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HomeMy WebLinkAboutVouchers & Affadavits '" CON", II\.UCTION PAYMENT VOULIIEB "'t Estimate Voucher No. 7 (FINAL) Date: July 3, 1996 For Period Ending: June 30, 1996 C.P. Number: S.A.P.: 93~1, 93~3, 95~1, 95~ Class of Work: RidgemontlCreekside Street Improvements & T.H. 13/Industrial Park Storm Sewer For: City of Prior Lake To: S.M. Hentges & Sons, Inc. 650 Quaker Avenue, Suite 200, P.O. Box 69 Jordan, MN 55352 A. Original CUUuAct Amount $ 424,147.85 B. Total Additions $ 31,204.00 C. Total Deductions $ 0.00 D. Total Funds Encumbered $ 455,351.85 E. Total Value of Work Certified to Date $ 461,927.12 F. Less Retained Percentage 0 % $ G. Less Total Previous Payments $ 451,378.47 H. Approved for Payment, This Report $ 10,548.65 I. J. Total Payment Including This Voucher Balance Carried Forward APPROVALS Pavment Breakdown Ridgemont $5,894.70 Creekside $8,827.96 Mitchell Pond ($362.02) Industrial Park ($3,811.99) $ $ 461,927.12 (6,575.27) Pursuant to our field observation, as performed in accordance with our contract, we hereby certify that the materials are satisfactory and and the work properly performed in accordance with the plans and specifications and that the total work is 100% completed as of June 11, 1996 I hereby recommend payment of the voucher. Project Engineer Approval: " 'l~ P:r~ER.P.E. ~ -..,.) This is to certify that to the best of my knowledge, information, and belief, the quantities and values of work certified herein is a fair approximate estimate for the period covered by this voucher. !SiMo~igned by: Contractor: S.I11. ih'A q/t? !qh Date: CITY OF PRIOR LAKE ~~JJ~.~ {Noucher Checked By 4 - 9 4 -qe, Date Title: c./~? ~#.:dktJ1. ~4-- /- r 0 r. thu l;1M/rlhd AWrovooZ~ Author6ed Representative q 1u/9 (, Date 102023VH.XLS FINAL PAYMENT ESTIMATE NO. 7 (FINAL) FROM: JUNE I, 1996 TO: JULY 1, 1996 CONTRACfOR: S.M. HENTGES & SONS, INC. ADDRESS: 650 QUAKER AVENUE, SUITE 200, PO. BOX 200, JORDAN, MN 55352 OWNER: CITY OF PRIOR LAKE, MINNESOTA PROJECf: RIDGEMONT/CREEKSIDE/INDUSTRIAL PARK STORM SEWERIT.H. 13 MITCHEL POND COMPLETION DATE ORIGINAL: SEPTEMBER 14, 1995 REVISED: AMOUNT OF CONTRACf: ORIGINAL: $ 424,147.85 REVISED: $ 455,351.85 SLoJl..I.IULE 1 0 RIDGEMONT AVENUE STREET MOBILIZATION 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 SALVAGE AND REINSTALL SIGNS CLEAR AND GRUB COMMON EXCA VA TION SUBGRADE PREPARATION 0 - 12" MILL BITUMINOUS PAVEMENT AGGREGATE BASE, CLASS 5 TYPE 41A, WEAR COURSE MIXTURE TYPE 31B, BASE COURSE MIXTURE BITUMINOUS MATERIAL FOR TACK COAT CONCRETE CURB & Gu 1 u~.R, 8618 BITUMINOUS DRIVEWAY CONCRETE DRIVEWAY AND APRONS 4" CONCRETE SIDEWALK 8" CONC. VALLEY Gu I u:,R BITUMINOUS PATH PEDESTRIAN RAMP 4" EQUlV WIDTH PAVEMENT STRIPING ADJUST FRAME AND RING CASTING ADJUST GATE VALVES SILT FENCE SODDING, LAWN & BOULEVARD SEEDING WOOD FIBER BLANKET CATCH BASIN SEDIMENT BARRIER WATER FOR DUST CONTROL JUNIPER, 24" HT, POT LILAC, 36" HT, POT SUBGRADE DENSITY TEST, INPLACE CLASS 5 GRADATION TEST I 02023#7. XLS LS LS AC CY RDSTA SY TON TON TON GAL LF SY SY SF SF SY EA LF EA EA LF SY AC SY EA MGAL EA EA EA EA 0.06 2958 15.5 54 2223 455 845 236 3100 194 41 7572 104 120 2 3100 2 2 800 4283 0.3 1417 2 35 2 2 3 7,000.00 1,000.00 5,000.00 3.50 200.00 5.00 6.50 22.00 19.00 1.20 5.40 11.50 25.00 2.00 3.00 11.50 100.00 0.30 250.00 250.00 1.50 1.40 1,250.00 1.45 50.00 20.00 35.00 30.00 30.00 45.00 Page I 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90.00 0.00 0.04 3,104.00 0.00 24.16 2,408.64 414.54 7'T1.'T1 173.00 3,244.00 391.69 7.41 7,955.00 104.10 111.11 3.00 0.00 2.00 2.00 250.00 3,960.00 0.00 0.00 2.00 30.00 4.00 4.00 3.00 2.00 1.00 7,000.00 1,000.00 200.00 10,864.00 0.00 120.80 15,656.16 9,119.88 15,161.43 207.9.> 17,517.9.> 4,504.44 185.25 15,910.00 312.30 1,277. 77 300.00 0.00 500.00 500.00 375.00 5,544.00 0.00 0.00 100.00 600.00 140.00 120.00 90.00 90.00 1.00 102-023-30 31 32 33 34 35 36 37 38 39 CLASS 5 PROCTOR TEST CLASS 5 DENSITY TEST, INPLACE CONC. CYLINDER COMPRESSIVE TEST CONC. AIR ENTRAINMENT TEST CONC. SLUMP TEST BITUMINOUS EXTRACTION BITUMINOUS GRADATION BITUMINOUS AIR VOID TEST BITUMINOUS CORE DENSITY TEST EA EA EA EA EA EA EA EA EA T SCHEDULE 1.0 RlDGEMONT AVENUE STREET - TOTAL BASE BID SCHEDULE 1.1 RlDGEMONT AVENUE ALTERNATE A COMMON EXCAVATION - DEDUCT CY AGGREGATE BASE, CLASS 5 - DEDUCT TON MILLED BIT.lSALVAGE CLASS 5 - ADDITION CY 2 3 T SCHEDULE 1.1 RlDGEMONT AVENUE ALTERNATE A - TOTAL SCHEDm.E 20 RIDGEMONT AVENUE SANITARY SEWER 2 3 4 5 6 7 8 9 10 CONNECT TO EXIST. SANITARY MANHOLE 8" PVC (8' TO 10' DEEP) 8" PVC (10' TO 12' DEEP) 8" PVC (12' TO 14' DEEP) 8" PVC (14' TO 16' DEEP) 8"x4"WYE 4" PVC SDR40 SERVICE PIPE STANDARD MANHOLE EXTRA DEPTH FOR MANHOLES IN-PLACE DENSITY TEST EA LF LF LF LF EA LF EA LF EA T SCHEDULE 2.0 RlDGEMONT AVENUE SANITARY SEWER .TOTAL SCHEDULE 3.0 RIDGEMONT AVENUE WATERMAIN CONNECT TO EXISTING W ATERMAlN EA 8" DIP LF 6" GATE VALVE EA FITIINGS LB HYDRANT WI GATE VALVE EA WATER SERVICE EA I" WATER SERVICE PIPE LF IN-PLACE DENSITY EA 2 3 4 5 6 7 8 T SCI~I&.E 3.0 RlDGEMONT AVENUE WATERMAIN - TOTAL 1 CJ2CY23#7 . XLS 483 898 483 124 465 198 131 7 251 3 11.28 19 934 710 2 7 180 11 3 6 6 6 5 5 5 5 74.00 40.00 90.00 90.00 75.00 75.00 75.00 120.00 100.00 (3.50) (6.50) 10.00 500.00 20.00 20.00 20.00 20.00 100.00 12.00 1,200.00 100.00 30.00 500.00 22.00 500.00 1.50 2,250.00 150.00 12.00 30.00 Page 2 0.00 0.00 1.00 1.00 1.