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HomeMy WebLinkAbout[04f] Pay Application # 10 Main Pump Station Council Agenda Item 4f c.r,ry carp S-r.josswil MEETING DATE: November 2, 2015 AGENDA ITEM: 2014 Main Pump Station and Collection System Improvements SUBMITTED BY: Randy Sabart BOARD/COMMISSION/COMMITTEE RECOMMENDATION: PREVIOUS COUNCIL ACTION: Application for Payment No. 9 BACKGROUND INFORMATION: BUDGET/FISCAL IMPACT: $78,371.44 ATTACHMENTS: Application for Payment No. 10 (FINAL) REQUESTED COUNCIL ACTION: Approve Application for Payment No. 10 (FINAL) P:APT\S\STJ0E\common\D39 Req Council Action\2015\126869 Pmt 10 FINAL 110215.doc -A SEH Building a Better World for All of Us" October 19, 2015 RE: St Joseph, Minnesota 2014 Main Street Pump Station and Collection System Improvements SEH No. STJOE 126869 14 Honorable Mayor and Members of the City Council c/o Judy Weyrens, City Administrator City of St. Joseph 25 College Avenue North PO Box 668 St. Joseph, MN 56374-0668 Dear Mayor and Members of the City Council: Please find enclosed Application for Payment No. 10 (FINAL)for the 2014 Main Street Pump Station and Collection System Improvements project, together with the following documents: • IC-134 Withholding Affidavit for Contractors • Consent of Surety to Final Payment • Lien Waivers • Final Statement The quantities completed to date have been reviewed with the contractor, and we hereby recommend approval for final payment to Geislinger& Sons, Inc. in the amount of$78,371.44. We also recommend the City continue routine maintenance of the collection system and pump station, which were improved as part of this project. The Contractor's two-year correction period for this project will commence at the date of final payment approval, which is anticipated to be November 2, 2015. When payment is made, please sign all copies and distribute as follows: Geislinger&Sons, Inc. SEH City of St. Joseph We appreciate the opportunity to help the City of St. Joseph improve their sewage collection and pumping systems and look forward to the next project. Feel free to contact me at 320.229.4359 if you have any questions. Sincerely, L�;4 7eo^e� Colin Marcusen, PE Project Engineer djg Enclosures c: Randy Sabart, SEH (w/enclosures) Terry Thene, City of St. Joseph p Apt\s\stjoe\126869\7-const\73.0-pay men t\a p I-o.d oc Engineers Architects Planners Scientists Short Elliott Hendrickson Inc.,1200 25th Avenue South,P.O.Box 1717,St.Cloud,MN 56302-1717 SEH is an equal opportunity