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Item 3.3 Fire and Emergency Services Facility Project Pay Application 10 Request for City Council Action DEPARTMENT INFORMATION ORIGINATING DEPARTMENT REQUESTOR: MEETING DATE: Public Safety City Administrator/Finance Director Flaherty October 27, 2025 PRESENTER(s) REVIEWED BY: ITEM #: Consent Kraus-Anderson 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 recommend City Council approval of Pay Application #10 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 #10 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 11 individual work scope requests included within Pay Application #10 for a total of $1,521,546.05: Voss Plumbing & Heating of Paynesville, Inc. $1,128.60 Molin Concrete Products Company $239,573.62 Spartan Steel Erectors, Inc. $25,080.00 BCI Construction, Inc. $175,525.96 Roof Tech, Inc. $475,413.25 Contract Hardware Co., Inc. $82,213.00 Northern Glass & Glazing $36,641.50 Masters Plumbing Heating & Cooling LLC $160,297.77 Klein Electric, Inc. $169,287.15 Belair Builders, Inc. $55,100.00 Voss Plumbing & Heating of Paynesville, Inc. $101,285.20 In accordance with Minnesota Statute, the City is withholding the maximum of 5% retainage of work completed, which amounts to $322,319.42 at this time. SUPPORTING DOCUMENTS ATTACHED: • Pay Application #10 POSSIBLE MOTION PLEASE WORD MOTION AS YOU WOULD LIKE IT TO APPEAR IN THE MINUTES: Motion to approve Pay Application #10 in the amount of $1,521,546.05 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: 1014499 75th St Ne New Fire StationPERIOD TO: 9/30/2025OWNEROtsego, 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)$2,514.053. TOTAL CONTRACT SUM TO DATE (Item C Totals) $14,020,883.054. TOTAL COMPLETED & STORED TO DATE (Item F Totals)$6,446,388.265. RETAINAGE (Item H Totals)$322,319.42 6. LESS PREVIOUS TOTAL PAYMENTS (Item I Totals)$4,602,522.797. CURRENT PAYMENT DUE (Item J Totals)$1,521,546.05 TOTAL OF AMOUNTS CERTIFIED…………………….. $1,521,546.05The 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: 10/10/25CONSTRUCTION MANAGER: Kraus-Anderson Construction CompanyBy:_________________________________________________________Date:10/10/25State of: MinnesotaCounty of: HennepinSubscribed and sworn to before me this 10th day of October, 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: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT AIA DOCUMENT G737 - 2009Summary of Contractors' Applications for Payment, Construction Manager as Adviser EditionAIA Document G732, Application and Certificate for Payment, hasAPPLICATION NO.:10been completed by each Contractor. The content of those G732APPLICATION DATE:9/30/2025forms is summarized belowPERIOD FROM:9/1/2025Otsego Fire StationPERIOD TO:9/30/2025PROJECT 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 $4,810.50 $772,022.50 $301,023.00 $0.00 $301,023.00 5.00% $15,051.15 $284,843.25$1,128.60$470,999.50 39%WS-03B Precast Structural Concrete Molin Concrete Products Company $1,456,510.00 ($1,865.00) $1,454,645.00 $1,454,645.00 $0.00 $1,454,645.00 5.00% $72,732.25 $1,142,339.13$239,573.62$0.00 100%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 $373,972.00 $0.00 $373,972.00 5.00% $18,698.60 $355,273.40$0.00$201,559.00 65%WS-05B Structural Steel Erection Spartan Steel Erectors, Inc $150,000.00 $0.00 $150,000.00 $112,400.00 $0.00 $112,400.00 5.00% $5,620.00 $81,700.00$25,080.00$37,600.00 75%WS-06A/07F/09A Carpentry, Metal Panels, Drywall BCI Construction, Inc $1,030,000.00 $0.00 $1,030,000.00 $295,300.42 $0.00 $295,300.42 5.00% $14,765.02 $105,009.44$175,525.96$734,699.58 29%WS-07H Roofing Package Roof Tech, Inc $755,620.00 $0.00 $755,620.00 $512,035.00 $0.00 $512,035.00 5.00% $25,601.75 $11,020.00$475,413.25$243,585.00 68%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 $146,549.00 $0.00 $146,549.00 5.00% $7,327.45 $57,008.55$82,213.00$138,423.00 51%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 $38,570.00 $0.00 $38,570.00 5.00% $1,928.50 $0.00$36,641.50$320,130.00 11%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 $2,441.55 $3,137,441.55 $1,121,055.50 $0.00 $1,121,055.50 5.00% $56,052.78 $904,704.95$160,297.77$2,016,386.05 36%WS-26A Electrical Klein Electric, Inc $1,693,205.00 ($24,669.00) $1,668,536.00 $690,547.72 $0.00 $690,547.72 5.00% $34,527.39 $486,733.18$169,287.15$977,988.28 41%WS-31A Site Clearing & Earthwork Belair Builders, Inc. DBA Belair Sitework Services $1,429,318.00 $21,796.00 $1,451,114.00 $1,237,941.77 $0.00 $1,237,941.77 5.00% $61,897.09 $1,120,944.68$55,100.00$213,172.23 85%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 $121,616.00 $0.00 $121,616.00 5.00% $6,080.80 $14,250.00$101,285.20$219,071.00 36%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 $2,514.05 $14,020,883.05 $6,446,388.26 $0.00 $6,446,388.26 5.00% $322,319.42 $4,602,522.79 $1,521,546.05 $7,574,494.79 46.0%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: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/10/20251,128.60WS 03-ADocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/10/2025 239,573.62 WS 03-B Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/13/2025 | 9:03 AM CDT WX4217E---000039/23/20259/23/202524-42177100 PRECAST PLANK29,865.00 24,787.95 5,077.0529,865.00 100.001,493.257150 PLANK D&E5,452.00 5,452.005,452.00 100.00272.607600 RAMSEY WALL PANELS853,970.00 853,970.00853,970.00 100.0042,698.507650 RAMSEY D&E137,113.00 137,113.00137,113.00 100.006,855.658100 PLANK LABOR16,067.0016,067.0016,067.00 100.00803.358600 MISC MATLS/TRUCKING286,633.0077,390.91 209,242.09286,633.00 100.0014,331.658800 RAMSEY LABOR114,719.00 92,922.39 21,796.61114,719.00 100.005,735.958600B BONDS10,826.00 10,826.0010,826.00 100.00541.30100.0072,732.251,454,645.00252,182.751,202,462.251,454,645.00TotalsDocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 APPLICATION AND CERTIFICATION FOR PAYMENT,Construction Manager as Adviser Edition TO OWNER: FROM CONTRACTOR: Spartan Steel Erectors,Inc. PO Box 215 Mound,MN 55364 Contract for Bid Steel ErectionPackage: PROJECT:Otsego Fire Station VIA CONSTRUCTION MANAGER:Kraus Anderson VIA ARCHITECT: APPLICATION NO:2508-3 PERIOD TO:9.30.25 CONTRACT FOR: CONTRACT DATE: PROJECT NOS: AIA DOCUMENTG732 -2009 Distribution to: OWNER CONSTRUCTION MANAGER ARCHITECT CONTRACTOR FIELD CONTRACTORS APPLICATION FOR PAYMENT Application IS made for payment,as sh0XM1 below,in connection with the Contract. Continuation Sheet,AIA Document G703,IS attached. 1.ORIGINAL CONTRACT SUM 2.NET CHANGE BY CHANGE ORDERS 3.CONTRACT SUM TO DATE (Line 1 4.TOTAL COMPLETED &STORED TO DATE (Column G on G703) The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents,that all amounts have been pai the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner,and that current payment shown herein is now d 5.RETAINAGE: a.5 %of Completed Work 150,000.00 150,000.00 112,400.00 5,620.00 106,780.00 81,700.00 25,080.00 43,220.00 DEDUCTIONS CONIRACTOR. State of: Subscribed and sworn to before me this Notary Public: My Commission expires: Date:q County of: day of (Column D +E on G703) %of Stored Material (Column F on G703) 5,620.00 Total Retainage (Lines 5a +5b or Total in Column I of G703) 6.TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7.LESS PREVIOUS CERTIFICATES FOR PAYNENT(Line 6 from prior Certificate) 8.CURRENT PAYMENT