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Home My WebLink About20070917 - VI-05 u VI-5 2335 Highway 36 W St. Paul, MN 55113 Tel 651-636-4600 Fax 651-636-1311 www.bonestroo.com ... Bonestroo August 30, 2007 Mr. John Zgoda Public Works Superintendent City of Hastings 101 4th Street East Hastings, Minnesota 55033 Re: Rehabilitation of Well Pump NO.5 Bonestroo File No. 000222-06110-0 Pay Request No. 3 (Final) Dear Mr. Zgoda: Attached are four copies of Pay Request NO.3 (Final). This pay request is for work completed on the Well Pump NO.5 rehabilitation. We recommend that the City pay the requested amount of $2,198.25. Please sign all four copies and return one signed copy to our office, two copies to the contractor and retain one copy for your file. Consent of Surety to Final Payment, and Minnesota Tax Withholding Form IC -134 have been submitted and are enclosed. If you have any questions regarding this pay request please call me at (651) 967-4630. Sincerely, Kevin A. Andersen, P.E. Attachment Eng'neers Archicects Plarners St Paul St Cloud Rochester Milwaukee Chicago .- Bonestroo Owner: City of Hastings, 101 4th Street East, Hastings, MN 55033 Date: August 23, 2007 For Period: 5112/2007 to 8123/2007 Request No: 3 AND FINAL Contractor: Kevs Well Drilling Company, J 156 Homer Street, St Paul, MN 55116 CONTRAGOR'S REQUEST FOR PAYMENT REHABILITATION OF WEll PUMP NO.5 BONESTROO FILE NO. 000222-06110-0 SUMMARY 1 Original Contract Amount 2 Change Order - Addition 3 Change Order - Deduction 4 Revised Contract Amount 5 Value Completed to Date 6 Material on Hand 7 Amount Earned 8 less Retainage 0% 9 Subtotal 10 less Amount Paid Previously 11 liquidated damages - 12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO. $ $ $ 0.00 0.00 3 AND FINAL $ $ $ $ $ $ $ $ $ Recommended for Approval by: BONESTROO ~ - Approved by Contractor: KEYS WELL DRILUNG COMPANY Approved by Owner: CITY OF HASTINGS J~~t ~rb 51,780.00 51)80.00 43,965.00 0.00 43,965.00 0.00 43,965.00 41,766.75 0.00 2,198.25 Specified Contract Completion Date: July 15, 2007 Date: 9- l.o ~Ol 000222-oG110-0RFP3 Final.xls ., ":j i-j Keys Well Drilling Company 1156 Homer Street St. Paul, MN 55116-3232 Phone 651-646-7871 Fax 651-641-0216 EmaiI jkeys@keyswell.com INVOICE ~~:=:::.;.::-~.:.:::_::-:..::-_:. -.2:C.:- j :: -j i 1 ". i ~~ DATE NUMBER J ] '1 "1 .':l ':, ~1. 07/2312007 2007002-2 To: City of Hastings 1225 Progress Drive For Job: 2007002 Hastings Well #5 Pump Repair #5 Hastings, MN 55033- AR Code Quantity Price Amount U1M 01 MobilizelDemobilize 1.0000 0.0000 1,000.00 02 Remove Pump 1.0000 0.0000 2,100.00 03 Reinstall 1.0000 0.0000 2,500.00 04 Disassembly, Etc. 1.0000 0.0000 200.00 05 10" x 10' Sch 40 Col 21.0000 0.0000 10,080.00 06 Add 1 Ox1 0 Sch 40 Col 3.0000 0.0000 1,440.00 07 10"x 5' Sch 40 Col 2.0000 0.0000 750.00 08 10" Tail Pipe 1.0000 0.0000 1,000_00 09 1-11/16x10 416 SS 21.0000 0.0000 6,825.00 10 1-11/16x10 416 SS 3.0000 0.0000 975.00 11 1-11/16x5416SS 1.0000 0.0000 260.00 Page: f~~-~--._---"~~-'~~~ j Keys Well Drilling Company i ~ .:~ - :-..i :: INVOICE ':1 f:~ ~1 J .:, J 'e 1156 Homer Street St. Paul, MN 55116-3232 Phone 651-646-7871 Fax 651-641-0216 Email jkeys@keyswell.com DATE NUMBER 07/23/2007 2007002-2 "' ~~ d To: City of Hastings 1225 Progress Drive For Job: 2007002 Hastings Well #5 Pump Repair #5 Hastings, MN 55033- AR Code Quantity Price Amount UIM 12 lineshaft Bearings 25.0000 0.0000 500.00 13 Bearing Retainers 3.0000 0.0000 285.00 14 Replace Bowl Assy 1.0000 0.0000 6,000.00 15 Replace Headshaft 1.0000 0.0000 350.00 16 Replace Motor 1.0000 0.0000 8,400.00 17 Replace Disch Head 0.0000 0.0000 0.00 18 Remove Sandstone 0.0000 0.0000 0.00 19 Sand Content Tests 0.0000 0.0000 0.00 20 TV Well 1.0000 0.0000 1,300.00 Page: 2 Invoice T atals Invoice Totals Retention 43,965.00 0.00 43,965.00 41,766.75 2,198.25 Previous TOTAL DUE ,.. .