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Item 3.3 Fire Station Facility Project Pay Application 15
Request for City Council Action DEPARTMENT INFORMATION ORIGINATING DEPARTMENT REQUESTOR: MEETING DATE: Public Safety Interim Fire Chief Scott March 23, 2026 PRESENTER(s) REVIEWED BY: ITEM #: Consent Kraus-Anderson City Administrator/Finance Director Flaherty 3.3 – Pay Application for the Fire Station 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 #15 for the Fire Station project. ARE YOU SEEKING APPROVAL OF A CONTRACT? IS A PUBLIC HEARING REQUIRED? No No BACKGROUND/JUSTIFICATION: The amounts requested for Pay Application #15 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 ten individual work scope requests included within Pay Application #15 for a total of $667,470.12: Voss Plumbing & Heating of Paynesville, Inc. $9,591.02 JRK Steel, Inc. $10,564.00 BCI Construction, Inc. $56,065.69 Roof Tech, Inc. $13,680.00 Carciofini Company $19,042.75 Henkemeyer Coatings, Inc. $49,400.00 Woodside Industries, Inc. $92,297.92 Brothers Fire Protection Co. $4,560.00 Masters Plumbing Heating & Cooling LLC $291,458.82 Klein Electric, Inc. $120,809.92 In accordance with Minnesota Statute, the City is withholding the maximum of 5% retainage of work completed, which amounts to $572,473.55 at this time. SUPPORTING DOCUMENTS ATTACHED: • Pay Application #15 POSSIBLE MOTION PLEASE WORD MOTION AS YOU WOULD LIKE IT TO APPEAR IN THE MINUTES: Motion to approve Pay Application #15 in the amount of $667,470.12 for work completed on the Fire Station project. BUDGET INFORMATION FUNDING: BUDGETED: Fund 446 – Fire Station 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: 1514499 75th St Ne New Fire StationPERIOD TO: 2/28/2026OWNEROtsego, 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)$54,399.983. TOTAL CONTRACT SUM TO DATE (Item C Totals) $14,072,768.984. TOTAL COMPLETED & STORED TO DATE (Item F Totals)$11,449,470.825. RETAINAGE (Item H Totals)$572,473.55 6. LESS PREVIOUS TOTAL PAYMENTS (Item I Totals)$10,209,527.157. CURRENT PAYMENT DUE (Item J Totals)$667,470.12 TOTAL OF AMOUNTS CERTIFIED…………………….. $667,470.12The 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: 02/27/26CONSTRUCTION MANAGER: Kraus-Anderson Construction CompanyBy:_________________________________________________________Date:02/27/26State of: MinnesotaCounty of: HennepinSubscribed and sworn to before me this 27th day of February, 2026ARCHITECT: 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: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST AIA DOCUMENT G737 - 2009Summary of Contractors' Applications for Payment, Construction Manager as Adviser EditionAIA Document G732, Application and Certificate for Payment, hasAPPLICATION NO.:15been completed by each Contractor. The content of those G732APPLICATION DATE:2/28/2026forms is summarized belowPERIOD FROM:2/1/2026Otsego Fire StationPERIOD TO:2/28/2026PROJECT 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 $12,762.21 $779,974.21 $736,124.21 $0.00 $736,124.21 5.00% $36,806.21 $689,726.98$9,591.02$43,850.00 94%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 $1,381,912.75$0.00$0.00 100%WS-03D Specially Finished Concrete Quality Cleaning Inc, DBA QC Companies $26,625.00 $0.00 $26,625.00 $5,275.00 $0.00 $5,275.00 5.00% $263.75 $5,011.25$0.00$21,350.00 20%WS-05A Structural Steel Material Only JRK Steel, Inc $575,531.00 ($5,439.00) $570,092.00 $560,092.00 $0.00 $560,092.00 5.00% $28,004.60 $521,523.40$10,564.00$10,000.00 98%WS-05B Structural Steel Erection Spartan Steel Erectors, Inc $150,000.00 $13,251.05 $163,251.05 $150,151.05 $0.00 $150,151.05 5.00% $7,507.55 $142,643.50$0.00$13,100.00 92%WS-06A/07F/09A Carpentry, Metal Panels, Drywall BCI Construction, Inc $1,030,000.00 $7,566.30 $1,037,566.30 $851,800.29 $0.00 $851,800.29 5.00% $42,590.02 $753,144.58$56,065.69$185,766.01 82%WS-07H Roofing Package Roof Tech, Inc $755,620.00 $15,341.51 $770,961.51 $756,416.51 $0.00 $756,416.51 5.00% $37,820.83 $704,915.68$13,680.00$14,545.00 98%WS-07K Joint Sealants Carciofini Company $41,900.00 $0.00 $41,900.00 $20,045.00 $0.00 $20,045.00 5.00% $1,002.25 $0.00$19,042.75$21,855.00 48%WS-08A Doors, Frames, and Hardware Contract Hardware Co., Inc $284,972.00 $0.00 $284,972.00 $168,547.00 $0.00 $168,547.00 