DUE 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Line 3 minus Line 6) CHANGE ORDER SUN,nvLARY Total changes approved in previous months by Owner Total approved this Month TOTALS NET CHANGES by Change Order CERTIFICATE FOR PAYMENT In accordance with the Contract Documents,based on on-site observations and the data comprising the application,the Architect certifies to the Owner that to the best of the Architect's knowledge,information and belief 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. AMOUNT CERTIFIED 25,080.00 s ADDITIONS AIA DOCUMENT G702 -APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 (Attach explanation if amount certified differsfrom the amount applied Initial all figures on this Application and onthe Continuation Sheet that are changed to conform with the amount certified.) CONSTRUCTION MANAGER: Date: ARCHITECT:(NOTE:If Multiple Prime constractors are responsible for performingportions of the Project,the Architect's Certification is not required.) Date:By 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 under this Contract. THE AMERICAN INSTITUTE OF ARCHITECTS,M 735 NEW YORK AVE-„N.w.,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. 10/10/2025 WS 05-B City of Otsego Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/13/2025 | 9:03 AM CDT KRAUS ANDERSON Architect: Owner: Project Name:Otsego Fire Station G703 APPLICATION FOR PAYMENT SCHEDULE -G703 SPARTAN STEEL ERECTORS,INC. APPLICATION NO:2508-3 APPLICATION DATE: PERIOD TO: PROJECT NOS: 9/16/2025 9/30/2025 WORK COMPLETED ITEM NO. 001 002 003 004 005 006 SCHEDULED VALUE $6,000.00 $60,000.00 $40,000.00 $9,000.00 $25,000.00 $10,000.00 $0.00 so.oo $0.00 $0.00 $0.00 $0.00 $0.00 $000 $150,000.00 FROM PREVIOUS APPLICATION $45,000.00 $30,000.00 $5,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $86,000.00 TOTAL COMPLETED AND STORED TO DATE (D+E+F) $6,000.00 $60,000.00 $311000.00 $9,000.00 $5,000.00 $11400.00 $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 $112,400.00 RETAINAGE BALANCE TO (IF VARIABLEDESCRIPTIONOFWORK Bonds Structural -erection labor Joists -erection labor Deck -erection labor Misc.Metals -erection labor Allowance -erection labor TOTAL THIS APPLICATION PERIOD $0.00 $15,000.00 $1 ,ooo.oo $4,000.00 $5uooo.oo $1,400.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26,400.00 MATERIALS PRESENTLY STORED (NOT IN D OR $000 $0.00 Page I 100.00% 100.00% 77.50% 100.00% 20.00% 14.00% #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O' #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! #DIV/O! 0.749333333 FINISH $0.00 $0.00 $9,000.00 $0.00 $20,000.00 $8,600.00 $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 $37,600.00 RATE) 5% $300.00 $3,000.00 $1 ,550.oo $450 00 $250.00 $70.00 $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 $5,620.00 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 WS 06-AWS 07-FWS 09-AConstruction Manager:10/10/2025175,525.96Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/10/2025475,413.25WS 07-HDocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 PICTURES OF THE STORED MATERIAL ARE ATTACHED AND INSURANCE IS ON FILE145,750.4510/10/202582,213.00WS 08-ACity of OtsegoDocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT 26,688.0033,321.0086,540.0060,009.00Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 PICTURES OF THE STORED MATERIAL ARE ATTACHED AND INSURANCE IS ON FILE Construction Manager: Architect: Date Date 10/10/2025 WS 08-F Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/13/2025 | 9:03 AM CDT Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 09/24/2025 J.A. Price Agency, Inc. 6640 Shady Oak Road, Suite 500 Eden Prairie