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90.00 90.00 75.00 0.00 0.00 0.00 0.00 345.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 3.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 0.00 0.00 152.87 1.00 124.00 465.00 123.00 131.00 8.00 295.00 3.00 11.28 11.00 1.00 853.00 1.00 490.00 2.00 8.00 215.00 3.00 74.00 120.00 450.00 450.00 375.00 375.00 375.00 600.00 500.00 110,715.22 0.00 0.00 1.528.70 1,528.70 500.00 2,480.00 9,300.00 2,460.00 2,620.00 800.00 3,540.00 3,600.00 1,128.00 330.00 26,758.00 500.00 18,766.00 500.00 735.00 4,500.00 1,200.00 2,580.00 90.00 28,871.00 lCJ2-023-30 SCHEDUI.E 4 0 RIDGEMONT AVENUE STORM SEWER REMOVE CATCH BASIN EA IS" RCP CLASS 5 LF IS" FES RCP CLASS 5 EA CATCH BASIN EA 72" MANHOLE (SUMPED) EA RIP RAP CL 3 CY GEOTEXTILE FABRIC, TYPE IV SY HA YBALES EA IN-PLACE DENSITY TEST EA 2 3 4 5 6 7 8 9 13 31.7 8 7 T SCHEDULE 4.0 RlDGEMONT AVENUE STORM SEWER - TOTAL 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SCHEDULE 5 0 CREEKSIDE CIRCLE STREET MOBILIZATION SALVAGE AND REINSTALL SIGNS COMMON EXCA VA TION SUBGRADE EXCAVATION MILL BITUMINOUS PAVEMENT SELECT GRANULAR BORROW AGGREGATE BASE, CLASS 5 TYPE 41A, WEAR COURSE MIXTURE TYPE 31B, BASE COURSE MIXTURE BITUMINOUS MATERIAL FOR TACK COAT CONCRETE CURB & Gu I u~.R, B618 REM. EX 16" BARREL, INSTALL 12" BARREL REM. EX 24" BARREL, INSTALL 18" BARREL ADJUST FRAME AND RING CASTING ADJUST GATE VALVE BITUMINOUS DRIVEWAY CONCRETE DRIVEWAY CATCH BASIN SEDIMENT BARRIER WATER FOR DUST CONTROL JUNIPER, 24" HT, POT LILAC, 36" HT, POT SILT FENCE SODDING, LAWN & BOULEVARD SUBGRADE DENSITY TEST, INPLACE CLASS 5 GRADATION TEST CLASS 5 PROCTOR TEST CLASS 5 DENSITY TEST, INPLACE CONC. CYLINDER COMPRESSIVE TEST CONC. AIR ENTRAINMENT TEST CONC. SLUMP TEST BITUMINOUS EXTRACTION BITUMINOUS GRADATION 102023#7.XLS LS LS CY CY SY CY TON TON TON GAL LF EA EA EA EA SY SY EA MGAL EA EA LF SY EA EA EA EA EA EA EA EA EA 2747 645 45 645 1686 358 665 186 2653 3 5 549 17 9 30 4 4 100 5090 3 84 500.00 25.00 350.00 1,150.00 2,750.00 50.00 2.00 5.00 30.00 3 3 3 3 4 4 7,000.00 1.000.00 3.50 5.00 5.00 5.50 7.00 22.00 19.00 1.20 5.40 500.00 500.00 250.00 250.00 11.50 25.00 50.00 20.00 35.00 30.00 1.50 1.40 30.00 45.00 74.00 40.00 90.00 90.00 75.00 75.00 75.00 Page 3 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.00 2.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 550.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 150.00 150.00 1.00 86.00 1.00 1.00 1.00 13.00 31. 70 0.00 0.00 1.00 1.00 1,247.00 433.00 25.56 0.00 1,907.94 305.46 717.23 204.00 2,619.00 1.00 1.00 5.00 2.00 794.00 54.25 0.00 10.00 0.00 3.00 0.00 6,260.00 0.00 1.00 1.00 1.00 2.00 2.00 2.00 5.00 5.00 500.00 2,150.00 350.00 1,150.00 2,750.00 650.00 63.40 0.00 0.00 7,613.40 7,000.00 1,000.00 4,364.50 2,165.00 127.80 0.00 13,355.58 6,720.12 13,627.37 244.80 14,142.60 500.00 500.00 1,250.00 500.00 9,131.00 1,356.25 0.00 200.00 0.00 90.00 0.00 8,764.00 0.00 45.00 74.00 40.00 180.00 180.00 150.00 375.00 375.00 102-023-30 33 34 BITUMINOUS AIR VOID TEST BITUMINOUS CORE DENSITY TEST EA EA T SCHEDULE 5.0 CREEKSIDE CIRCLE STREET - TOTAL &.n"~lIm_E 5 1 CREEKSIDE CIRCLE ALTERNATE B 2 3 COMMONEXCAVATION-DEDUCT AGGREGATE BASE, CLASS 5 - DEDUCT MILLED BIT.lSALVAGE CLASS 5 - ADDITION CY TON CY 430 799 430 T SCHEDULE 5.1 CREEKSIDE CIRCLE ALTERNATE B - TOTAL SCHEDULE 6 0 CREEKSIDE CIRCLE STORM SEWER 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 REMOVE CATCH BASIN CONNECT TO EXISTING STORM SEWER 4" TP DRAINTlLE 12" RCP CLASS 5 IS" RCP CLASS 5 18" RCP CLASS 3 IS" HDPE 15" PES RCP CLASS 5 18" PES RCP CLASS 3 15" HDPE APRON CATCH BASIN 27" MANHOLE STANDARD MANHOLE 72" MANHOLE (SUMPED) HAY BALES IN-PLACE DENSITY TEST EA EA LF LF LF LF LF EA EA EA EA EA EA EA EA EA T S,",~u~E 6.0 CREEKSIDE CIRCLE STORM SEWER - TOTAL SCHEDULE 7 0 T H 13 DRAINAGE TO MITCHEU_ POND CLEARING AC 0.64 GRUBBING AC 0.64 COMMON BORROW (CV) CY 750 TOPSOIL BORROW (LV) CY 260 SALVo & REINSTALL EX. CHAIN LINK FENCE LF 110 BITUMINOUS RESTORATION SY 53 36" RC APRON WI TRASH GUARD EA 36" RC PIPE 7.5 DEG. BENDS DES. 3006, CL III EA 7 36" RC PIPE SEWER DESIGN 3006, CL III LF 491 CONSTR. DRAIN. STRUCTURE DES. 72-4020 EA 3 72" DIAMETER MANHOLE WI SUMP EA CONNECT TO EXISTING STORM SEWER EA RANDOM RIP RAP CLASS III CY 278 2 3 4 5 6 7 8 9 10 11 12 13 102023#7 .XLS 4 4 120.00 100.00 (3.50) (6.50) 10.00 731 63 375 60 113 500.00 350.00 5.00 20.00 25.00 30.00 30.00 350.00 400.00 350.00 1,150.00 850.00 1,150.00 2,750.00 5.00 30.00 2 5 2 28 7 4,500.00 4,500.00 5.50 10.00 15.00 20.00 1,750.00 750.00 70.00 2,750.00 2,750.00 500.00 60.00 Page 4 2.00 2.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 240.00 200.00 1,290.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 90.00 90.