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Item 3.3 Fire and Emergency Services Facility Project Pay Application 7 Request for City Council Action DEPARTMENT INFORMATION ORIGINATING DEPARTMENT REQUESTOR: MEETING DATE: Emergency Services Emergency Services Director Rausch July 28, 2025 PRESENTER(s) REVIEWED BY: ITEM #: Consent Kraus-Anderson City Administrator/Finance Director Flaherty 3.3 – Pay Application for the Emergency Services Facility STRATEGIC VISION MEETS: THE CITY OF OTSEGO: Is a strong organization that is committed to leading the community through innovative communication. Has proactively expanded infrastructure to responsibly provide core services. X Is committed to delivery of quality emergency service responsive to community needs and expectations in a cost-effective manner. Is a social community with diverse housing, service options, and employment opportunities. Is a distinctive, connected community known for its beauty and natural surroundings. AGENDA ITEM DETAILS RECOMMENDATION: City staff is recommending City Council approval of Pay Application #7 for the Fire & Emergency Services Facility project. ARE YOU SEEKING APPROVAL OF A CONTRACT? IS A PUBLIC HEARING REQUIRED? No No BACKGROUND/JUSTIFICATION: The amounts requested for Pay Application #7 are consistent with the work progress to date, have been signed by each respective contractor, and reviewed and signed by the City’s Architectural and Construction Management consultants. There are 7 individual contractor requests included within Pay Application #7 for a total of $1,093,596.19. • Voss Plumbing & Heating of Paynesville, Inc. ($54,150.00) • BCI Construction, Inc. ($49,064.66) • Contract Hardware Co., Inc. ($57,008.55) • Masters Plumbing Heating & Cooling, LLC ($140,233.30) • Klein Electric, Inc. ($92,686.75) • Belair Builders, Inc. ($686,202.93) • Voss Plumbing & Heating of Paynesville, Inc. ($14,250.00) In accordance with Minnesota Statute, the City is withholding the maximum of 5% retainage of work completed, which amounts to $97,152.71 at this time. SUPPORTING DOCUMENTS ATTACHED: • Pay Application #7 POSSIBLE MOTION PLEASE WORD MOTION AS YOU WOULD LIKE IT TO APPEAR IN THE MINUTES: Motion to approve Pay Application #7 in the amount of $1,093,596.19 for work completed on the Fire & Emergency Services Facility project. BUDGET INFORMATION FUNDING: BUDGETED: Fund 446 – Fire & Emergency Services Facility Yes AIA® DOCUMENT G736 - 2009Project Application and Project Certificate for Payment, Construction Manager as Adviser EditionCity Of Otsego New Fire StationPROJECT:City Of Otsego APPLICATION NO: 714499 75th St Ne New Fire StationPERIOD TO: 6/30/2025OWNEROtsego, MN 55330 Otsego, MNPROJECT NO: 2410290CONSTRUCTION MANAGERARCHITECTVIA CONSTRUCTIONAdam FlahertyMANAGER:Kraus-Anderson Construction Co. PROJECT APPLICATION FOR PAYMENTPROJECT CERTIFICATE FOR PAYMENTApplication is made for Payment, as shown below, in connection with the Project. AIADocument G737-2009, Summary of Contractors' Applications for Payment, is attached.1. TOTAL CONTRACT SUMS (Item A Totals)$14,018,369.002. TOTAL NET CHANGES BY CHANGES IN THE WORK (Item B Totals)$0.003. TOTAL CONTRACT SUM TO DATE (Item C Totals) $14,018,369.004. TOTAL COMPLETED & STORED TO DATE (Item F Totals)$1,943,054.355. RETAINAGE (Item H Totals)$97,152.71 6. LESS PREVIOUS TOTAL PAYMENTS (Item I Totals)$752,305.457. CURRENT PAYMENT DUE (Item J Totals)$1,093,596.19 TOTAL OF AMOUNTS CERTIFIED…………………….. $1,093,596.19The undersigned Construction Manager certifies that to the best of its knowledges, information CONSTRUCTION