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HomeMy WebLinkAbout20070102 - VI-232335 West Highway 3G • St: Paul, MN 55113 ` Bonestroo 0 ROSer1e . Office: G5i=G3G-4000 • Fax: G51-G3G. 1311 AtldePllk & www.bonestroo.corri VI-23 Associates Engineers &.Architects December 14, 2006 Mr. John Zgoda Public Works Superintendent City. of Hastings 101 '4th Street East $astings, Minnesota 55033. . Re: Construction of WeII No. 1 Abandonment Bonestroo File No. 000222-06Y08-1 Pay Request No. 3 and. Final -Dear Mr. Zgoda: Attached are four copies of Pay Request No. 3 and Final. This. pay request is for work completed on the Well No. 1 Abandonment through November 28, 2006. We have also enclosed the IC 134 Form. and the Consent of Surety form. We recommend that the City pay he requested amount of $30,720..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. If you have any questions regarding this pay request please call me at (651) 967-4630. Sincerely, BONESTROO, ROSENE, ANDERLIK & ASSOCIATES; INC. Kevin A. Andersen,-P.E. cc: Kurt Johnson, Bonestroo Attachment - St. Paul, St. Cloud, Rochester,. M1V ^ Milwaukee, 1X/l • Chicago, IL Affirmative Action/Equal Opportunity EmptoyeC and-Employee Owned s - vct. !Y, Lyii1~~V-t:,U~iapO Kosene Anderlifc st- Paul, Mt~t - (651)6N~,~ Q21)41 ~ . i3onestroo tItL71 Ratans AnQeAdc & Associates ~po+cM~ b Areh(est~d 8UMMARY 1 Oripinat Contract Amount 2 Chanp®Order - Addition 3 Change Order - [kductlon 4 Revised Contract Amount 5 Value Cornplatad to Date 6 Matertat on Hand 7 Amount Earned 8 Lela Retainape 9 Subtotal 10 Less Prav~ous Requests for Payment 11 Liquidated damages - 12 AMOUNT DUE THIS REQUEST FOR PAYMENT NO $ 0.00 $ 0.00 3 Recommended for Approval by; BONt=5TRQ0, ROSENE, DERLIK & ASSOCIATE, INC. Date: ~~l,~r / ~ KEYS WELL DRILLING COMPANY Date: Approved by Owner. CITY OF HASTINGS Dats: $ 115.075.00 $ i__ 1_ 5.075_00 ~ 49150.00 $ D.~ ~ 49150.00 $ 0.00 $ 49.1500D $ 18 430.00 $ a.oa $- 30. 0 00 00022~DE1030 PR3.rls CONTRACTpR'S REQUEST FOR PAYMENT CONSTRUCTION OF 1NELL NO. 1 ABANDONMENT BRA FILE N0.000222-06108-0 ' dec. 8. 2~:~0610:58AM 0 ~. g~ a ~ ~~ 0 n z w N ~ ~ r ~ _~ ~ 6. m O ~~ ~~~ $~~~~~5 ~ ~g ~ ~~~~ z ~:~~~~ ~~ ~W~~~ ~~ ~ ~ ~ ~. ,~ ~. ~m~~ ~~ ~. g Qo~~o~ ~ v° g o° $ g ~~ ~ ~ S J W ~ O 0 No. 0166 P. 7 x RR~ ~S c O m rte. ~~ ~_ ~~ o~ ~~ ~, A ~~~'~ ~° ~o a~ ~ J J ~ J ..- $ $~N m ` ' Qec. 8. _200610: 58AM C ~ ~ ~ ~ ~ ~ ~ N C ~~ ~R B~ pD .Cy 1 13r~ S ~ ~ w ~ $ ~ ~ ' ~ r r CT p v O O .~ ~. .~ g g~ 8 8 g~ g o ~ o a o Q o 0 0~ o ~ ~ ~ g $ ~ ~ ~ ~ ~. v $ o S a $ 0 8 0 8 4~ U $ ~ J $ ~ 8 ~ 8 Q 8 ~ S ~ N W + tT1 A ~ $~ S 8 0 8 8 8 8 8 ~~ a~ ~~ 1D c z ~~II y ~' 3 ~g ~~ 3 No. 0166 P. 3 .a 2 ~i x = g LC ~ ~ `~ .L '~ . z ~ _~ ~ w ~ n O D ~C ~ ~ ~ v ~ j S N Kk ~d4 o 3' $ ~ N ~a 1r ` ° Uec. $. 2806 1Q:58AM hfo. $l66 P 4 ~ ~ ~ €~ ~_ ~ N L = ~• ~. y S~ ~ K z J ~ C7 ~ ~ ~RRq = Q O IS ~.fl SL WY _~ i ~ +' r Q . x A 0 v ~ C O 8 S 8 S ~ ~ ~ 00 D 8 p~ $ ~ ,s w $O .. N 4~ Q J ~ O ¢ ~ ~ zi C j N + ~ C ..~ N g p $ ~ ~~ ~ •= Document G7o7~" -1994 of Surety to Final Payment os _ PR03ECT (Name and address) ,, Construction of Well Ho. l Abandonment Pro}ect Hastings,M>` <Inacc< -, (Inert W estBend ARCH{TECT'S PROJECT NUMBER: - --: - - OWNER ^ CONTRACT FOR: - ARCHITECT ^ Construction of Well No. 1 Abandont'itent Project - - CONTRACTOR ~ CONTRACT DATES=`_- y:,.. SURETY ^ August 7th, 2006 OTHER ~ s of the Contract between the Owner and the Contractor as indicated above, the 'h') ny _ ` ~ _ . ~: ~~ ~r t ~ _ (Signature o _ " , Attes[ `l ~~ ~.; , ~~ ~~ `-~-'~~; M.A. Jones, _/ _e~~tn-f - ~~~) _ ~~~'~` (Printed rtame and title) CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. - AIA Document G707TM -1994. Copyright ©1970 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This AIA® Document is protected by U.S. Copyright Law and international Treaties. Unauthorized reproduction or distribution of this A!A®Document, or any portion of It, may result in severe civil and criminal penaflies, 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 AIA Contract Documents, e- mafl The Americans Institute of Architects' legal counsel, copyright@aia.org. tc"•.ra-t.~'°.'v\\-.rv-~:~.. .""r.-r,.':rr~ Y~~v^^ .~F i_ -"• .3' '? - .-,~0. ;5,. - ,:~~::. - .w- .,.~t ;-_.. !: ~ Jt \~ .+..- . ` v`~ r t., . %;eF ~ "~J \\ . w: v . r ).. ,>:1.:i;I+~../b .. ;-r _^' •--.y,;- ,.1. r . +,::r........ __:. • ~tia ~, :-~Im., ..: ;l,,w:~°.;:::.x.,. . :t~ a+^- f+} L ~ fJ~r1.' -f - >3E.b\ L'.>r : \. =j; >Y, t ..1: `.T. a,sf~1. ..~~Ql.. '~'r.%..~ y ~•5j C ..:, ~i.~ i - - ~^ZJ: ~)..r. ). ~.;?. .>}fi •.;,-,. '.: .-:.~~d,,~^a .-~~-. f F/~ ,.= ,t. 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Cci~~O~'er~xecuted ~~cl G~r~,b .facsfle ~• tams a fi ~:~-e ~~~~e:se~ shall lSc~ ~a~~fr~ bi~c~tn9 ~pbn. fhe corgi ah}~r `#h'e tore with des ~c~~a ~i~ . bond"`or ui~a ~~ak~n j ~r ofh~r v, . j (~~tory ~n ~ttt~ ~w~~rt ~s ht~act~ An ~u~fa~f~i~ ment mays re~o'~ed, for cairs~, ar wrth~`'cau$e ; rf k.~~~~ d ~~per of any~im~'"$ ~ ry 5: s ~ \3~) 7~! c\ -.+4a tf l rs ~ x~`Erk~ -~r ~/2 _, S r s - M~/ f.~ Y =1 a, ~' L _ f ~~xx. c~ ~ - Jar. ~ )3 .-# Fr` T, ~: ,1~.; t Y~ Crt~xvatnes~v~heof, #J~re ~esJ~ BetStAut~t~C Ins)un ~omfaat~y"hes caused theme presents fo be signed by its president >~ ur~ersi~~ed ~rjtJ its-corp~te f ts'~ beliere'tlula`' ~ , . t , y attester! Js~ its sacre.~ary thi~.1 st~`day Af ~Aar~h 2Q02 ~ ~ A~es~ ~. x 4,5 5 kT y. 3 t - -2 ) Y . ~ _ ?~ :~ ~: ~..'tY ~ i. F ~ ~ .t c 7 ~ RM = S (R~1, ~ r j if' <Y ; '~ .5 '`,t a Ji ~a33 ) ys. ! b ) ~ I' , c'~~-tF 8 A.ntt>~y ,~ . amen = s ,,f Se tary ~ ;_ ~~ SE1~L ~ ~. C~iief Executive Offie~er i President ~~ :' .'State of3111#ser~nsm .... ~ a~~cA~<g .. ~r3unty.~~~Wi~sfiingtbh ~ .; ~,., :; ~ ~ Mt,, Orf tfie 1st dey of March,~~002 before'me:persorally came Rnthony JW Warren; #o me known being by duly sworn -.'did 'depose ahd:~ay that he resides Intha County o#':Wasliington State nf. Wiscinsin,;that he:is the President of VVest:Bend. trAutltaJ t~tst~~dnce Company, th~.cotporation descnbed: in and yiihich executec.:the above instrument; #hat he Knows the seel of the said corporattor~ that#he. seat: affixed'to said instrument is such corporate seat; that is was so affixed by order of`fhe board of directors of said corporation and that he signed his name thereto by like order. ~~ ~. DUFF! ~_ ~.* NQrgRY * :Joh Dwell y Ft1sUC _y Sr. ~~° #'resstent Npta ~u s \'. J ~9~ o= bll~c, Wa h~ngtanent VV1 ) ;,- +>`O .:; :: ....,. ___.__ _ . .... !S~' IVIy.. Comfn>ssion is Perm in '~ w~ > <.r~:, .w-=°~~ ovi'~fe°ihcumbent ir[~Ali3st`Bend Mutual finstrance Company; a E3~_Hereby Certtfj! :tt~:at the foregoing attached, Rower of <ed and hat the I~esolutior.of ttteBoard.ofi Dtrectors.set forth Page 1 of 1 1~~111f S.b~Y~A `y L\S1 1 ~1 \ ~~~ Contractor's Withholding Affidavit Confirmation KEYS WELL QRiLLING CO ID 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 140326 Fri Dec 08 11:14:47 CST 2006 CITY OF HASTINGS 000222-06108-0 September 2006 November 2006 CITY OF HASTINGS WELL NO. 1 No subcontractors listed. rttps://www.mndor.state.mn.us/wc/action/confirmationPrint 1 ~/ttQi~nn~