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.00 7.00 0.00 0.00 354.64 1.00 1.00 100.00 62.00 350.00 60.00 110.00 1.00 2.00 1.00 1.00 1.00 5.00 2.00 0.00 5.00 0.62 0.62 750.00 275.00 180.00 155.26 1.00 7.00 491.00 3.00 1.00 1.00 255.66 600.00 700.00 87,758.02 0.00 0.00 3.546.40 3,546.40 500.00 350.00 500.00 1,240.00 8,750.00 1,800.00 3,300.00 350.00 800.00 350.00 1,150.00 850.00 5,750.00 5,500.00 0.00 150.00 31,340.00 2,790.00 2,790.00 4,125.00 2,750.00 2,700.00 3,105.20 1,750.00 5,250.00 34,370.00 8,250.00 2,750.00 500.00 15,339.60 102-023-30 14 IS 16 17 18 19 20 21 22 23 24 25 GROUTED RIP RAP CLASS III GEOTEXTILE FABRIC, TYPE IV CATCH BASIN SEDIMENT BARRIER BITUMINOUS CURB TRAFFIC CONTROL BALE CHECK SILT FENCE, HEAVY DUTY SOD, EROSION CONTROL SOD, LAWN & BOULEVARD WooDFIBER BLANKET, REGULAR SEEDING WITH MIX SOO INPLACE DENSITY TEST CY SY EA LF LS EA LF SY SY SY AC EA 40 SO 1222 222 1222 0.52 3 T SClu.uJLE 7.0 TH 13 DRAINAGE TO MITCHEL POND-TOTAL SCHEDULE 8 0 INDUSTRIAL PARK STORM SEWER 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 CLEARING GRUBBING 12" RCP STORM SEWER, CL V 12" RC APRON WI TRASH GUARD 27" DlA. MANHOLE WITH STOOL CASTING 48" DIAMETER MANHOLE 72" DlAMr. U:.K MANHOLE WITH 3' SUMP CONSTRUCT 48" DlA. MH OVER EX. 12" PVC CL III RANDOM RIP RAP GEOTEXTILE FABRIC, TYPE V CATCH BASIN SEDIMENT BARRIER HAY BALES SILT FENCE, HEAVY DUTY WooDFIBER BLANKET, REGULAR SEEDING, #SOO INPLACE DENSITY TEST AC AC LF EA EA EA EA EA CY SY EA EA LF SY AC EA 0.11 0.11 208 2 T SCHEDULE 8.0 INDUSTRIAL PARK STORM SEWER-TOTAL CHANGE ORDER NO.1 DELETE S\.-J1I!.JJULE 8.0 BID, ADD SCHEDULE 8.0 REVISED SCh~uIJLE 8 0 INDL.". ___IAI, PARK STORM SEWER CREVlSED) CLEARING AC 0.3 GRUBBING AC 0.3 HAUL AWAY CONSTRUCTION DEBRIS CY 125 12" RCP STORM SEWER, CL V LF 200 15" RCP STORM SEWER CL V LF 40 IS" RC APRON WI TRASH GUARD EA 27" DIA. CB WITH STOOL CASTING EA 48" DIAMETER MANHOLE EA 2 2 3 4 5 6 7 8 1(11.(11.3#7 .XLS 28 222 4 50 7S.00 2.00 50.00 6.00 2,SOO.00 5.00 3.00 1.40 1.40 I.4S 1,250.00 30.00 2 7,500.00 7,SOO.00 30.00 1,000.00 850.00 1,150.00 2,7S0.00 1,250.00 75.00 2.00 SO.OO 5.00 3.00 1.50 1,250.00 30.00 S9 180 S 20 200 533 0.2 2 7,500.00 7,500.00 17.50 30.00 35.00 1,100.00 8S0.00 1,500.00 Page S 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28.00 222.00 4.00 99.00 1.00 7.00 50.00 0.00 0.00 670.00 1.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.30 0.30 154.00 186.00 35.00 1.00 1.00 2.00 2,100.00 444.00 200.00 594.00 2,SOO.00 35.00 150.00 0.00 0.00 971.S0 1,375.00 0.00 94,839.30 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,250.00 2,250.00 2,695.00 S,580.00 1,225.00 1,100.00 8S0.00 3,000.00 1(11.-023-30 ~-I"II_, - ."" ,.. - - ~ 9 72" DIAMETER MANHOLE WITH 3' SUMP EA 3,250.00 0.00 10 EXTEND/CONNECT 12" PVC TO MH 3 LS 350.00 0.00 11 CL III RANDOM RIP RAP CY 4 75.00 0.00 12 GEOTEXTILE FABRIC, TYPE V SY 10 2.00 0.00 13 HAY BALES EA 20 5.00 0.00 14 SILT FENCE, HEAVY DUTY LF 70 4.00 0.00 15 WOODFIBER BLANKET, REGULAR SY 1000 1.50 0.00 16 SEEDING, #500 AC 0.2 1,250.00 0.00 17 INPLACE DENSITY TEST EA 2 30.00 0.00 T CHANGE ORDER NO.1 - SCHEDULE 8.0 IND1.J~.lAIAL PARK STORM SEWER (REVlSED)-TOTAL CHANGE ORDER NO 2 - RIDGEMONT IillBGRADE CORRECTION SUBCUT CY 2150 3.50 2 3" MINUS TN 4000 7.50 3 SUBGRADE PREP. STA 15.42 (200.00) 4 CONTRACTOR SHARING LS (4,500.00) 0.00 1.00 3,250.00 0.00 1.00 350.00 0.00 4.00 300.00 0.00 10.00 20.00 0.00 20.00 100.00 0.00 70.00 280.00 0.00 0.00 0.00 0.00 0.20 250.00 0.00 0.00 0.00 0.00 23,500.00 0.00 0.00 2,150.00 7,525.00 109.82 823.65 4,381.23 32,859.23 0.00 0.00 15.42 (3,084.00) 0.00 0.00 1.00 (4.500.00) 823.65 32,800.23 T CHANGE ORDER NO.2 - RIDGEMONT SUBGRADE CORRECTION-TOTAL CHANGE ORDER NO.3 - CREEKSIDE SUBGRADE CORRECTION 3" MINUS CRUSHED LIMESTONE 0.00 TN 945 7.50 T CHANGE ORDER NO.3. CREEKSIDE SUBGRADE CORRECTION-TOTAL TOTAL AMOUNT TIllS PERIOD TOTAL AMOUNT TO DATE 1 02023#7. XLS Page 6 0.00 1,687.58 12.656.85 0.00 12,656.85 2,548.65 461,927.12 102-023-30 DESCRu: uON SCHEDULE 1.0 RIDGEMONT AVENUE STREET - TOTAL BASE BID SCHEDULE 1.1 RIDGEMONT AVENUE ALTERNATE A - TOTAL SCHEDULE 2.0 RIDGEMONT AVENUE SANITARY SEWER -TOTAL SCHEDULE 3.0 RIDGEMONT AVENUE WATERMAIN - TOTAL SCHEDULE 4.0 RIDGEMONT AVENUE STORM SEWER - TOTAL SCHEDULE 5.0 CREEKSIDE CIRCLE STREET - TOTAL SCHEDULE 5.1 CREEKSIDE CIRCLE ALTERNATE B - TOTAL SCHEDULE 6.0 CREEKSIDE CIRCLE STORM SEWER - TOTAL SCHEDULE 7.0 TH 13 DRAINAGE TO MITCHEL POND-- TOTAL SCHEDULE 8.0 INDUSTRIAL PARK STORM SEWER--TOTAL CHANGE ORDER NO. I - SCHEDULE 8.0 INDUSTRIAL PARK STORM SEWER (REVISED)--TOTAL CHANGE ORDER NO.2 - RIDGEMONT SUBGRADE CORRECTION-- TOTAL TOTAL mIS PERIOD CHANGE ORDER NO.3 - CREEKSIDE SUBGRADE CORRECTlON-- TOTAL 345.00 0.00 0.00 0.00 0.00 1,290.00 0.00 90.00 0.00 0.00 0.00 823.65 0.00 TOTAL TO DATE 110,715.22 1,528.70 26,758.00 28,871.00 7,613.40 87,758.02 3,546.40 31,340.00 94,839.30 0.00 23,500.00 32,800.23 12,656.85 '. ... . . .... ......... . ...................................... ~:::.::~::,~:::.~:::.':::.!.~:::~:::.::::.::~::.~:::.;:::.:.::1:,~:::.1:::.':::.~::~::,~:::,'::::.~:.~::~:::,1:::,:::.~:.