MANAGER: Kraus-Anderson Construction Companyand belief this Project Application for Payment is an accurate compilation of the Contractors'Applications for Payment, attached hereto. By: _______________________________________ Date: 07/03/25CONSTRUCTION MANAGER: Kraus-Anderson Construction CompanyBy:_________________________________________________________Date:07/03/25State of: MinnesotaCounty of: HennepinSubscribed and sworn to before me this 3rd day of July, 2025ARCHITECT: Wold Architects & EngineersNotary Public: By: _______________________________________ Date: My Commission expires: January 31, 2029AIA DOCUMENT G736 - 2009 (formerly G722/CMa - 1992). COPYRIGHT © 1981,1992 and 2009 by The American Institute of Architects.Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's AuthenticityTO OWNER:ATTENTION: DISTRIBUTION TO:In accordance with the Contract Documents, based evaluation of the Work and the data comprising this Application, the Construction Manager certified to the Owner that to the best of its knowledge, information and belief the Work has progressed as indicated; the quality of the Work is in accordance with the Contract Documents; and the Construction Manager recommends to the Owner and Architect that the Contractors be paid the AMOUNTS set forth in the attached Summary of Contractors' Applications for Payment.In accordance with the Contract Documents, based evaluation of the Work and the data comprising this Application, the Construction Manager's recommendation, the Architect certifies to the Owner, that to the best of its knowledge, information and belief the Work has progressed as indicated; the quality of the Work is in accordance with the Contract Documents; and the Contractors are entitled to payments of the AMOUNTS set for in the attached Summary of Contractors' Applications for Payment.Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D7/3/2025 | 2:58 PM CDT AIA DOCUMENT G737 - 2009Summary of Contractors' Applications for Payment, Construction Manager as Adviser EditionAIA Document G732, Application and Certificate for Payment, hasAPPLICATION NO.:7been completed by each Contractor. The content of those G732APPLICATION DATE:6/30/2025forms is summarized belowPERIOD FROM:6/1/2025Otsego Fire StationPERIOD TO:6/30/2025PROJECT NOS.:2410290A B C D E F G H IJK LSTORED TOTALMATERIALS COMPLETED ANDCURRENTBALALANCE %ORIGINAL NET CHANGES IN CONTRACT SUM WORK IN PLACE (Not in D or I) STORED TO DATE RETAINAGE RETAINAGE PREVIOUSPAYMENTFINISH COMPL.DESCRIPTION OF WORK CONTRACTOR'S NAMECONTRACT SUM THE WORK TO DATE TO DATE(D + E) %AMOUNTPAYMENTS(F - H - I)(C - F) (F / C)WS-01J Final Cleaning Prime Solutions, LLC DBA Prime Construction Solutions $35,000.00 $0.00 $35,000.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$35,000.00 0%WS-03A Concrete & Masonry Package Voss Plumbing & Heating Of Paynesville, Inc $767,212.00 $0.00 $767,212.00 $57,000.00 $0.00 $57,000.00 5.00% $2,850.00 $0.00$54,150.00$710,212.00 7%WS-03B Precast Structural Concrete Molin Concrete Products Company $1,456,510.00 $0.00 $1,456,510.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$1,456,510.00 0%WS-03D Specially Finished Concrete Quality Cleaning Inc, DBA QC Companies $26,625.00 $0.00 $26,625.