employer I www.sehinc.com 1 320.229.4300 1 800.572.0617 1 888.908.8166 fax OWNER CONTRACTOR SEH APPLICATION FOR PAYMENT NO.10(FINAL) CONTRACTOR FOR: 2014 MAIN PUMP STATION &COLLECTION SYSTEM IMP PROJECT NO. STJOE 126869 AGREEMENT DATE: 01/16/15 OWNER CITY OF ST.JOSEPH,MN CONTRACTOR GEISLINGER&SONS,INC. FOR WORK ACCOMPLISHED THROUGH: 08/31/15 CONTRACT THIS PAYMENT I WORK TO DATE ITEM DESCRIPTION UNIT UNITCOST11 QUANTITY I AMOUNT I QUANTITY I AMOUNT I QUANTITY I AMOUNT BASE BID GENERAL 1 MISCELLANEOUS PROJECT LUMP SUM $40,000.00 1.00 $40,000.00 0.05 $2,000.00 1.00 $40,000.00 DEWATERING 2 MOBILIZATION LUMP SUM $60,000.00 1.00 $60,000.00 0.05 $3,000.00 1.00 $60,000.00 3 TRAFFIC CONTROL LUMP SUM $5,000.00 1.00 $5,000.00 0.10 $500.00 1.00 $5,000.00 4 ROCK CONSTRUCTION ENTRANCE EACH $1,000.00 1.00 $1,000.00 $0.00 0.00 $0.00 5 REMOVE WATER MAIN LIN FT $2.00 250.00 $500.00 $0.00 20.00 $40.00 6 REMOVE SANITARY SEWER LIN FT $5.00 460.00 $2,300.00 $0.00 145.00 $725.00 7 REMOVE BITUMINOUS PAVEMENT SQ YD $4.00 3,310.00 $13,240.00 $0.00 3,310.00 $13,240.00 8 REMOVE CONCRETE PAVEMENT SQ YD $6.00 130.00 $780.00 $0.00 70.00 $420.00 9 REMOVE/ABANDON CHLORINE LUMP SUM $5,000.00 1.00 $5,000.00 $0.00 1.00 $5,000.00 CONTACTTANK 10 REMOVE METERING CHANNEL LUMP SUM $5,000.00 1.00 $5,000.00 $0.00 1.00 $5,000.00 11 REMOVE DIVERSION MANHOLE LUMP SUM $6,500.00 1.00 $6,500.00 $0.00 1.00 $6,500.00 12 REMOVE UNDERGROUND FUEL LUMP SUM $2,500.00 1.00 $2,500.00 $0.00 1.00 $2,500.00 STORAGE TANK 13 REMOVE BOLLARD EACH $50.00 2.00 $100.00 $0.00 2.00 $100.00 14 REMOVE RV DUMP SIGN EACH $50.00 1.00 $50.00 $0.00 1.00 $50.00 15 REMOVE CURB STOP EACH $25.00 1.00 $25.00 $0.00 1.00 $25.00 16 REMOVE GATE VALVE&BOX EACH $50.00 1.00 $50.00 $0.00 1.00 $50.00 17 REMOVE YARD HYDRANT EACH $350.00 1.00 $350.00 $0.00 1.00 $350.00 18 REMOVE SANITARY SEWER EACH $350.00 3.00 $1,050.00 $0.00 3.00 $1,050.00 MANHOLE 19 SAWING CONCRETE PAVEMENT LIN FT $6.00 115.00 $690.00 $0.00 6.00 $36.00 20 SAWING BITUMINOUS PAVEMENT LIN FT $4.00 200.00 $800.00 $0.00 0.00 $0.00 21 TEMPORARY CONSTRUCTION LIN FT $5.00 175.00 $875.00 $0.00 0.00 $0.00 FENCE 22 ABANDON WATER MAIN LIN FT $6.00 140.00 $840.00 $0.00 0.00 $0.00 23 ABANDON SANITARY SEWER LIN FT $10.00 765.00 $7,650.00 $0.00 500.00 $5,000.00 24 ABANDON YARD HYDRANTS AND LUMP SUM $500.00 1.00 $500.00 $0.00 1.00 $500.00 PIPING-NO GROUT 25 SALVAGE CHAIN LINK FENCE LIN FT $10.00 290.00 $2,900.00 $0.00 252.00 $2,520.00 26 SALVAGE HYDRANT ASSEMBLY EACH $250.00 1.00 $250.00 $0.00 1.00 $250.00 