~:::~:::,"::!:,.~:::~:::.'::::.:::~:..~:::~:::.:.:::1,._:::::::,'::::,:.:::~:::.::::.:::.::.~:::::::.'::::':_::.~:::,::::.::::~'~:::,':::,::.::::~::,::::.'::::,::::.::::,::::.::::~,:~::.1:::.';:::._::~:'::::.':::,'::.::.~:::::::.:::.~::::.::::,::::.:::~:,::::.~:::,::::'.::::::::,::::.'::;:.,~:::,::::.:~::::,~:::.~:::,!:::,:::~:,::::,::::,:::.:.~:::::::.!:::,~:.:::.m.~:::'~:::.'::.::::::.::::,'::::.:::.::::::.1a:::.'::::..::::~:::,'::::.':;::.~:::,~:::'.':::;':~::_~:::.:'::.~:.~:::~:::,::::.~:.~::.~:::::::.~:~::,~:::. _:::.~:::.::::.:.::::::::.:::.~::.::::::,::::..::::,;:::.::::.':::.:::.~:~:::,;.Qii:::.::.:::.~:::~:::,':::~,,::::':::,"::::.:~::,~:::.::::.~'::.:.~:::,':::.:::.::::::.::::,'.:::.:::::.~:::..::::,::::.1:::,'::::.~:::~'::::.':::.:::.::::::,::::'.::.::::::,~:::.::,.::~::,~:::,'::::'::::,':::.:::::.::::,~:::.":::.':.:::~:::,~:::.::~::,~:::.::::,:::~:..~:::::::.~::.~:~:::.1:::.'::~:..~:::~:::.::::~.~:::.::::.~:.~::.~:::1:::,:::~:'~:::,;:::.::.~::~:::.~:::,:'::;:,~:::,~:::.:::~:.~:::,::::.~.~:::~:::.::::,~:.~::~:::.::::.1:.~::~:::.::::.::.~::~:::.::::.~:~::,~:::,::::.~ - iilljllili1111j11111!1111111~1~111~111j11j11!11111j11111!11111!11111j~11!1!~11!11111j~11j1j1111111111j11111jl11j111111111j111I11!111!111111111j111j~1111~1111j11111~111j~111111fl~~i~~~if1ilj11~111~111~11111j111~j1111~j11I11~111j1~j11j1~111j11111j~11i~1~jilij]li~j11~11111~ ~?~. ~ ~~ ....................................., .::,.~:::::::,.::.~:.::.',~:,:::::.:.:::~:.:::.::,:::~:.':::~:.:::::.':.:'~:.:::":.::::~:.:::'.~::::::.':.:'~:.::::.~:::~:.:::~:,:::~:.':::.~::::::.'.::,~:.':::::.::::~:.':::.~::::~:.':::~:,::::::,:::~:,:::.~::::::.'::.',~:,:::~:.:::~:.:::'::.::::~:.'::::~,:::~:.:::~:,:::.:.::::~:.:::~::,:::r:.:::.~::::f:.:.:,~:,:::~:.::::r:.:::,:~,;::~:,.::::~,;::~:.:::~:,';::.:.ro::~:,:::'.~::::~:.:?:~:,:::' :::::.::::~:.::::~,:::~:.':.:'~:,:::::.:.::,~:.:::':.::::;:.':.:'~:,:::'::.'.::,~:,:::.~::::::,':::.~::::::.:.::,~:.':::.~::::~:.:.:,~:.:::'::,.::,~:.':.:'~:,:::':.::::~:.':::~:,:::::.:.::,~:.':::~:,:::;:.':::~:.':::,~::::::,':::~:,:::':,::::~:,':::'~::::'.:::::~:.':::~:,:::~::,:::~:.:.:,~:.:::.:.::::j:,.:.~,~:,:::,,:::::::.":::~:.:::'.:::::~:.:.:,~:.:::'.~: ~i~~I~~i~ii~ii~iii~~~~~~~~i~~~i~ijiijii~~i~iI~i~i~~~i~ij~~i~~~iij~iji~~~i~ii~~i~i~i~i~ij~~i~i~~~i~i~~i~i~i~I~~i~Ii~i~~~i~i~j~i~~~~ MATERIAL ON SITE :::,:::"::::::.:::.:::,:::.:::.:::,:::.:::.:::,:::,:::.':.'::::,:::.:::.:::,:::,:::.:.::.::::::.::.:.::::::,:::.::.::::.:::.'::":::,:::.:::.:::':::,:::.'::',:::,:::,:::.'::::::,:::..::::::,:::.'::":::,:::,:::.:::,:::,:::.'::"'::::::,:::.:::,:::,:::.::.::::,:::.:::.:::':::,:::.:::.:::,:::,:::.:.:::::,:::.::.::::,:::,'::":::,:::,:::.::::::,:::.:::.:::,:::,:::.':':,:::,:::.:::.:::,:::,:::.:::,:::,:::.~:.::::,:::,:::.:.:::::,:::.::".:::p<l::.::.::::,:::,,::.,:.:::::,:::.:::,:::, ~~~~~I~~~~~~I~~~~I~~~~~~~~I~j~i~~j~~I~~~~~I~~~~I~~~~iI~~~~~~~~I~I~~i~~~i~~~~iII~II~I~~I~~~~~1I~~ $0.00 I~1II~1~~1~1~~~~I1I~~~~1~~~1~~~~~~~I~if~I~~~jfI~f~~~~~1~If~ffIf~IIf~~~ iil.j~i]l~i~jj~j:~jIfjf~jffj:fjffj:fjff~:fj:fjIff:ffIIfj:~j:fjf~jj~~~fjj:~j::~j:fjjffjf~j:~jIj~jjf~I:~jj:jjj~jj:~j:~jff~j:fj:~j::~j:fjjffj:~j~ffjffjjf:j:~jj~~jffj:~f~Iijfi:fjfjf~jffjj~fjI~jjf~jf~j:~jjf~If~jf~jjf~jffjffjffj:fI:~j:f~:~fjfjf~fjffjfji[ji~j:f~jfjf :iiiii~1~~iiii!f~!~1I~~!1~!~1I~jf1~!~1!!~!I~!~1I~1If~~!~j!I1!!~jf~~ .................................. ~1~!~j~~~j~1~!~j~1~j~1~!~1f~~j~1~!~j~~~j~1f1~j~jIf1~~~jj1~i~~~~j1i~~i~i~~j!~~j~j ~!~j!~~!~~~!~j!~~jI~1!!~1I!~!!~j!~~j!j~!~j~!~j!!~!~1~!~j!!~j!~~~~j!!~~~!~jI~1~~1j!1~!~1~!~~~~~j!~~!!~~~~j!~~!~ ilti~~ji~~III~~~I~IIIIIII~~~~~I~~I~~I~~II~IIII~III~~I~~ItIII~III~tt~~~~II~~~~Ij~]~~~~~~i~j~~~~~~IIII~~~~~~~~~1~~I~~III~I~~I~~~~~~i1~~f~~i~ID~~1 I 02023#7. XLS Page 7 102-023-30 Project RidgemontlCreekside Street Improvements & TH 13/lndustrial Park Storm Sewer Prior Lake Date Project No 07/09/96 102-23-30 Client 1 Pay Est 1 Pay Est 2 Pay Est 3 Pay Est 4 Pay Est 6 Pay Est 6 Pay Est 7 Totals ~ ~ Rldgemont 70,442.40 112,632.57 9,582.75 (666.00) 3,408.70 \ 11,717.48 1,168.65 $208,286.55 Creekside 0.00 41,377.00 36,158.73 31,263.37 7,706.10 17,416.07 1,380.00 $135,301.27 o Mitchell Pond 8,550.00 70,519.00 7,745.70 7,989.60 35.00 0.00 0.00 $94,839.30 -:t Industrial Park 0.00 0.00 0.00 0.00 23,440.00 60.00 0.00 $23,500.00 Retained 3,949.62 11 ,226.43 2,674.36 1,929.35 1,729.49 (13,509.25) (8,000.00) $0.00 Amount earned $78,992.40 $224,528.57 $53,487.18 $38,586.97 $34,589.80 $29,193.55 $2,548.65 $461,927.12 ! Amount paid _ Ridgemont 66,920.28 107,000.94 9,103.61 (632.70) 3,238.27 16,761.45 5,894.70 $208,286.55 ~ Creekside 0.00 39,308.15 34,350.79 29,700.20 7,320.79 15,793.38 8,827.96 $135,301.27 ~ Mitchell Pond 8,122.50 66,993.05 7,358.42 7,590.12 33.25 5,103.98 (362.02) $94,839.30 Industrial Park 0.00 0.00 0.00 0.00 22,268.00 5,943.99 (3,811.99) $23,500.00 ~Amount Due $75,042.78 $213,302.14 $50,812.82 $36,657.62 $32,860.31 $42,702.80 $10,548.65 $461,927.12 l qr#'- " ~ ..\~\ ~ " AUI~09-1996 16:03 P.02/03 CERIU-ICATE OF SUBSTANTIAL COMPLETION O~~.K's Project No. .93-01. 93-03. 