5.00% $8,427.35 $160,119.65$0.00$116,425.00 59%WS-08D/08E Four Fold Doors/Sectional Overhead Door Crawford Door Sales Company Twin Cities, Inc $458,540.00 $0.00 $458,540.00 $448,540.00 $0.00 $448,540.00 5.00% $22,427.00 $426,113.00$0.00$10,000.00 98%WS-08F Exterior Glass & Glazing Northern Glass & Glazing $358,700.00 $0.00 $358,700.00 $339,370.00 $0.00 $339,370.00 5.00% $16,968.50 $322,401.50$0.00$19,330.00 95%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 $27,000.00 $0.00 $27,000.00 5.00% $1,350.00 $25,650.00$0.00$121,000.00 18%WS-09D Flooring Resilient & Carpet M.C.I., Inc, DBA Multiple Concepts Interiors $53,764.00 $0.00 $53,764.00 $36,164.95 $0.00 $36,164.95 5.00% $1,808.25 $34,356.70$0.00$17,599.05 67%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 $62,000.00 $0.00 $62,000.00 5.00% $3,100.00 $9,500.00$49,400.00$62,210.00 50%WS-12C Manufactured Casework Woodside Industries, Inc $272,575.00 $0.00 $272,575.00 $184,144.35 $0.00 $184,144.35 5.00% $9,207.22 $82,639.21$92,297.92$88,430.65 68%WS-21A Fire Supression Brothers Fires Protection Co. DBA Brothers Fire & Security $133,600.00 $0.00 $133,600.00 $132,640.00 $0.00 $132,640.00 5.00% $6,632.00 $121,448.00$4,560.00$960.00 99%WS-23B Combined Mechanical Masters Plumbing Heating & Cooling, LLC $3,135,000.00 $986.54 $3,135,986.54 $2,529,987.87 $0.00 $2,529,987.87 5.00% $126,499.39 $2,112,029.66$291,458.82$605,998.67 81%WS-26A Electrical Klein Electric, Inc $1,693,205.00 ($25,678.45) $1,667,526.55 $1,250,164.07 $0.00 $1,250,164.07 5.00% $62,508.20 $1,066,845.95$120,809.92$417,362.48 75%WS-31A Site Clearing & Earthwork Belair Builders, Inc. DBA Belair Sitework Services $1,429,318.00 $37,474.82 $1,466,792.82 $1,407,604.52 $0.00 $1,407,604.52 5.00% $70,380.23 $1,337,224.29$0.00$59,188.30 96%WS-32A Asphalt Paving Omann Contracting Companies, Inc $189,800.00 $0.00 $189,800.00 $102,395.00 $0.00 $102,395.00 5.00% $5,119.75 $97,275.25$0.00$87,405.00 54%WS-32B Concrete Paving Voss Plumbing & Heating Of Paynesville, Inc $340,687.00 $0.00 $340,687.00 $217,814.00 $0.00 $217,814.00 5.00% $10,890.70 $206,923.30$0.00$122,873.00 64%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 $54,399.98 $14,072,768.98 $11,449,470.82 $0.00 $11,449,470.82 5.00% $572,473.55 $10,209,527.15 $667,470.12 $2,623,298.16 81.4%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: D43E8F56-B6A1-4741-A86E-A2F367DE0294 2/26/20269,591.02WS 03-ADocusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 2/26/202610,564.0010,564.00MM532,087.4028,004.6028,004.60-5,439.00570,092.00560,092.00WS 05-ADocusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST 7 Change Order #1 0.008 Change Order #2 -5,439.00 -5,439.00 -5,439.00 100% 0.00 -271.95 570,092.0011,120.00Changes orders 1&2were added in since theyare now fully executed.560,092.0098%28,004.60402/2026Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 PICTURES OF THE STORED MATERIAL ARE ATTACHED AND INSURANCE IS ON FILEConstruction Manager:2/26/202656,065.69WS 06-AWS 07-FWS 09-ADocusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 2-25-2026 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 02/17/2026 AssuredPartners of MN - Chaska 101 W 3rd St Chaska MN 55318 Amanda Swanson (952) 448-3800 (952) 556-4873 amanda.swanson@assuredpartners.com CE LLC DBA CE Contract CE LLC DBA Contract Shades & Blinds LLC 7174 Shady Oak Rd Eden Prairie MN 55344 Owners Insurance Company 32700 Auto-Owners Insurance Company 18988 AmTrust/Technology Insurance Company Inc 42376 Southern-Owners Insurance Company 10190 2025 Liability A/D Contractual Liability Y Y 08568136 / 08098692 09/29/2025 09/29/2026 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 B Y Y 5409869200 09/29/2025 09/29/2026 1,000,000 A Waived Y Y 5409869201 09/29/2025 09/29/2026 5,000,000 5,000,000 C N TWC4664495 09/29/2025 09/29/2026 1,000,000 1,000,000 1,000,000 A Blkt. Employee Theft/Dishonesty BPP of Others / Rented Equipment 08568136 09/29/2025 09/29/2026 Occurrence $100,000 Stored Materials $176,210 Rented Equipment $50,000 [Job #: Job Type: Otsego - New Fire Station] BCI Construction Inc and City of Otsego are included as additional insureds on General Liability, Auto, and Umbrella. Coverage is on a primary and non-contributory basis. Waiver of Subrogation applies. BCI Construction Inc 7135 5th