the amount of $9,089.39 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, 4,J, Z"-� Ryan J. Goodman, P.E. City Engineer Enclosure: Contractor's Request for Payment No. 2 & Final, IC- 134s, and Lien Waiver DESIGNING FOR A BETTER TOMORROW Bolton & Menk is an equal opportunity employer Date: 27-Oct-15 PUBLICLY BID CONTRACTOR'S PAY REQUEST 2015 SEAL COAT PROJECT Pay Request No. 2 & Final City of Scandia, MN BMI Project No. N15.109471 For Period Ending: 27-Oct-15 Original Contract Amount $142,011.60 Approved Change Orders - Addition $0.00 Approved Change Orders - Deduction $0.00 Revised Contract Amount $142,011.60 Completed Work to Date $119,063.86 Stored Materials on Hand $0.00 Sub -Total $119,063.86 Retained Percentage 0% $0.00 Liquidated Damages $0.00 Total $119,063.86 Total Amount Paid on Previous Estimates $109,974.47 Amount Due Contractor This Pay Request $9,089.39 Approved for Payment: Allied Blacktop Company Signature Date 10503 89th Ave N Maple Grove, MN 55369 Printed Name and Title Checked and Approved as to Quantities and Amount: Signature Date Bolton & Menk, Inc. 2035 County Road D East, Suite B Maplewood, MN 55109 Printed Name and Title Approved for Payment: City of Scandia Name Title Date Final Pay Estimate No.: 2 & Final 2015 SEAL COAT PROJECT CITY OF SCANDIA, MN BMI PROJECT NO. N15.109471 WORK COMPLETED THROUGH OCTOBER 20, 2015 ITEM NO. ITEM UNIT PRICE AS BID PREVIOUS ESTIMATE COMPLETED TO DATE ESTIMATED QUANTITY ESTIMATED AMOUNT ESTIMATED QUANTITY ESTIMATED AMOUNT ESTIMATED QUANTITY ESTIMATED AMOUNT PART A: LOCAL STREETS 1 MOBILIZATION $5,000.00 1 LS $5,000.00 1 LS $5,000.00 1.00 LS $5,000.00 2 TRAFFIC CONTROL $2,150.00 1 LS $2,150.00 1 LS $2,150.00 1.00 LS $2,150.00 3 BITUMINOUS MATERIAL FOR SEAL COAT $2.65 17160 GAL $45,474.00 15824 GAL $41,933.60 15,824.00 GAL $41,933.60 4 SEAL COAT AGGREGATE, FA-2 MOD - TRAP ROCK $45.00 590 TN $26,550.00 590 TN $0.00 590.00 TN $26,550.00 5 4" DOUBLE SOLID LINE YELLOW - PAINT $0.16 15520 LF $2,483.20 0 LF $0.00 15,192.00 LF $2,430.72 6 ROUTE AND SEAL $2.04 25180 LBS $51,367.20 15700 LBS $32,028.00 15,700.00 LBS $32,028.00 TOTAL PART A: $133,024.40 $81,111.60 $110,092.32 PART B: CITY HALL PARKING LOT 7 BITUMINOUS MATERIAL FOR SEAL COAT $3.30 1470 GAL $4,851.00 1470 GAL $4,851.00 1,470.00 GAL $4,851.00 8 SEAL COAT AGGREGATE, FA-2 MOD - TRAP ROCK $65.00 50 TN $3,250.00 50 TN $3,250.00 50.00 TN $3,250.00 9 4" SOLID LINE WHITE - PAINT $0.29 2280 LF $661.20 0 LF $0.00 2,226.00 LF $645.54 10 PAVEMENT MESSAGE HANDICAP SYMBOL - PAINT $75.00 3 EA $225.00 0 EA $0.00 3.00 EA $225.00 TOTAL PART B: $8,987.20 $8,101.00 $8,971.54 TOTAL AMOUNT PART A + PART B: $142,011.60 1 $89,212.60 $119,063.86 https://www.mndor.state.mn.us/tp/eservices/ /Retrieve/O/b-/GdWIYR... MINNESOTA• REVENUE Thank you, your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: Submitted Date and Time: Legal Name: Federal Employer ID: User Who Submitted: Type of Request Submitted: Affidavit Summary Affidavit Number: Minnesota ID: Project Owner: Project Number: Project Begin Date: Project End Date: Project Location: Project Amount: 2-089-639-808 15-Oct-2015 12:59:55 PM ALLIED BLACKTOP COMPANY 41-0827871 N10503 Contractor Affidavit 1738031104 8606387 CITY OF SCANDIA N15.109471 16-Jul-2015 21-Sep-2015 VARIOUS ROADS, STREETS, CITY HALL PARKING LOT $118,233.36 Subcontractor Summary Name ID Affidavit Number AAA STRIPING SERVICE CO 6290097 1329807360 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) withhold ing.tax@state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. Please print this page for your records using the print or save functionality built into your browser. 1 of 1 10/15/2015 1:00 PM Page 1 of 1 MINNESOTA• REVENUE Contractor Affidavit Submitted Thank you, your Contractor Affidavit has been approved Confirmation Summary Confirmation Number: 2-019-860-352 Submitted Date and Time: 14-Oct-2015 10:56:08 AM Legal Name: AAA STRIPING SERVICE CO Federal Employer ID: 41-0997871 User Who Submitted: Kelly Kasper Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 1329807360 Minnesota ID: 6290097 Project Owner: CITY OF SCANDIA Project Number: 2015 SEALCOAT PROJECT- N15.109471 Project Begin Date: 09-Sep-2015 Project End Date: 21-Sep-2015 Project Location: SCANDIA Project Amount: $5,452.08 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. taxca state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. Please print this page for your records using the print or save functionality built into your browser. https:Hww-,v.mndor.state. mn.tis/tp/eservices/_/Retrieve/0/b-/gF94ONR]ilEL6fQ5e6tSUxA... 10/14/2015 RECEIPT AND WAIVER OF MECHANICS LIEN RIGHTS The undersigned hereby acknowledges that payment has been received in `.all from Allied Blacktop Company, for striping services purchased from l ,e undersigned delivered or furnished to (or performed at) City of Scandi;:, MN for 2015 Seal Coat and for value received hereby waives those rights which m-jy have been acquired by the undersigned to file mechanics liens against s,�id premises on account of the above described labor and/or materials delivered ,-. ;d furnished by the undersigned, to the extent only of the amount of the cforeL ,id payment: and the undersigned hereby expressly reserves the right to. as::rt, without prejudice to it's heretofore existing priority, mechanics lien rights ag . -1st said premises for labor and/or materials delivered and/or furnished to:�-id premises payment for which is not included in the aforesaid payment. Dated this i (J f < 1 it 2015. 1 By: Title: 0i) C _. 1 AAA Striping Service Co. 12220 43rd Street NE St. Michael, MN 55376 (763) 428-4322