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Item 3.3 Fire Station Facility Project Pay Application 17
Request for City Council Action DEPARTMENT INFORMATION ORIGINATING DEPARTMENT REQUESTOR: MEETING DATE: Fire Fire Chief McCoy May 26, 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 #17 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 #17 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 thirteen (13) individual work scope requests included within Pay Application #17 for a total of $1,131,856.64: Voss Plumbing & Heating $22,325.00 BCI Construction, Inc. $80,364.60 Roof Tech, Inc. $9,675.31 Contract Hardware Co., Inc. $10,990.55 Grazzini Brothers & Company $27,597.50 Henkemeyer Coatings, Inc. $41,021.00 Woodside Industries, Inc. $6,593.46 Brothers Fire Protection Co. $912.00 Masters Plumbing Heating & Cooling LLC $279,564.92 Klein Electric, Inc. $139,175.26 Belair Builders, Inc. $12,197.58 Voss Plumbing & Heating $111,979.35 Greenscape Companies, Inc. $389,460.11 In accordance with Minnesota Statute, the City is withholding the maximum of 5% retainage of work completed, which amounts to $680,864.36 at this time. SUPPORTING DOCUMENTS ATTACHED: • Pay Application #17 POSSIBLE MOTION PLEASE WORD MOTION AS YOU WOULD LIKE IT TO APPEAR IN THE MINUTES: Motion to approve Pay Application #17 in the amount of $1,131,856.64 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: 1714499 75th St Ne New Fire StationPERIOD TO: 4/30/2026OWNEROtsego, 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)$170,737.273. TOTAL CONTRACT SUM TO DATE (Item C Totals) $14,189,106.274. TOTAL COMPLETED & STORED TO DATE (Item F Totals)$13,617,287.325. RETAINAGE (Item H Totals)$680,864.36 6. LESS PREVIOUS TOTAL PAYMENTS (Item I Totals)$11,804,566.327. CURRENT PAYMENT DUE (Item J Totals)$1,131,856.64 TOTAL OF AMOUNTS CERTIFIED…………………….. $1,131,856.64The 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: 05/12/26CONSTRUCTION MANAGER: Kraus-Anderson Construction CompanyBy:_________________________________________________________Date:05/12/26State of: MinnesotaCounty of: HennepinSubscribed and sworn to before me this 12th day of May, 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: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 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.:17been completed by each Contractor. The content of those G732APPLICATION DATE:4/30/2026forms is summarized belowPERIOD FROM:4/1/2026Otsego Fire StationPERIOD TO:4/30/2026PROJECT 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 $759,624.21 $0.00 $759,624.21 5.00% $37,981.21 $699,318.00$22,325.00$20,350.00 97%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 $26,625.00 $0.00 $26,625.00 5.00% $1,331.25 $25,293.75$0.00$0.00 100%WS-05A Structural Steel Material Only JRK Steel, Inc $575,531.00 ($5,439.00) $570,092.00 $560,842.00 $0.00 $560,842.00 5.00% $28,042.10 $532,799.90$0.00$9,250.00 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 $30,974.48 $1,060,974.48 $1,001,703.54 $0.00 $1,001,703.54 5.00% $50,085.18 $871,253.76$80,364.60$59,270.94 94%WS-07H Roofing Package Roof Tech, Inc $755,620.00 $32,205.05 $787,825.05 $785,468.05 $0.00 $785,468.05 5.00% $39,273.41 $736,519.33$9,675.31$2,357.00 100%WS-07K Joint Sealants Carciofini Company $41,900.00 $0.00 $41,900.00 $38,495.00 $0.00 $38,495.00 5.00% $1,924.75 $36,570.25$0.00$3,405.00 92%WS-08A Doors, Frames, and Hardware Contract Hardware Co., Inc $284,972.00 $17,714.00 $302,686.00 $265,815.00 $0.00 $265,815.00 5.00% $13,290.75 $241,533.70$10,990.55$36,871.00 88%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 $1,613.00 $141,613.00 $141,613.00 $0.00 $141,613.00 5.00% $7,080.65 $134,532.35$0.00$0.00 100%WS-09C Ceiling & Acoustical Treatment Sonus Interiors, Inc $148,000.00 $0.00 $148,000.00 $148,000.00 $0.00 $148,000.00 5.00% $7,400.00 $140,600.00$0.00$0.00 100%WS-09D Flooring Resilient & Carpet M.C.I., Inc, DBA Multiple Concepts Interiors $53,764.00 ($491.04) $53,272.96 $51,276.96 $0.00 $51,276.96 5.00% $2,563.85 $48,713.11$0.00$1,996.00 96%WS-09H Fluid Applied Flooring Grazzini Brothers & Company $29,700.00 $0.00 $29,700.00 $29,700.00 $0.00 $29,700.00 5.00% $1,485.00 $617.50$27,597.50$0.00 100%WS-09K Wall Covering & Painting Henkemeyer Coatins, Inc $124,210.00 $15,180.00 $139,390.00 $123,390.00 $0.00 $123,390.00 5.00% $6,169.50 $76,199.50$41,021.00$16,000.00 89%WS-12C Manufactured Casework Woodside Industries, Inc $272,575.00 $375.36 $272,950.36 $272,950.36 $0.00 $272,950.36 5.00% $13,647.51 $252,709.39$6,593.46$0.00 100%WS-21A Fire Supression Brothers Fires Protection Co. DBA Brothers Fire & Security $133,600.00 $0.00 $133,600.00 $133,600.00 $0.00 $133,600.00 5.00% $6,680.00 $126,008.00$912.00$0.00 100%WS-23B Combined Mechanical Masters Plumbing Heating & Cooling, LLC $3,135,000.00 $8,747.02 $3,143,747.02 $3,061,461.90 $0.00 $3,061,461.90 5.00% $153,073.10 $2,628,823.88$279,564.92$82,285.12 97%WS-26A Electrical Klein Electric, Inc $1,693,205.00 ($23,822.69) $1,669,382.31 $1,555,532.17 $0.00 $1,555,532.17 5.00% $77,776.60 $1,338,580.31$139,175.26$113,850.14 93%WS-31A Site Clearing & Earthwork Belair Builders, Inc. DBA Belair Sitework Services $1,429,318.00 $37,474.82 $1,466,792.82 $1,420,444.07 $0.00 $1,420,444.07 5.00% $71,022.20 $1,337,224.29$12,197.58$46,348.75 97%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 $335,687.00 $0.00 $335,687.00 5.00% $16,784.35 $206,923.30$111,979.35$5,000.00 99%WS-32F Landscaping Grennscape Companies, Inc $387,900.00 $32,058.01 $419,958.01 $409,958.01 $0.00 $409,958.01 5.00% $20,497.90 $0.00$389,460.11$10,000.00 98%$14,018,369.00 $170,737.27 $14,189,106.27 $13,617,287.32 $0.00 $13,617,287.32 5.00% $680,864.36 $11,804,566.32 $1,131,856.64 $571,818.95 96.0%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: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/202622,325.00WS 03-ADocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Construction Manager:5/12/202680,364.60WS 06-AWS 07-FWS 09-ADocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 8Construction Manager:5/12/20269,675.31WS 07-HDocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT 8Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 8Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/202610,990.55265,815.00City of OtsegoWS 08-A13,290.75252,524.2550,161.75MM10,990.55Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT Change to the special liteline was requested by thePM27,482.00 1,374.100.000.00 29,586.0011,569.00 265,815.0013,290.7510,990.5536,871.00Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/202627,597.50WS 09-HDocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/2026WS 09-KDocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/2026 6,593.46 WS 12-C Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 ■ APPLICATION AND CERTIFICATE FOR PAYMENT TO PROJECT: SC00126 CITY OTSEGO NEW FIRE STATION FROM: Brothers Fire & Security 9950 East Highway 10 CONTRACT FOR: 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 SUM ................ . 2. NET CHANGE BY CHANGE ORDERS .......... . 3. CONTRACT SUM 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 EARNED LESS RETAINAGE .......... . (Line 4 less Line 5 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:;T CHAN~ES by Change Order $0.00 $133,600.00 $0.00 $133,600.00 $133,600.00 $6,680.00 $0.00 $6,680.00 $126,920.00 $126,008.00 $912.00 $6,680.00 DEDUCTIONS 0.00 0.00 0.00 APPLICATION NO.: 7 PERIOD TO: Apr 30/26 PROJECT NOS . : CONTRACT DATE: Dec J(X)~Sog Distribution to: OWNER 0 ARCHITECT 0 CONTRACTOR 0 FIELD 0 OTHER 0 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. CON~~~e & Security _ By: --Date: '-f-;}4 ~ State of: Minneso~a County of: S\nef""b"4'"rt£.., Subscribed and sworn to before me this l4t,h,,.,d~~ ~of -~E_ri],,, _?Q.,2§., 4 ,, ,,-;~~,\·;:, TNv1MY JO ROBERTS /,.5!:,.jt{;J:. Notary Public ,:~~\~~§ M. •fo ~--• .. ,'1:.