Ave NE Sauk Rapids MN 56379 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 belowIf 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 HIREDAUTOS ONLY Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Construction Manager: 2/26/2026 13,680.00 WS 07-H Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 3/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 2/26/2026 19,042.75 WS 07-K Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 3/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 2/26/2026WS 09-KDocusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 2/26/2026 92,297.92 WS 12-C Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 3/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 APPLICATION AND CUTIFICA'l'E l'OR PAYMENT TO PROJECT: SC00126 CITY OTSEGO NEW FIRE STATION FROM: Brothers Fire & Security 9950 East Highway 10 CONTRACT FOR 1 Elk River, MN55330 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet is attached. 1. ORIGINAL CONTRACT SOM ................ . 2 . NET CHANGE BY CHANGE ORDERS . . . . . . .... . 3. CONTRACT SOM TO DATE (Line 1 +-2) ... . 4. TOTAL COMPLETED & STORED TO DATE ..... . (Column G) 5. RETAINAGE: a. S.00 % of Completed Work (Columns D + E) b. S.00 % of Stored Material (Column F) Total Retainage (Line Sa+ Sb or Total in Column I) ................. . 6. TOTAL BARNED LESS RETAINAGI .......... . (Line 4 less Line S Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 8. CURRENT PAYMENT DUE .................. . 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS Total changes approved in previous months by Owner 0.00 Total approved this Month 0.00 TOTALS 0.00 N~T CHANGES by Change Order $0.00 $133,600.00 $0.00 $133,600.00 $132,640.00 $6,632.00 $0.00 $6,632.00 $126,008.00 $121,448.00 $4,560.00 $7,S92.00 DEDUCTIONS o.oo "IT.00 0.00 APPLICATION NO.: 6 PERIOD TO: Feb 28/26 PROJECT NOS , : CONTRACT DATE: Dec 03/24 Joo~4l i Distribution to: OWNER D ARCHITECT 0 CONTRACTOR 0 FIELD D OTHER D 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 paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein in now due. CONTRA~Security _ By: __ -_--_--::...::==~~_::-~--Date: :).-)-3 oCP State of: Minnesota County of: 5~ Subscribed and sworn to before me this i3r_d _day ,of. Febr~agJ_,.._.2.026 _, _,,_ ---. . TA, ..... '{ JO ?OBERTS I -':~ .. ~ • .,,\·., No!,'V Pub.IC -ii ... ,-. ,< ~ r:.-.n,::sota Notary fubiic: 1.~ \--~ My commission expires: ~ 0 1-_3\-}-1 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Document, based on on-site observations and the data comprising this 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. AK>UNT CERTIFIED ............. $ ARCHITECT: By: Date: 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. City of OtsegoBy: Date: This Certifi Construction Manager:2/26/20264,560.00WS 21-ADocusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST CONTINUATION SHEET APPLICATION NO. : 6 l?ERIOD TO: Feb 28/26 APPLICATION DATE: Feb 23/26 PROJECT NO. : SC00126 A B C D I F a H I WORK CCMPLET&D MATERIALS TOTAL PRESENTLY COMl?LETED BALANCE RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED nae PREVIOUS STORED AND STORED ' TO (IF VARIABLE NO. VALUE Al'PLICATION THIS PERIOD (NOT IN TO DATE (G I C) fINISH RATE) (D + I) DOR El (D+E+F) (C -G) CONTRACT 00001 PERMIT 3800.00 3800.00 0.00 0.00 3800.00 100 0.00 190.00 00002 DESIGN 9000.00 9000.00 0.00 0.00 9000.00 100 0.00 450.00 00003 MATERIAL 71277.00 71277.00 0.00 0.00 71277.00 100 0.00 3563.85 00004 LABOR 48000.00 42240.00 4800.00 0.00 47040.00 98 960.00 2352.00 00005 BOND 1523.00 1523.00 0.00 0.00 1523.00 100 0.00 76.15 133600.00 127840.00 4800.00 0.00 132640.00 99 960.00 6632.00 Total Contract 133600.00 127840.00 4800.00 0.00 132640.00 99 960.00 6632.00 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 2/26/2026291,458.82WS 23-BDocusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Construction Manager:120,809.92MM120,809.922/26/2026479,870.68-25,678.451,667,526.551,250,164.0762,508.2062,508.201,187,655.87WS 26-ADocusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE02943/2/2026 | 11:22 AM CST Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294 (1,617.20)(1,617.20)(1,617.20)62,508.20127,168.33Change Order #71,250,164.0775.00%417,362.48Docusign Envelope ID: D43E8F56-B6A1-4741-A86E-A2F367DE0294