95-01. & 95-Q2 ENGnrnER's Projca No. 102-021-~ Project Ridgemont A venneJCreelaide Cirele Street TntPfOvemenh and Tmnk Hi,hway 13/1ndustrial Park StUUII Sewer L..~. ,-,vements CONTRACTOR S M. Hentges &: Sons Inc. CVULUlct For Ridff':mnnt A venlle/C~1cJ:iQe Cirele Street Impmve~'Ots and TnmIc High U ~! 13I1ndu~l.L:al Park StU&lll Sewer ImproVemfmLf&. Co.~e&Ct Date June lQ 1~ This ~tillcate of Substantial Completion applies to all W Oft under the Contract Documenrs or to the following specified parts thereof: To -.CiJv of Prior 1 ",lee, Minnesota OWNBR And To S M 5emges & ~ns Inc. CON1'RACTOk Tl1e Wark to which tbis Ce&.Lif~te applies bag b~"'1I inspected by authorized representatives of OWl'lbJ.{,. CONTRAl: 1 OR9 and ENG~btu{, and that Work: is hereby declared to be substRntiJllly complete in accordance with the Contract Documents on July 1 r 19C)6 DATE OF SUBSTAlmAL COMPlBl'ION A tmtative list of items to be cu~leted or corrected is attached l..,;~wW. ThiBlist may not be aU- inclusive, and the failure to iDtlude an item in it does not alter the responsibility of COl't l.l'iACTOR to complete all the wort: in accordance with the Contract Docum~. The items in the ~~ Ie list shall be completed or corrected by CO~ 1 t<ACTOR within.JL days of tile above date of Snbstantial Completion EJeDC No. 1910-8-D (1983 Edition) Pr~ by the ~. .IcJW CauIBct Dal:aJmelllll CammitJl:c aad aabsaIl'Y The AssadDd Galen) CDIaIcrlln cl AJaMrica. j :\cL-:....J\ l02\wordpaf\l Q2..023.~ 102-023-30 AUG-09-1':39b 16; 1213 F. 83.< 03 The responsibilities between OWNER and CO~ 1 KACfOR for security! operation, safety, maintenance, beal, utilities, insurance and w8J.1'anties sbaIl be as follows; RESPONSIBfu! 1.05: OWNER The Owner as~um~ responsibilitY fOT operation and maintelJan~ of tb.c imnrovfl!tt1.. "~~"" co~ lltACTOR The Co....:....r.Ctor shan be Te~n~ible for allY ~~ nf fai.ure for the above ~jlities other 11mn which ~ be anribumble to nOUJ1~tl wea~ and ~r. The following documents are attached to and made a part of this Certificate: This ~..~ficare does not constitute an acceptaOCe of Wark not in accordance with the Contract Documenrs nor is it a release of COl'll.t<ACTORtg obligation to complete the Work in accordance with the Contract Documents. ExccutedbYENGINEEROn~~q .19~. MSA Consulti~ Ellii~m BY~~' COlt( lttACTOR accepts this certi:ticare of Substantial Completion on , 19~. CIP Jie ~:jJ- / I OWNER accepts . ~L:ficate of Substantial Completion on _ q - 4 _, 19-2ti.. CibLQfPrior T.SI~ Minn~ot:a BY ~L. ';."~~ )~. E - j:\cleriul\l02\ Ilj,~.';'.erf\l02-023.c.se 102-023-30 TOTAL P, 03 r e:ONSENT OF SURt I Y COMPANY TO FINAL PAYMENT AlA DOCUMENT G707 owNER ARCHITECT CONTRACTOR SURETY OTHER o o o o PROJECT: Ridgemont Avenue/Creekside Circle Street Improvements and Trunk Highway 13 (name, address) Indus trial Park Storm Sewer Improvements City..of Prior Lake, MN TO (Owner) r City of Prior Lake 16200 Eagle Creek Ave. SE Prior Lake, MN 55372 L CONTRACTOR: S.M. Hentges & Sons, Inc. I ARCHITECT'S PROJECT NO: CONTRACT F<6~~: $424,147 . 85 FCP: $461,927.12 ..J CONTRACT DATE: 6-19-95 {here insert rume and address of Surety Company} In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the Hartford Fire Insurance Company .Hartford Plaza Hartford, CT 06115 , SURElY COMPANY, on bond of there insert name and address of Contractor) S.M. Hentges & Sons, In~. P.O. Box 69 Jordan, MN 55352 , CONTRACTOR, to the Contractor shall not hereby approves of the final payment to the Contractor, and agrees that final payment relieve the Surety Company of any of its obligations to (here insert name and address of Owner) City of Prior Lake 16200 Eagle Creek Ave. SE Prior Lake, MN 55372 as set forth in the said Surety Company's bond. IN ~ITNESS WHEREOF, the Surety Company has hereunto set its hand this ~ (Seal) : , OWNER, 13th day of August 19 96 . Hartford Fire Insurance ~ny Surety Company . ~( ? c.JOI;J~ Signature of Jtrothorized Representative Nina E. Werstein Attorney-in- Fact Title NOTE: This form is to be used as a companion document to AlA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, (urrent Edition ' AlA DOCUMENT C707. CONSENT OF SURETY COMPANY TO FINAL PAYMENT. APRil 1970 EDITION · AlAS CC 1970. THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 ONE PAGE . .- : f" ACKNOWLEDGMENT OF SURETY ,TATE OF COUNTY OF Minnesota Hennepin 55. : On this 13th day of August .intheyear1996 ,before me personally comers) Nina E. We rs tein Attorney (SHn.Fact of Hartford Fire Insurance Comoanv with whom I am personally acquainted, and who, being by me duly sworn, says that he reside(s) in ~finnetonk~. MN that he is (are) the Attorney(s)-in-Fact of Hartford Fire InsuranC'e r.nm!1::lny , the company described in and which executed the within instrument; that he know(s) the corporate seal of such Company; and that the s~.a.1 affixed to the within instrument is such corporate seal and that it was affixed by order of the Board of Directors of said Company, and that he signed said instrument as AttorneyCs).in-Fact of the said Company by like order. .~<<"~ "KATHY M. WARNER J ~/ rtf. til2 Mlt1 \ NOTARY fl'UlJUC.