MN 55344-6176 Jeanette Kraemer (952) 944-8790 (952) 944-0097 jeanette.kraemer@japrice.com 00004617 Northern Glass & Glazing, Inc. 165 W 88TH St Bloomington MN 55420-2804 Selective Insurance Co. of America 12572 25-26 Stored Materials 155-165 WEST 88TH STREET BLOOMINGTON MN 55420 A 2,500 S 2121461 06/01/2025 06/01/2026 BPP incl Stock 500,000 Project: Otsego Fire Station Stored Materials at 165 W 88th St, Bloomington, MN Storing - $30,000 of Aluminum Doors & Frames City of Otsego c/o Kraus-Anderson Construction Company 501 South 8th Street Minneapolis MN 55404 INSURER(S) AFFORDING COVERAGE NAIC # INSURER F : INSURER E : INSURER D : NAME:CONTACT INSURER C : INSURER B : (A/C, No):FAX E-MAILADDRESS: CUSTOMER ID: PRODUCER PRODUCER (A/C, No, Ext):PHONE INSURED INSURER A : The ACORD name and logo are registered marks of ACORD 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. LOCATION OF PREMISES / DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) REVISION NUMBER:CERTIFICATE NUMBER: 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. COVERAGES $$ $BOILER & MACHINERY / EQUIPMENT BREAKDOWN $ $ $ TYPE OF POLICY CRIME POLICY NUMBER $ $ $ $ NAMED PERILS CAUSES OF LOSS TYPE OF POLICYINLAND MARINE $ RENTAL VALUE CONTENTS BUILDING DEDUCTIBLES WIND $ $ $ $ $ $ $ $ $ BLANKET BLDG & PP BLANKET PERS PROP BLANKET BUILDING EXTRA EXPENSE BUSINESS INCOME PERSONAL PROPERTY BUILDING FLOOD EARTHQUAKE SPECIAL BROAD BASIC CAUSES OF LOSS PROPERTY POLICY EXPIRATION DATE (MM/DD/YYYY) POLICY EFFECTIVE DATE (MM/DD/YYYY) INSR LTR LIMITSCOVERED PROPERTYPOLICY NUMBERTYPE OF INSURANCE $$ $ SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) © 1995-2015 ACORD CORPORATION. All rights reserved. ACORD 24 (2016/03) AUTHORIZED REPRESENTATIVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CANCELLATION CERTIFICATE OF PROPERTY INSURANCE DATE (MM/DD/YYYY) CERTIFICATE HOLDER Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 PICTURES OF THE STORED MATERIAL ARE ATTACHED AND INSURANCE IS ON FILE10/10/2025WS 26-ADocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 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)$283,610 1,000 Evidence of Insurance RSCHAEFER TC3380207 1/13/2025 1/13/2026 KLEIELE-01 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/10/2025 160,297.77 160,297.77 1,065,002.72 WS 23-B Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/13/2025 | 9:03 AM CDT Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITIONAIA DOCUMENT G702/CMa (Instruction on reverse side)PAGE ONE OF TWO PAGESPROJECT: City of Otsego New Fire Station APPLICATION NO.: 6 Distribution to:14499 57th Street NE PERIOD TO: 9/30/2025 OWNEROtsego, MN 55330 PROJECT NOS.: ARCHITECT CONTRACTORFROM CONTRACTOR: Belair Builders, Inc. dba Belair Sitework Services CONTRACT DATE: 11/15/242200 Old Highway 8 NWNew Brighton, MN 55112BELAIR JOB NO.: 40590-30/50VIA CONSTRUCTION MANAGER: Kraus-Anderson MinneapolisCONTRACT FOR: Earthwork & Site Utilities VIA ARCHITECT: Wold Architects & EngineersApplication is made for payment, as shown below, in connection with the Contract.Continuation Sheet, AIA Document G703, is attached.1.ORIGINAL CONTRACT SUM1,429,318.00$ 2.Net Change By Change Orders21,796.00$ CONTRACTOR:3.CONTRACT SUM TO DATE (Line 1 +/- 2)1,451,114.00$ By: __________________________________________________________ Date: __9/25/25________________4.TOTAL COMPLETED & STORED TO DATE1,237,941.77$ (Column G on G703)State of: Minnesota5.RETAINAGE:County of: Ramseya. 