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$26,625.00 0%WS-05A Structural Steel Material Only JRK Steel, Inc $575,531.00 $0.00 $575,531.00 $34,510.00 $0.00 $34,510.00 5.00% $1,725.50 $32,784.50$0.00$541,021.00 6%WS-05B Structural Steel Erection Spartan Steel Erectors, Inc $150,000.00 $0.00 $150,000.00 $6,000.00 $0.00 $6,000.00 5.00% $300.00 $5,700.00$0.00$144,000.00 4%WS-06A/07F/09A Carpentry, Metal Panels, Drywall BCI Construction, Inc $1,030,000.00 $0.00 $1,030,000.00 $90,263.63 $0.00 $90,263.63 5.00% $4,513.18 $36,685.79$49,064.66$939,736.37 9%WS-07H Roofing Package Roof Tech, Inc $755,620.00 $0.00 $755,620.00 $11,600.00 $0.00 $11,600.00 5.00% $580.00 $11,020.00$0.00$744,020.00 2%WS-07K Joint Sealants Carciofini Company $41,900.00 $0.00 $41,900.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$41,900.00 0%WS-08A Doors, Frames, and Hardware Contract Hardware Co., Inc $284,972.00 $0.00 $284,972.00 $60,009.00 $0.00 $60,009.00 5.00% $3,000.45 $0.00$57,008.55$224,963.00 21%WS-08D/08E Four Fold Doors/Sectional Overhead Door Crawford Door Sales Company Twin Cities, Inc $458,540.00 $0.00 $458,540.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$458,540.00 0%WS-08F Exterior Glass & Glazing Northern Glass & Glazing $358,700.00 $0.00 $358,700.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$358,700.00 0%WS-09B Tile Tim's Construction Group, LLC $140,000.00 $0.00 $140,000.00 $7,900.00 $0.00 $7,900.00 5.00% $395.00 $7,505.00$0.00$132,100.00 6%WS-09C Ceiling & Acoustical Treatment Sonus Interiors, Inc $148,000.00 $0.00 $148,000.00 $2,000.00 $0.00 $2,000.00 5.00% $100.00 $1,900.00$0.00$146,000.00 1%WS-09D Flooring Resilient & Carpet M.C.I., Inc, DBA Multiple Concepts Interiors $53,764.00 $0.00 $53,764.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$53,764.00 0%WS-09H Fluid Applied Flooring Grazzini Brothers & Company $29,700.00 $0.00 $29,700.00 $650.00 $0.00 $650.00 5.00% $32.50 $617.50$0.00$29,050.00 2%WS-09K Wall Covering & Painting Henkemeyer Coatins, Inc $124,210.00 $0.00 $124,210.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$124,210.00 0%WS-12C Manufactured Casework Woodside Industries, Inc $272,575.00 $0.00 $272,575.00 $15,859.85 $0.00 $15,859.85 5.00% $792.99 $15,066.86$0.00$256,715.15 6%WS-21A Fire Supression Brothers Fires Protection Co. DBA Brothers Fire & Security $133,600.00 $0.00 $133,600.00 $14,323.00 $0.00 $14,323.00 5.00% $716.15 $13,606.85$0.00$119,277.00 11%WS-23B Combined Mechanical Masters Plumbing Heating & Cooling, LLC $3,135,000.00 ($207.00) $3,134,793.00 $556,071.00 $0.00 $556,071.00 5.00% $27,803.55 $388,034.15$140,233.30$2,578,722.00 18%WS-26A Electrical Klein Electric, Inc $1,693,205.00 $207.00 $1,693,412.00 $317,449.00 $0.00 $317,449.00 5.00% $15,872.45 $208,889.80$92,686.75$1,375,963.00 19%WS-31A Site Clearing & Earthwork Belair Builders, Inc. DBA Belair Sitework Services $1,429,318.00 $0.00 $1,429,318.00 $754,418.87 $0.00 $754,418.87 5.00% $37,720.94 $30,495.00$686,202.93$674,899.13 53%WS-32A Asphalt Paving Omann Contracting Companies, Inc $189,800.00 $0.00 $189,800.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$189,800.00 0%WS-32B Concrete Paving Voss Plumbing & Heating Of Paynesville, Inc $340,687.00 $0.00 $340,687.00 $15,000.00 $0.00 $15,000.00 5.00% $750.00 $0.00$14,250.00$325,687.00 4%WS-32F Landscaping Grennscape Companies, Inc $387,900.00 $0.00 $387,900.00 $0.00 $0.00 $0.00 5.00% $0.00 $0.00$0.00$387,900.00 0%$14,018,369.00 $0.00 $14,018,369.00 $1,943,054.35 $0.00 $1,943,054.35 5.00% $97,152.71 $752,305.45 $1,093,596.19 $12,075,314.65 13.9%AIA DOCUMENT G737 - 2009 (formlerly G723CMa - 1992) · Copyright ©1992 and 2009 by The Amiercan Institutue of Architects.Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's AuthenticityTOTALSDocusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D 7/3/202554,150.00WS 03-ACity of OtsegoDocusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D7/3/2025 | 2:58 PM CDT Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D PICTURES OF THE STORED MATERIAL ARE ATTACHED AND INSURANCE IS ON FILE7/3/202549,064.66WS 06-A WS 07-F WS 09-ADocusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D7/3/2025 | 2:58 PM CDT Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/5/2025 Cartier Agency,LLC.dba Cartier Insurance 310 E Superior St Suite 220 Duluth MN 55802 Jordyn Anderson 218-727-5992 218-727-8501 janderson@caduluth.com Integrity Insurance Company 14303 INTEINC-01 Intectural Inc 1025 London Road Duluth MN 55802 148305904 A X 1,000,000 100,000 50,000 1,000,000 2,000,000 BP 2867755-3 1/1/2025 1/1/2026 1,000,000 A 1,000,000 X X X CA 2867757-2 1/1/2025 1/1/2026 A X X 5,000,000CUP2868523-2 1/1/2025 1/1/2026 X 0 A WCP 2868054-2 1/1/2025 1/1/2026 500,000 500,000 500,000 A Property BP 2867755-3 1/1/2025 1/1/2026 Re:City of Otsego and BCI Construction,Inc. BCI Construction,Inc 7135 5th Avenue NE Sauk Rapids Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D 57,008.55Construction Manager:7/3/2025WS 08-ADocusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D7/3/2025 | 2:58 PM CDT Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D PICTURES OF THE STORED MATERIAL ARE ATTACHED AND INSURANCE IS ON FILE WS 23-B (207.00) 3,134,793.00 2,606,525.55 MM 7/3/2025 140,233.30 Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D 7/3/2025 | 2:58 PM CDT Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D LENDER'S LOSS PAYABLE PHONEAGENCY COMPANY(A/C, No, Ext): FAX E-MAIL (A/C, No):ADDRESS: SUB CODE: AGENCY CUSTOMER ID #: INSURED LOAN NUMBER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE THIS REPLACES PRIOR EVIDENCE DATED: LOCATION/DESCRIPTION COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE NAME AND ADDRESS CONTINUED UNTIL TERMINATED IF CHECKED ADDITIONAL INSURED LOSS PAYEE MORTGAGEE LOAN # PERILS INSURED BASIC BROAD SPECIAL THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PROPERTY INFORMATION COVERAGE INFORMATION REMARKS (Including Special Conditions) CANCELLATION ADDITIONAL INTEREST ACORD 27 (2016/03)© 1993-2015 ACORD CORPORATION. All rights reserved. EVIDENCE OF PROPERTY INSURANCE DATE (MM/DD/YYYY) CODE: AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD 6/25/2025 (952) 653-1000 Middlesex Insurance CompanyChristensen Group, Inc. 9855 W 78th Street Suite 100 Eden Prairie, MN 55344-8004 (952) 653-1100 Masters Plumbing Heating & Cooling, LLC; Tilleskjor Properties LLC 3446 State Hwy 29 N Alexandria, MN 56308 Blanket Property Coverages Business Income $100,000 Blanket Building & Business Personal Property $3,809,998 1,000 Equipment Breakdown - Included 1,000 Personal Property of Others - Included 1,000 Wind/Hail Deductible 10,000 Special Conditions: RE: Otsego Fire Station project : - Stored plumbing materials value $40,900.00 . Blanket Limit of Personal Property applies to Personal Property of Others stored by Masters Plumbing Heating & Cooling Inc at 3446 State Hwy 29N Alexandria, MN 56308. City of Otsego 13400 90th St NE Elk River, MN 55330 BZAWATZKE A0181968002 11/3/2024 11/3/2025 MASTPLU-38 X Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D PICTURES OF THE STORED MATERIAL ARE ATTACHED AND INSURANCE IS ON FILE208,889.8092,686.7592,686.75Construction Manager:7/3/2025WS 26-AMMDocusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D7/3/2025 | 2:58 PM CDT 0.002,500.00Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D 2,500.00219,884.00Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D LENDER'S LOSS PAYABLE PHONEAGENCY COMPANY(A/C, No, Ext): FAX E-MAIL (A/C, No):ADDRESS: SUB CODE: AGENCY CUSTOMER ID #: INSURED LOAN NUMBER POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE THIS REPLACES PRIOR EVIDENCE DATED: LOCATION/DESCRIPTION COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE NAME AND ADDRESS CONTINUED UNTIL TERMINATED IF CHECKED ADDITIONAL INSURED LOSS PAYEE MORTGAGEE LOAN # PERILS INSURED BASIC BROAD SPECIAL THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PROPERTY INFORMATION COVERAGE INFORMATION REMARKS (Including Special Conditions) CANCELLATION ADDITIONAL INTEREST ACORD 27 (2016/03)© 1993-2015 ACORD CORPORATION. All rights reserved. EVIDENCE OF PROPERTY INSURANCE DATE (MM/DD/YYYY) CODE: AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD 3/24/2025 (952) 653-1000 SECURA Insurance A Mutual CompanyChristensen Group, Inc. 9855 W 78th Street Suite 100 Eden Prairie, MN 55344-8004 (952) 653-1100 Klein Electric Inc. 24729 Lake Road Saint Cloud, MN 56301-9713 Loc # 0, Bldg # 0, Blanket Loc # 0, Bldg # 0 Special (Including theft)$283,610 1,000 Evidence of Insurance RSCHAEFER TC3380207 1/13/2025 1/13/2026 KLEIELE-01 Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITIONAIA DOCUMENT G702/CMa (Instruction on reverse side)PAGE ONE OF TWO PAGESPROJECT: City of Otsego New Fire Station APPLICATION NO.: Distribution to:14499 57th Street NE PERIOD TO: 6/30/2025 OWNEROtsego, MN 55330 PROJECT NOS.: ARCHITECT CONTRACTORFROM CONTRACTOR: Belair Builders, Inc. dba Belair Sitework Services CONTRACT DATE: 11/15/242200 Old Highway 8 NWNew Brighton, MN 55112BELAIR JOB NO.: 40590-30/50VIA CONSTRUCTION MANAGER: Kraus-Anderson MinneapolisCONTRACT FOR: Earthwork & Site Utilities VIA ARCHITECT: Wold Architects & EngineersApplication is made for payment, as shown below, in connection with the Contract.Continuation Sheet, AIA Document G703, is attached.1.ORIGINAL CONTRACT SUM1,429,318.00$ 2.Net Change By Change Orders-$ CONTRACTOR:3.CONTRACT SUM TO DATE (Line 1 +/- 2)1,429,318.00$ By: __________________________________________________________ Date: __6/25/25________________4.TOTAL COMPLETED & STORED TO DATE754,418.87$ (Column G on G703)State of: Minnesota5.RETAINAGE:County of: Ramseya. 5% of Completed Work 37,720.94$ Subscribed and sworn to before(Columns D + E on G703) me this _25th_ day of _June_, _2025_.b. 5% of Stored Material Notary Public:(Column F on G703) My Commission expires: 1/31/2027Total Retainage (Line 5a + 5b orTotal in Column I of G703) 37,720.94$ 6.TOTAL EARNED LESS RETAINAGE716,697.93$ (Line 4 less Line 5 Total)7.LESS PREVIOUS CERTIFICATES FOR PAYMENT30,495.00$ (Line 6 from prior Certificate)8.CURRENT PAYMENT DUE686,202.93$ 9.BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED$(Line 3 less Line 6) 712,620.07$ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONSTRUCTION MANAGER:Total changes approved in By: __________________________________________________________ Date: ________________________previous month by OwnerARCHITECT:Total approved this Month By: __________________________________________________________ Date: ________________________TOTALS - - NET CHANGES by Change Order - This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor underthis Contract.Jennifer LeeCERTIFICATE FOR PAYMENTCONTRACTOR'S APPLICATION FOR PAYMENTIn accordance with the Contract Documents, based on on-site observations and the data comprising this application,the Construction Manager and Architect certify to the Owner that to the best of their knowledge, information andbelief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED.The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Workcovered by this Application for Payment has been completed in accordance with the Contract Documents, that allamounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued andpayments received from the Owner, and that current payment shown herein is now due.