-MNNUOrA I NOTARY PUBLIC . "" ,,' MY COU"'SSION EXPIRES ,-at... . F.97J3-8/81 _...; ................,.. ~ I .-n. " "",no.., I-In.~ "'''''UI'V'\.''vC ,",V IV.,... Jo\rt T ",4 Hartford, ConnKtlcut POWER OF ATTORNEY Know .a men by .... PNMntI, That the HARTFORD FIRE INSURANCE COMPAHY, . corpcntion duly organized &ftMr the laws of the sa. of ComecIIcut. and hIIVing Ita principIII office In the City of Hartford, County of Hartford, State of Connec:ticut. does hereby make. conatitute Met appoint THOMAS G. ~ scorr D. D~ ELDON Hf. OLDRE, NINA E. ~JJ.u~ .AImlURJ. DOllDEL IUId C4ROL WElbu..... of MlNNETO~ MINNESOTA Ita true n lawful Aaamey(a)-in-F1lCt. wiIh fuI power and authority to each of Aid AIlomey(.)-in-F8d. In their ...... CIIpICity If mare than one is named above. to Iign. aecute and acknowledge atrt Ind II banda n ~ Ind OCher wrtIIngs ~, In the NIbn thentof on beh8If of the Comp8ny in .. buIinea of guaw"'lg the ftdeIIty 01 peqona holding places of pubic << private tnI8t; gu8IaIl1eeing the perfonMnce of c:annctI other thM inIurance poI..~., .. guaranteeing the perfonnIf~ of NurancIt conhdI where surety bonds 1ft accepted by atates Met munidpalties. n executing or gu8I1II1Ieeing bonds and undertakinga ntq'*-d << permitted In aD adiona or pIOCMdinga or by law allowed, and to bind the HARTFORD FIRE INSURANCE COMPANY thereby .. fuIy and to the same l.. .. ,.. . ,1 as if auc:h bonds and undertakings and other writings obligatory In the nature thereof were signed by an Executive Officer of the HARTFORD FIRE INSURANCE COMPANY 8nd sealed and attested by one other of such Officers. and hereby ratifies and confirms all that its said Attomey(s)-in-Fact may do in pursuence hereof. This power of attorney is grard8d by .xi under authority of the following provisions: (1) By-Laws adopted by the StocIchaAderI of the HARTFORD FIRE INSURANCE COMPANY at. meeting duly called and held on the 9th day of March. 1971. ARTICLE N secnON 8. The Pr8IIdent or .., ~ ICIIng WII\ IIf'/ Sec:Ntwy or AIIiIt8nt Sec:rItary. ..... ... polRr and auIhorily to IPPOint. far pUIpOMI onty of eucuting and all:8IIIng bondI and u..~ttaldl~ Ind oaw wrtIingI obIigIIDry In the Mbn ...,.. one or men ~ Vk:II PreIidInIa. Resident AuiItant Sec:nttaries ... ~8Ct and lit IIT'I time ID rwncMt IIT'I such Re8idert ~ R8sident AaiItant s.a.e.y, or ~ and rftoU the power and IUthOrily giYIn ID tWn. SECTlON 11. ~8Ct .... ... power and 8UIhorIy. sutlject ID the IItrma and IimibItionI of the power of IUDmey iIIuId to them, to eucuc. and deliver on bIhd ft the ~ Ind to dIlctI the .... d the CompIny theNID IIf'IInd II bonds and wldettllcillg&. and oIher wrItinga GbIigIIDry In the nan ......,. and IIT'I such inIIrument.-aDd by IIT'I such ~.c:t sh8I be - binding .... the Company _ If Ii;ned by III ex.c::utive 0C'ficer lInG IeIJId and III8IIIId by CInI aItIer of such 0ftk::erI. . ..--~,-.._...".. _..'~.... ....-- ."'.... --.- This power-Of ~ is Signed Dei. ..8i;d -by f8c:IinWe WIder 8I1d by the IUIhority of the foIawing Resolution Ildopted by the Oiredors of the HARTFORD FIRE INSURANCE COMPANY at. meeting duly called and held on.the 1211I day of Fttbr.-y. 1993- ReIaIved. ... .. ....... d IUCtt ~ IIId .. .... ~ .. ~ .., be ..... ID ." IUCtt poIIa" ~ IIIIlIrww, orlD ." ClIrIlIIcIlIe fWIIIIIng ... ~ ..... Ind .., 8UCft .' , . aI ...., or ~ ..... 8UCft fIlcIIinliIe ....... or....... .... ... be WIld Ind binding upan .. eomp.n, Ind ." u:tI ..... .0 ..... Ind C*tIIed a., iIc:IlI* ....... tnd IIcIirIlIa .... ... be ... ... bIdnQ ... .. eomp.w, n .. .... wlIll'llPlCllD art tland t/I WIdIItIIIdnCIID wtlidl . II IIIIIIl:tIId. In Witneu Whereof. the HARTFORD FIRE INSURANCE COMPANY has caused these presents to be signed by its Va- President. and its....... ...te seal to be [ ';,.:i. affixed. duly attested by its Secretary, thil1st day ofMlly. 1995. HAft. rORD FIRE INSURANCE COMPANY AUMt: ~tf)L~-(l' ~. ..... ~ - Aictwd R.llMnlillloQ. ..... . ~JJ.. ~ /~ .' s.c.w.y ._~ . . ~~"H. STATE OF CONNECTICUT I.... . Paul L Marabella COUNTY OF HARTFORD VICe-President On this 1st day of May. A.D. 1995, before me personally came Paul L. Marabella, to me known. who L .::.,. by me duly sworn. did depose and say: that he resides in the County of Hartford. State of Connecticut that he is the VICe-President of the ~ I rORD FIRE INSURANCE COMPANY. the corporation desaibed in and which executed the above instrument that he knows the seal of the said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed by order of the Board of Di. ",~.....a. of sai~ corporation and that he signed his name thereto by 6ke order. STATE OF CONNECTICUT !:g"';;:.~ ... · -..uc · COUNTY OF HARTFORD ~ Y-- #.~7.~~,~./ NtJaIy AIbIic My C" ',' , 1:".' .... 30. 1188 ~. .....cATE I, the undersigned, Se......Wy of the HAr\ I rORO FIRE INSURANCE COMPANY. a Connec:tk:ut Corporation. 00 HEREBY CERTIFY that the foregoing and attached POWER OF ATTORNEY remains in full force and has not been revoked; and fwth." ..1'8. that . the, Resolutions of the Board of Directors, set forth in the Power of AIlDmey, are now in 1.,. ..... Signed and sealed at the City of Hartford. 