5% of Completed Work 61,897.09$ Subscribed and sworn to before(Columns D + E on G703) me this _25th_ day of _Sept_, _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) 61,897.09$ 6.TOTAL EARNED LESS RETAINAGE1,176,044.68$ (Line 4 less Line 5 Total)7.LESS PREVIOUS CERTIFICATES FOR PAYMENT1,120,944.68$ (Line 6 from prior Certificate)8.CURRENT PAYMENT DUE55,100.00$ 9.BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED$(Line 3 less Line 6) 275,069.32$ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONSTRUCTION MANAGER:Total changes approved in By: __________________________________________________________ Date: ________________________previous month by OwnerARCHITECT:Total approved this Month 16,416.00 By: __________________________________________________________ Date: ________________________TOTALS 21,796.00 - NET CHANGES by Change Order 21,796.00 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 PAYMENT5,380.00 In 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.)Subscribed and sworn to beforeme this _25th_ day yyyyyyyof ooofooooofooooofooooooooooooooooooooooooooooooooooooooo_Sept_, _,,,2020200225_.5Notary Public:My Commission eeeeeeeeeeeeeeeeeeeixpixpxpxpxpxxpxpxpxxxpppxxxxxpppppppxxpres:1/31/2027CERTIFICATE FOR PAYMENTdwiththeContractDocuments, based on on-siteobCTOR:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________MinnesotaJenJeJeJeeJeJeeJeJeJeeeJeJeeJJJJeJeJJeJJJJJJJJJJJJnifiniifnifiiniifniininiiiiiiiiiniiniiiiiiiininiiiniiniiiiiiiniiininnnnnnnner Leeen completed ihave beenpaid by the Contractor for Work for whichreceived from the Owner, and that current payment shTo: City of Otsego10/10/202555,100.00WS 31-ADocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT CONTINUATION SHEETPAGE TWO OF TWO PAGESAIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT,APPLICATION NO.:6containing Contractor's signed Certification, is attached.APPLICATION DATE:09/24/25In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:09/30/25Use Column I on Contracts where variable retainage for line items may apply.CUSTOMER PROJECT NO: ABCDEFHIMATERIALSTOTALITEMSCHEDULEDFROM PREVIOUSPRESENTLYCOMPLETEDBALANCERETAINAGENO.DESCRIPTION OF WORKVALUEAPPLICATIONTHIS PERIODSTOREDAND STORED%TO(IF VARIABLE(D + E)(NOT INTO DATE(G / C)FINISHRATE)D OR E)(D + E + F)(C - G)EARTHWORK500Flag Pole Furnish & Install 3,632.00 3,632.00 3,632.00 100.00% - 181.60 600 Work Scope Allowance20,000.00 2,472.80 2,472.80 12.36% 17,527.20 123.64 315Equipment Moves59,650.00 59,650.00 59,650.00 100.00% - 2,982.50 320Erosion Control 80,406.00 66,205.00 6,000.00 72,205.00 89.80% 8,201.00 3,610.25 325Site Demolition & Clearing21,682.00 21,682.00 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 30,407.00 30,407.00 100.00% - 1,520.35 351Building Pad Class 5 Cushion43,275.00 30,915.00 30,915.00 71.44% 12,360.00 1,545.75 352Building Sand Subbase for Draintile at Doors & Footed Stoops30,694.00 - 0.00% 30,694.00 - 355Site Finishing359,657.00 194,502.25 52,000.00 246,502.25 68.54% 113,154.75 12,325.11 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 46,008.00 46,008.00 100.00% - 2,300.40 415 Watermain311,733.00 311,733.00 311,733.00 100.00% - 15,586.65 420Storm Sewer203,551.00 203,551.00 203,551.00 100.00% - 10,177.55 425Trench Drain (Supply Only) 304.00 304.00 304.00 100.00% - 15.20 CO001 -Additional Tree Removal5,380.00 5,380.00 5,380.00 100.00% - 269.00 CO002 -Change FES with Riprap to FES with ACM16,416.00 - 0.00% 16,416.00 - 1,451,114.00 1,179,941.77 58,000.00 - 1,237,941.77 85.31% 213,172.23 61,897.09 AIA DOCUMENT G703 (Instructions on reverse side)WORK COMPLETEDGDocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127 10/10/2025101,285.20WS 32-BCity of OtsegoDocusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F587612710/13/2025 | 9:03 AM CDT Docusign Envelope ID: A18F973D-C9B1-4524-97D3-AEB0F5876127