-~---' innesota • .. \.~, .) •• ""' •:. ~:,1_:;;·,-~ C'1rnrriss1011 E1pirer-.!_an. Notary .F;>ubiic: . . v ...... I 3·, ··yi'l.· My comrrn.ss1.on expires. ' /l ,11, _'L~ 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. AM:>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. By: Date: This Certificate is not negotiable. The Construction Manager:5/12/2026912.00WS 21-ACity of OtsegoDocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT CONTINUATION SHEET APPLICATION NO.: 7 PERIOD TO: Apr 30/26 APPLICATION DATE: Apr 24/26 PROJECT NO. : SC00126 A B C D B F G H I 'NOR!t CCMPLITID MATERIALS TOTAL PRESENTLY COMPLETED BALANCE RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED nae PREVIOUS STORED AND STORED ' TO (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G / C) E'INISH RATE) (D + B) DORE) (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 47040.00 960.00 0.00 48000.00 100 0.00 2400.00 00005 BOND 1523.00 1523.00 0.00 0.00 1523.00 100 0.00 76.15 133600.00 132640.00 960.00 0.00 133600.00 100 0.00 6680.00 Total Contract 133600.00 132640.00 960.00 0.00 133600.00 100 0.00 6680.00 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/2026 279,564.92 279,564.92 MM 2,908,388.80 WS 23-B Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Construction Manager:5/12/2026WS 26-A(23,822.69)1,669,382.31191,626.74Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 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 StationAPPLICATION NO.: Distribution to:14499 57th Street NEPERIOD TO:4/30/2026 OWNEROtsego, MN 55330PROJECT NOS.:ARCHITECTCONTRACTORFROM CONTRACTOR: Belair Builders, Inc. dba Belair Sitework ServicesCONTRACT DATE: 11/15/242200 Old Highway 8 NWNew Brighton, MN 55112BELAIR JOB NO.:40590-30/50VIA CONSTRUCTION MANAGER: Kraus-Anderson MinneapolisCONTRACT FOR: Earthwork & Site UtilitiesVIA 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 Orders37,474.82$ CONTRACTOR:3.CONTRACT SUM TO DATE (Line 1 +/- 2)1,466,792.82$ By: __________________________________________Date: 4.TOTAL COMPLETED & STORED TO DATE1,420,444.07$ (Column G on G703)State of: Minnesota5.RETAINAGE:County of: Ramseya. 5% of Completed Work71,022.20$ Subscribed and sworn to before(Columns D + E on G703)me this 22nd day of April, 2026.b. 5% of Stored MaterialNotary Public:(Column F on G703)My Commission expires:1/31/2027Total Retainage (Line 5a + 5b orTotal in Column I of G703)71,022.20$ 6.TOTAL EARNED LESS RETAINAGE1,349,421.87$ (Line 4 less Line 5 Total)7.LESS PREVIOUS CERTIFICATES FOR PAYMENT1,337,224.29$ (Line 6 from prior Certificate)8.CURRENT PAYMENT DUE12,197.58$ 9.BALANCE TO FINISH, INCLUDING RETAINAGEAMOUNT CERTIFIED$(Line 3 less Line 6)117,370.95$ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONSCONSTRUCTION MANAGER:Total changes approved inBy: __________________________________________________________ Date: ________________________previous month by OwnerARCHITECT:Total approved this MonthBy: __________________________________________________________ Date: ________________________TOTALS37,474.82 - NET CHANGES by Change Order37,474.82 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 PAYMENT37,474.82 In accordance with the Contract Documents, based on on-site observations and the data comprising thisapplication, the Construction Manager and Architect certify to the Owner that to the best of their knowledge,information and belief the Work has progressed as indicated, the quality of the Work is in accordance with