13th day of August 19 96 Dated the e,~ . . ~~ Pif L W- Aabeft L POll SKrIfaty FOIWs.3507.' (BF) L:"...JiDU.s.A. COl't 1 KACTORrS ArrWA vrr Stan: of M1.u~ta Dan:: August 8, J 99~ The COWM.f of Scot t The City of Jordan of S. M. Hen t.~~ {.. Sons, Inc. (ContractOr~ s name) Street & stqrm sewer improvements on has [U4.Jshed an labor ~ ~,,~ entering into the RidSJemont/Creekside/TH 13 In~. Park Storm Sewer Jeanette M. Hentges, Vice-President (O(f~ts ~ and title) i:'4Vje:: for the City of Prior Lake (Qwncr)... . Jeanette M. Hentoes scm:s kJ1er tbar he has fu1l knowI~ orall obligations (Qffic::rts name) .. . -.'-.- _ . for ",c.o-:. labor and ma..aw...:a1s w!ri:h Qave ~~ into me! L"-Uwe pan of that c.. wAin ~l.ujec: kI1crwn and des~ above. and 1:= furJ1:r disposes and says that: an debt5 .~ other obligations for such iabor 2lld materials have ~ fully and wW:Jletely paid for in' goOd and !G w ~w1 mot1CY of the U~w:-: States or .~.~ ~ :Oat there a.r: no O)~~ rUJ. da.mages.. ~~~~ ~~ ~I.~,aa ~~. :JI. w~~_~~ we or om.... wis:~ In ..ya:a~ of:heir ope:arions on the abov:. ~.d p~je-=. The said Contractor, S. M. Hentges & Sons, Inc. will hold the Owners. the City of Prior Lake biameiess of ~ and all Mtr...hanic "s Liens thaI mav be '.. 4 h.;..~ emered or filed for I.___~L~ so as tc _v~~u.","" charge ~aaiDst said p...~es for work or iabor done or ~ furnished by tl1em.. :~Hl::~~OF. heh2s~.~forcputd:;~.~ $J. ~C='S DaIDe) ( J:{ &.f4:.J L Jean Schneider , Nowy Public in ami for the above na~ Coum;y and State do hw~by c-.~ that Jeanette M. Hentqes ~omIly known to me to be tbe a.ffiaDt in the fuA._~~:..z afu~m.. U\o..4.)\.I~V 4.~..,ear::d before me tbis day ~ and.. bavi:a2: ~... . ", - - .... bef:n dIll}" SWO~ deposes and say that tlle facts set fUlL.il in the atx:>.:'!! ~idavit a..--e tIUe ~ CO!..L -;.ct. v, 111'iESS my ~ and se31 tbis ~ day of ~'~f- -~. :. ~.:-. ':"~ "19.2..6 my ~UJW' .~ion lw.A~~~ January 31, iooo 1:'Ci' ~(:'1 . - :=~ : r- ?6-=.j~c-ln:- RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS Auaust 8. 1996 The undersigned hereby acknowledge receipt of the sum of $ 451.378.47 CHECK ONLY ONE 1) as partial payment for labor, skill and material furnished on project) x 2) as payment for all labor, skill and material furnished or to be furnished (except the sum of 10,548.65 retainage or holdback) 3) as full and final payment for all . labor , skill and material furnished to the following described real property: (legal description, street address or project name): All materials delivered to Ridaemont/Creekside street Imorovements TH 13/Industrial Park Storem Sewer through 8-8-96 which is city of Prior Lake Pay Request No. 7/FINAL and pays in full the following materials: Invoice Nos: and for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill or material furnished to said real property (only for the amount paid if Box 1 is checked, and except for retainage shown if Box 2 is checked). The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: . PLEASE SIGN AND RETU NOTE: If this instrument is executed by a corporation, it must be signed by an officer, and if executed by a par~ner- ship, it must be signed by a partner. IA r#f!tfLj .. U..ct ~,.~ Company Name S.M. HENTGES AND SONS, INC. ,c.._. _ _ __ ...... .. . .-.,. I H:.J.g 1 t.4 .~t::> TO ~~:~~ NO.JU( ~.U2 ~'G:;II P.e2 "6'" . , '. " Form 1C-m Aw. "110 .. .. ... - - . MInI.... ~~I..~Ri~~ .. WIthholding AffidaVIt for..CoIitractors "....... ....-~br.,........ r' ,~lj..-.e1................ a. III". ..Ot..,d.. ,. ~ .,............'b-~L ~ ... . .......D~ '3 I .;l:z. ~-'~ ~ s.M. HEHTao; a. ~ l'-lc <,,? ~~ F~Q.Q'.J~Ji AVENlE, SUITE 200 ~ 1 C\ C\ ~. .0. eox ee . ~ JOR1)AW; MN ~..... ~ . .. rqq~ .-.-,.,.-.....,..... "... '- yaur' ,..... .a_I ~ ~ ,\, ~ .... ......__ "~J:t>..A... -. .c ~, 'f ? l~ ~- .....IfIIE{~ 6-"'(JU I../.,D 1 '.i.jtf.) 6' .s1~ (> ~ Dld~""'~.'....._til~ 1(..0 ~~"~~}/.q~-o'!J Lf~-O' IC,'S-o~ .-.~-*-~ : =:;;~r~~:ii~ ChCk_IItD",., ~e..1tNJr lnNI___4 In ",. PIfJ/f1<< ad,., In III IMDft..",. ~...1tJ ". ~. _ Soiacct~ .! But.-m -lOa 1f)lOU are aau1._.bCCDr. fiU in 1M nanw..-.d eckirWI vf tt.CiOnb1a;tarthat h1tee )Oil: iZ ~me Carma_w ~. - If you IUbco.ltk..aed out any won on fhC ~ III of your _ .....L~,..~ mutt me thlirOVll\ rc-":34 ~b led have ~ cerrI*, by the ~ of R8WIf1UIl befOr. you _. ....~~ .. dIdIMl. t"'Or eedt ..~.. "l1Ir8CIOr you hs1 fll ~ tbet ~ i'1form8fJOn beiCM'. Md ~ . ~1 of each llA~nwdX"l cer1Ilad ICe t34. (I,ou need more .......,..... dJIct\ a .... .n.et.) . 8~.1NPt ~ 0wrntrI0fIIwr *,/hJ.J..u? . r 1JtF4 17f" CJ!JP . '"1l7~ f11u ~ * l~J1J+f?Ji~ ~. Qa!7(~n~ It- ~J~I~~5!n.~.'fM~bJ't.J La-t:c. J...Jw. ~ C;.e "t:t~~ \..t~. ~ J ~~ (:M..d. ~ .,-;nrJ*-' E1?,!h.t~,,=- ~?- ~, ) --... " --'Jl~.I'" 'iII8lf~- '* bin it...", ""-10" DeltotlllP ...... lid MW. ..,..... ~ 0,....1- _"... n..n.tp....~ w.. -.....-g 1DlblaJllDJld. ......... ~",...1IInft. _ . 111" ~~ 'I _. a.4.....,~,"i. and tD arw &.. ., ".' t..,' ':.& IIftU DrirN~. ...~ two tptwatnllabCRJ' iii.... .,.... 0- ~..... t'(::n,r'V\ LJL.-, FOt CJ:9n*' and one ~ to: G MIrw.