=.... AlA Document G707'" - 1994 Consent of Surety to Final Payment 0512754 PROJECT: (Name and address) Well Pump No.5 Hastings, Minnesota ARCHITEcrs PROJECT NUMBER: OWNER 0 CONTRACT FOR: Rehabilitation ARCHITECT 0 CONTRACTOR 0 TO OWNER: (Name and address) City of Hastings 101 East 4th Street Hastings, Minnesota 55033 CONTRACT DATED: December 29th, 2006 SURETY 0 OTHER 0 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (Insert name and address of Surety) West Bend Mutual Insurance Company P.O. Box 620976 Middleton, Wisconsin 53562 on bond of (lnsen name and address of Contractor) Keys Well Drilling Company 1156 Homer Street St. Paul, Minnesota 55116 ,SURETY, , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (Insert name and address of Owner) City of Hastings 10 1 East 4th Street Hastings, Minnesota 55033 as set forth in said Surety's bond. , OWNER, IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: August 10th, 2007 (Insen in writing the month fallowed by the numeric date and year.) West Bend A~~L (Seal): M. A. Jones, Attorney'J:fn-Fact (Prin;{~i:'$me and title) CAUTION: You should sign an original AlA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AlA Document G707T11 - 1994. Copyright @ 1970 and 1994 by The American Institute of ArcMects. All rights reserved. WARNING: This AlA"' Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA"Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AlA Contract Documents, e- mail The American Institute of Architects' legal counsel, copyright@aia.org. ,~:.. ~ . -. .. ,. . ....... .:...... .... -'" .-'-: -....... ,,:~""" 11::__..--. No. '"-c.:.:'::..' ,. 'COMPANY ~nMRTESI"Bl' .:: (>.:,j~~~VEN~'.~~: - ->Powerof Attotne~ '.r;~~'~7~~,..t~A;t. ~tii:.!'~~~~~~~~,~Jor~ratj;\"1m~(\\$f;fS ~~~it~lji~~~~;~n:t!:ib~~~~~f~~ ... .....'......Tlii.sPowerofe.,t~(}~ey)sgrant~ Clod is $igned,-~d SE;a1edbyfacsiml'.e under ~nd bytheauthqrityofthe ff.?!lpwrOgi/'i,: ,.,.,...... Re$olutiol} Cidopted by the B~"9 of Directors of West Bend Mutuallrjsurance Company at a meetin9duly~IIt;#and I:t~td ..... ... . > On the 21st day of December, 1999; .. '.. . . . .. .'. .'. . Appointment of Attorney-In-Fact. Tii~pfe$(dent or any vice president, or any other officer of West Bend MutuaUfJ$ui-iiiJi:'e ....COmpanymayappointIJY writtencertificateAttorneys.4n-Fact to act on behalf ofthe company in theexecutiorf(jf ang . .. .. attesting of bonds and undertakingsaiJdother written Obligatory instruments of1ike nature. The signature oNjnyofficer authorized hereby and the corporate seal mayl)e affixedbjt facsimile to any such power of attorney or to anycertmcate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corpprate al to be hereto duly attested ..~~~;~:etary th~iS 1st day of March, 2002. Attest ~"V"\.-..... -_.~..~ '{.. ................ II'RPORA;~\~\ Anthony J. arren, ". ;:',u ~\S~ tlJj(;J}ief Executive Officer I President -., .-: ........S.:~:~::..}:C -..-:..: ,.:~ Page 1 of 1 MINNESOTA. REVENU E Contractor's Withholding Affidavit Confirmation KEYS WELL DRILLING CO 10 8105506 Please keep this information for your records. Submit a copy of this page to the project owner to receive your final payment. Confirmation number Project owner Project number Project begin date Project end date Project location Subcontractors 162265 Tue Aug 0713:41:50 CDT 2007 CITY OF HASTINGS 000222-06110-0 January 2007 June 2007 HASTINGS, WELL NO.5 No subcontractors listed. lttps://www.mndor.state.mn.us/wc/action/confirmationPrint 08/07/2007