theContract 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 theWork 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 wereissued and payments 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.)4/22/2026CONTRACTOTOOOTOOOOOOOTOOOOOTOOOOOOOOOOOOTOOTOOOOTOOOTOOTOOOOOOOOTOTOTOTOOOOOTOOTOTOOOOOOTOOOOOOOOOOOTOTOOOTOOOOOOOOOOOTOOOOTOOTOTTTTTTTTTTTTTTTTTTTTTTTTTR:RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRBy: _____________________________________________________________________________________________________________________________________________________________________________Statef:of:of:of:f:f:of:f:f:ffffof:fff:ff:fffffffffffffffffffffffffffffffffffffffoooMinnesotaJennifer Leeged Contractorcertifiesthattothebest oftWork covered by this Application for Payment has beencthatall amounts have been paid by the Contractor for Wissued and payments received from the Owner, and that currme this 22nd dayofofooooooooooooooooooooooooooooooooooooooooooooooooooooo April, 2026.Notary Public:My Commission eneeeexpires:1/3CERTIFICATE FOR PAYMENTb5/12/202612,197.58To: City of Otsego9WS 31-ADocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM 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:04/22/26In tabulations below, amounts are stated to the nearest dollar.PERIOD TO: 04/30/26Use 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 WORK VALUE 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)EARTHWORK500 Flag Pole Furnish & Install 3,632.00 3,632.00 - 3,632.00 100.00% - 181.60 600 Work Scope Allowance20,000.00 16,560.45 3,439.55 20,000.00 100.00%- 1,000.00 EWO28036 Re-Dig FootingsEWO28041 Trash Enclosure RevisionsEWO28225 R&R Casting @ Odean AveEWO28224 Relocate CB15 EWO28232 Concrete Stoop Removal315 Equipment Moves59,650.00 59,650.00 - 59,650.00 100.00%- 2,982.50 320 Erosion Control80,406.00 77,058.00 2,000.00 79,058.00 98.32% 1,348.00 3,952.90 325 Site Demolition & Clearing21,682.00 21,682.00 - 21,682.00 100.00%- 1,084.10 330 Site Grading211,704.00 204,304.00 7,400.00 211,704.00 100.00%- 10,585.20 350 Structure Excavation and Backfill30,407.00 30,407.00 - 30,407.00 100.00%- 1,520.35 351 Building Pad Class 5 Cushion43,275.00 43,275.00 - 43,275.00 100.00%- 2,163.75 352 Building Sand Subbase for Draintile at Doors & Footed Stoops 30,694.00 30,694.00 - 30,694.00 100.00%- 1,534.70 355 Site Finishing359,657.00 314,656.25 - 314,656.25 87.49% 45,000.75 15,732.81 360 Temp. 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%- 158.90 405 Removals3,437.00 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%- 15,586.65 420 Storm Sewer203,551.00 203,551.00 - 203,551.00 100.00%- 10,177.55 425 Trench Drain (Supply Only)304.00 304.00 - 304.00 100.00%- 15.20 CO 001 -Additional Tree Removal5,380.00 5,380.00 - 5,380.00 100.00%- 269.00 CO 002 -Change FES with Riprap to FES with ACM16,416.00 16,416.00 - 16,416.00 100.00%- 820.80 CO 003 - RFI 036 Updated Schedule - No Cost- - - - - 0.00%- - CO004 - Extend Excavation for Watermain Connection15,678.82 15,678.82 - 15,678.82 100.00%- 783.94 1,466,792.82 1,407,604.52 12,839.55 - 1,420,444.07 96.84% 46,348.75 71,022.20 AIA DOCUMENT G703 (Instructions on reverse side)WORK COMPLETEDG9Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/2026111,979.35WS 32-BCity of OtsegoDocusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF35/15/2026 | 8:40 AM CDT Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/12/2026 20,497.90 20,497.90 409,958.01 389,460.11 389,460.11 MM 30,497.90 389,460.11 WS 32-F Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3 5/15/2026 | 8:40 AM CDT 130,000.00 Changes the the fence line item were requested by the PM 93.00%130,000.00 10,000.00 6,500.00 409,958.01 409,958.01 98.00%10,000.00 20,497.90 Docusign Envelope ID: 6898A5CB-89E9-4776-9929-2201287CAFF3