-=-dA ~ RIYenuI. fJusNI5"(UII:' Tax S. '-1,..., Mal SWtiarI SrS10,8l P"'. UN 5514&-0810 CermIo8le of ~___~ .un 1I1inaDa1a1ncame Ta WIthhc*fina Law B~ on ~ or !he MiMlllGCa ~ of Revenue. J 08f1ff). thId the ~ wtJo ... aigfted lid. elrifl*, .. t\JftfIecl tift.. N<<nJft",** of J6wM...-';' SbItutes 210.82 and ZlO.rn aoncennv tt>> wIti1cJldino fJI Ut.. .......1ncDne .. froM ~es paid to ~.~_ re!atinW tQ QIICrad ....mces WIIh ,.. ~.. of Jhtr.ola enckI' Irs ~. -..--. l7/tZ:' IX~ ;, ~ .AUG 14 1996 1DIc",~ It._: - . .. .,.,.., ""-' . AC.I .. ,.....-, .. -. ... Hug 14 ~b :5:57 No.DO? P.03 10 CClIC..J '~:J P. BJ '..-.- ...... ---...--............-. ---... _ . _..~ .~D:l1 MlU1..lI...~J'~ .lD G'-".P..a,. ,-.-.'.' . - --.-". . .. . '-..--- ---... __.~.1A Deputmentvt..~ . .:-:. '.~7:-..". . .. .. Affid&wit fOr-ComiQaors:- 111I& ........,. .. -A.." .... r J I U ............... .... 01 Jl _ -..,rla. .:A It ~~_ cat....... ..,...,.. ......... -- . 1C-1-34 -...,...... .................",..............- .-:;;--;;;;.-------------" ......... ':~." .:.'.!.~~~~, :,...,= ~ 1lfIt./M I ~ij~'" . . ~----------------~. ~ D ...... r I ~ .;r~D!! ~ & AlIIIIa. & ~~- . ...".. ~_.:~~... .............--: . . a-t"_"'~ff"~.iJ I ~...",.._...,....L ~"r~( C... I....... Jlf I. I llJ. - ..' .......~-.~..S.m. i/t!J:u~ ~ ~.l..r~. --- ~ 0, m... ~7~ ... ... ~ -- .0 - 1 I Cl...... ~.. , .,- pu ... t ........,..,....,. ~ ... .. PfIItM..llle ,.... wicD. __..... ~ own . r-,lU M'..I .. GIllIS _... as1iIilIcf Dym~ ~ ol~ ~'" CiM fir .,........ t;,r -=it MIl "'r~""" Is_ hIF__ ~ ~ rJAd ....... fPW el ~~....'.....1C1&L II ~ ...... ..... 161ch~...."" . ....... ~ ~ -':" '........... .. I~..._-....-...-~..--<<:i .' .'+..,J.......,~....A...... ~.~..... _ ...~~*'..~........... ........JD~....... I~.r 1 . -.. oiior_.... _... t _ _ _. " ~._'. r-s.. .. .... . _,. ~ .-.- - ... I ~~ ~~ ~~ ~.,.......... ..ao, ~.... aIM .1~1O ft. ~. ~ I t - ('h'Ik,-t.ci~"} .. 1aJad_-=-.~u:--.~be. ...tol............w'- 11 J_ ~-~....~e.l_ ~CII... w . tiJiM- = *' liatm.m.Q, .., 206.G' ~11Ig" ....aIN<< A......- ~~ 1Itce-._ I ... .... ....;'.. bhlki- ..... .. ~ ......... "4! I ~~ fI/IIU,. . Mil.. I ~ .-fJk uP': ':' _.. PIIt AUS 14 1996 l .t{If~ ./)(~t~ ..It '" J t...NL"'" 'j~ .. I'''' 1f......._ ... ~- ..... ... .. IW'f'I. P.ei- . ~ -.... . . "ot'beveanue ,..-.-....-.... .. ~nl\,:r~" ~!ll~~t !J. I' .. .. __ _. . .~."U.JI . .~~~~, "_. ... ..... .. . . .J~~~" w~~kiing. Affidcrni JOr:C;;tdldci~ ~ ~-:-:- -:- 'Fona ~ .. . .~1M. ... 1Ms....... _....-.JbybaMlir . '" ~...oI~~ ~ . __ ,,11.61.. r ."! t.r, 01 tiiiJx/WPOIJU'CIIJ .....1aoI ,.,...,., h ~~4. ~,.., _ . ... JM -IQ....... ~ 9aviDg, IDtt. RECEIVED JUH 1 0 -=:';"begOIt t)8OO 13tb Ava. I.' OB19S . 017 s..... Zip Cede ~ ~ ..... ..... .. .:tIt-l. ~. . ~ Hn 553'19 '. 05196 . -.. TnilWIII be yo" TaIII--..t--= ~"-..un...; '-e.... I . I forIft. $51 ,.401.40 ,..,..,.,. -- ' .......duE ( 612 I ...s-a&15 18.~/.,).S3 OW)GI" Ap1aV'. -- - flU ~ Prvted ~ .JIClM....."a.-...... . L. f_ -flroIed~ic:teV.ti~ --t, ~...-c1t.v of ~c:r !.m.IM .....16200 Bag1e at Dr. Prior Ia8,) a-k" ....... --- L )'1M' ~ ill lite JMajIct _ fIIlft ..ilia ... N ~ J1~"" _,~ ~ ~.~~,~ '-- ..L"- ~ "'",." ~. ~ t-t'lItI'I ..J TO ~..J.CI~ P.84 o We _~.~ G1 S.._A-:tor . '0. .. . 1f)IUG ore c Mbeonl, '. ,,:,. ,. tit .. ~ and oddms of the_nmc:tor IImt hnd JOU: 5...M. ~lmiS AND SONS. P.O- BOX 69 JI......~an, HN S5~52 . . . o Prime cMtreftr f you sTJbcontrocMd out CIOT..ort on Ibis protact, all of your tubeon~ bIIIIt if. hi, own C.t ~ a~~ 0It~ ~ ~ carflSad hy fhe ~1a" r:l R~ bebw yau CDI1 il. you:- affidcMt. For 80dt sabccntra..'"kK you bud, (iU iC'l 1M DosInallnformcmon below, ond ~ c eopvofecch subcon:.....:.r'. ~ c..;~.. ",~neecf fJW:)ftt~choG "-t-.- '.... sn-.] ~ ~. AddreN ~/afteer ._~"'''''I,..... . __ tII....-.... IIIt:Mf a.d itt m .. /otIIt d.... 0Ni ~ I) Ie .. of tJty ir;J"'~-tJ.r1ga and w;"r. I ~ _...... *' ~...... .4ol....~~ ,.., WI ~,.",.,.,. fJJc:IuJiag ~ alP'- vi". _ _ . ".. _.' r.h1~al:...... .~I_a1JlI/JrfJ~,Oftd"''''~CIIIWtW. . 1. ~ Off}.a: Manager 05/31/96 Fer CIIMi art~1 a.a ~ copy to; ,..,........, al Ren:n.. IWtIneu Audit MralSl_:,," 6610. Sf. ~t MN55'~'O ~11icat& 01 t;oIDpIiance with MinnuOIa .COIIIe fax WllbI~ldln& law Baad on J&.- J5 cllhe ~n'" o.pa.__fUnt al ~ I CIIrt1ly tnaI ite ..... 1';....Jor who fa ~ tQ (.riif~ hell fvl1led aJj ,I.. ,..qui,.,....", cI MinncNCJtQ SIofu* 290.92 end 790.97 ~ the wIthho~ of MlnnelCta IKome tax ffOCl'l ~ ~ 10 enwpl" , ~ .~ ~ to co. 00'". ..: leMca with .. statlt of Mi.~ ~#Ot Iii- ..:oMiiom. ~oi"""""'~~ - ~ -JJUN ~ __ 1q-:.~ t7.J: '-=t'M -...-t<<..f1 .._~ -' 'TO -..."....-" .,......_~. . CCIC.';U~ P . es 'Jiitd~t of ~ . Vl1 . .. s:.. JC.i,.. ....- ..~~'~~ . .. ... .......~"''O''-\~lfl vr ....,....... _h' - . WIthholding Affidavit for eoa.t.actows JU ~ - 6199B ,...........~~............~.. ..J0.4a................. . .... - .....~ ".,,,, 1lI."-iIl~_....... .........IOQDlI...... ~:~ ~ ~~ J..rc.~~ 61CS'-IS ~/~ cAoe. -....,.. GJ./~ ~ --..............--- (, I ~Inet~ n'Y"'\ ~c./ /qr., ---~o;a.I; I . . -........ 771. 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