(Attach explanation if amount certified differs from the amount applied for. Initial all figures on this applicationand on the Continuation Sheet that changed to conform to the amount certified.)e this _25th_ ddddday of _June_, _____________2otary Public:c::c::::::::::::::::::::c:::::y Commission expires:ERTIFICATE FOR PAYM20251/1/1111/31/20272025_.TRACTOR:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________of: MinnesoooooooooooooooooooooooooooooooooooooooooooooooootatatatatatatatatataaataaatataatataaattaatataaaaaattttaatttttaattttatattttatttttttttttttttttJenJeJeJeeJeJeJeJeJeJeJeJJJJJeJeJeJJJeeJJJJeeJeJJJJJJJJJJJJJJJJJJJJniffififffifffifffiffffffifffffffffffffffffifffffffffffffffffifffffffffffffiffiffiifiiifeer LeecertifiesthattothebestoftheContractor'sredbythis Application for Payment has been completed in accorunts have been paid by the Contractor for Work for which previoents received from the Owner, and that current payment shown her2To: City of Otsego7/3/2025686,202.93WS 31-ADocusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D7/3/2025 | 2:58 PM CDT CONTINUATION SHEETPAGE TWO OF TWO PAGESAIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT,APPLICATION NO.:containing Contractor's signed Certification, is attached.APPLICATION DATE:June 25, 2025In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:06/30/25Use Column I on Contracts where variable retainage for line items may apply.CUSTOMER PROJECT NO: AB CDEF HIMATERIALS TOTALITEMSCHEDULED FROM PREVIOUS PRESENTLY COMPLETED BALANCE RETAINAGENO.DESCRIPTION OF WORKVALUE APPLICATION THIS PERIOD STORED AND STORED%TO(IF VARIABLE(D + E)(NOT IN TO DATE(G / C)FINISH RATE)D OR E)(D + E + F)(C - G)EARTHWORK500Flag Pole Furnish & Install 3,632.00 - 0.00% 3,632.00 - 600 Work Scope Allowance20,000.00 - 0.00% 20,000.00 - 315Equipment Moves59,650.00 6,500.00 53,150.00 59,650.00 100.00% - 2,982.50 320Erosion Control 80,406.00 5,600.00 10,000.00 15,600.00 19.40% 64,806.00 780.00 325Site Demolition & Clearing21,682.00 20,000.00 1,682.00 21,682.00 100.00% - 1,084.10 330Site Grading211,704.00 196,884.72 196,884.72 93.00% 14,819.28 9,844.24 350Structure Excavation and Backfill 30,407.00 13,683.15 13,683.15 45.00% 16,723.85 684.16 351Building Pad Class 5 Cushion43,275.00 - 0.00% 43,275.00 - 352Building Sand Subbase for Draintile at Doors & Footed Stoops30,694.00 - 0.00% 30,694.00 - 355Site Finishing359,657.00 - 0.00% 359,657.00 - 360Temp. Construction Fabric - 7 rolls- - 0.00% - - 361Temp. Construction 3-inch Rock - 1,051 ton- - 0.00% - - 362Temp. Construction 3/4-inch to 1 1/2-inch Rock - 525 ton- - 0.00% - - UTILITIES400Mobilization3,178.00 3,178.00 3,178.00 100.00% - 158.90 405Removals3,437.00 3,437.00 3,437.00 100.00% - 171.85 410Sanitary Sewer46,008.00 40,000.00 40,000.00 86.94% 6,008.00 2,000.00 415 Watermain311,733.00 300,000.00 300,000.00 96.24% 11,733.00 15,000.00 420Storm Sewer203,551.00 100,000.00 100,000.00 49.13% 103,551.00 5,000.00 425Trench Drain (Supply Only) 304.00 304.00 304.00 100.00% - 15.20 1,429,318.00 32,100.00 722,318.87 - 754,418.87 52.78% 674,899.13 37,720.94 AIA DOCUMENT G703 (Instructions on reverse side)WORK COMPLETEDG2Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D 7/3/202514,250.00WS 32-BCity of OtsegoDocusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D7/3/2025 | 2:58 PM CDT Docusign Envelope ID: 73258E83-6B8D-4685-A5D2-149CAE0C732D