CONTROL BUILDING AND WET WELL 27 EXISTING AND PROPOSED WET LUMP SUM $180,000.00 1.00 $180,000.00 0.05 $9,000.00 1.00 $180,000.00 WELL IMPROVEMENTS 28 WET WELL DEWATERING LUMP SUM $75,000.00 1.00 $75,000.00 $0.00 1.00 $75,000.00 29 GENERATOR REMOVAL AND LUMP SUM $2,500.00 1.00 $2,500.00 $0.00 1.00 $2,500.00 SALVAGE 30 BUILDING SHELL UPGRADES LUMP SUM $3,000.00 1.00 $3,000.00 $0.00 1.00 $3,000.00 31 CONCRETE CRACK SEALING BY LIN FT $150.00 30.00 $4,500.00 $0.00 30.00 $4,500.00 PRESSURE INJECTION 1 OWNER CONTRACTOR SEH APPLICATION FOR PAYMENT NO.10(FINAL) CONTRACTOR FOR: 2014 MAIN PUMP STATION &COLLECTION SYSTEM IMP PROJECT NO. STJOE 126869 AGREEMENT DATE: 01/16/15 OWNER CITY OF ST.JOSEPH,MN CONTRACTOR GEISLINGER&SONS,INC. FOR WORK ACCOMPLISHED THROUGH: 08/31/15 CONTRACT THIS PAYMENT I WORK TO DATE ITEM DESCRIPTION UNIT I UNITCOST11 QUANTITY I AMOUNT I QUANTITY I AMOUNT I QUANTITY I AMOUNT 32 PUMP LIFTING HOOK LUMP SUM $1,200.00 1.00 $1,200.00 $0.00 1.00 $1,200.00 REPLACEMENT 33 WATER HEATER REPLACEMENT EACH $1,500.00 1.00 $1,500.00 $0.00 1.00 $1,500.00 34 CONTROL BUILDING COATINGS LUMP SUM $15,000.00 1.00 $15,000.00 0.50 $7,500.00 1.00 $15,000.00 35 BUILDING VENTILATION LUMP SUM $3,500.00 1.00 $3,500.00 $0.00 1.00 $3,500.00 36 BUILDING PLUMBING LUMP SUM $2,500.00 1.00 $2,500.00 $0.00 1.00 $2,500.00 IMPROVEMENTS-WATER AND WASTE 37 GENERAL ELECTRICAL LUMP SUM $3,500.00 1.00 $3,500.00 $0.00 1.00 $3,500.00 DEMOLITION 38 SITE LIGHTING POLE LUMP SUM $5,000.00 1.00 $5,000.00 $0.00 1.00 $5,000.00 39 INSTRUMENTATION AND LUMP SUM $63,000.00 1.00 $63,000.00 $0.00 1.00 $63,000.00 CONTROLS 40 BUILDING ELECTRICAL AND LUMP SUM $125,000.00 1.00 $125,000.00 $0.00 1.00 $125,000.00 CONTROLS 41 175 KW GENERATOR WITH LUMP SUM $73,000.00 1.00 $73,000.00 $0.00 1.00 $73,000.00 WEATHERPROOF ENCLOSURE 42 GENERATOR PAD AND LUMP SUM $5,000.00 1.00 $5,000.00 $0.00 1.00 $5,000.00 FOUNDATION-INCLUDES 43 ELECTRICAL SERVICE ENTRANCE LUMP SUM $10,000.00 1.00 $10,000.00 $0.00 1.00 $10,000.00 44 PANEL BOARDS LUMP SUM $8,000.00 2.00 $16,000.00 $0.00 2.00 $16,000.00 SCREENING CHANNEL 45 IBAR SCREEN STRUCTURE LUMP SUM $25,000.00 1.00 $25,000.00 $0.00 1.00 $25,000.00 MODIFICATIONS STREET 46 COMMON EXCAVATION(P)(CV) CU YD $10.00 4,100.00 $41,000.00 $0.00 4,100.00 $41,000.00 47 WET WELL SUBGRADE CU YD $8.00 1,000.00 $8,000.00 $0.00 1,000.00 $8,000.00 EXCAVATION 48 AGGREGATE BASE PLACED CLASS CU YD $22.00 1,970.00 $43,340.00 $0.00 1,159.00 $25,498.00 5(CV)(P) 49 AGGREGATE BASE PLACED CLASS CU YD $22.00 200.00 $4,400.00 $0.00 200.00 $4,400.00 2(CV)(P) 50 WEARING COURSE MIXTURE TON $74.00 435.00 $32,190.00 $0.00 443.24 $32,799.76 51 NON WEARING COURSE MIXTURE TON $72.00 680.00 $48,960.00 $0.00 661.00 $47,592.00 52 BITUMINOUS MATERIAL FOR TACK GAL $3.00 225.00 $675.00 $0.00 200.00 $600.00 COAT 53 GEOTEXTILE FABRIC,MNDOT TYPE SQ YD $3.00 750.00 $2,250.00 $0.00 400.00 $1,200.00 6 54 6"CONCRETE PAVEMENT SQ YD $75.00 185.00 $13,875.00 $0.00 162.00 $12,150.00 55 CHAIN LINK FENCE LIN FT $18.00 550.00 $9,900.00 $0.00 533.00 $9,594.00 56 12'WIDE DOUBLE LEAF SWING EACH $1,500.00 1.00 $1,500.00 $0.00 1.00 $1,500.00 GATE 57 16'WIDE ROLLING VEHICLE GATE EACH $4,000.00 1.00 $4,000.00 $0.00 1.00 $4,000.00 58 24'WIDE ROLLING VEHICLE GATE EACH $7,500.00 1.00 $7,500.00 $0.00 1.00 $7,500.00 59 BOLLARD EACH $550.00 10.00 $5,500.00 $0.00 9.00 $4,950.00 60 FURNISH&INSTALL 2"PVC UTILITY LIN FT $5.00 650.00 $3,250.00 $0.00 714.00 $3,570.00 CONDUIT 61 FURNISH&INSTALL 4"PVC UTILITY LIN FT $10.00 70.00 $700.00 $0.00 54.00 $540.00 CONDUIT 62 STREET SWEEPING HOUR $115.00 4.00 $460.00 $0.00 0.00 $0.00 2 OWNER CONTRACTOR SEH APPLICATION FOR PAYMENT NO.10(FINAL) CONTRACTOR FOR: 2014 MAIN PUMP STATION &COLLECTION SYSTEM IMP PROJECT NO. STJOE 126869 AGREEMENT DATE: 01/16/15 OWNER CITY OF ST.JOSEPH,MN CONTRACTOR GEISLINGER&SONS,INC. FOR WORK ACCOMPLISHED THROUGH: 08/31/15 CONTRACT THIS PAYMENT I WORK TO DATE ITEM DESCRIPTION I UNIT JUNITCOST11 QUANTITY I AMOUNT I QUANTITY I AMOUNT I QUANTITY I AMOUNT SANITARY SEWER 63 10"PVC SANITARY SEWER,SDR35, LIN FT $100.00 160.00 $16,000.00 4.00 $400.00 164.00 $16,400.00 WITH TYPE 2 BEDDING 64 24"PVC SANITARY SEWER,SDR35, LIN FT $285.00 28.00 $7,980.00 $0.00 25.00 $7,125.00 WITH TYPE 2 BEDDING 65 42"CCFRPM SN 18 SANITARY LIN FT $250.00 186.00 $46,500.00 6.00 $1,500.00 187.00 $46,750.00 SEWER WITH TYPE 2 BEDDING 66 42"CCFRPM SN72 SANITARY LIN FT $270.00 189.00 $51,030.00 $0.00 190.00 $51,300.00 SEWER WITH TYPE 1 BEDDING 67 2"PVC SCH 80 SANITARY SEWER LIN FT $50.00 120.00 $6,000.00 2.00 $100.00 13.00 $650.00 FORCE MAIN 68 JACK&BORE 42"SANITARY SEWER LIN FT $1,000.00 180.00 $180,000.00 $0.00 180.00 $180,000.00 69 JACKING PIT DEWATERING LUMP SUM $25,000.00 1.00 $25,000.00 $0.00 1.00 $25,000.00 70 CLEAN&TELEVISE SANITARY LIN FT $3.00 808.00 $2,424.00 404.00 $1,212.00 808.00 $2,424.00 SEWER 71 2"INSULATION SQ YD $17.00 825.00 $14,025.00 $0.00 544.00 $9,248.00 72 60"FRP SANITARY MANHOLE EACH $15,000.00 2.00 $30,000.00 $0.00 2.00 $30,000.00 73 72"FRP SANITARY MANHOLE EACH $17,000.00 1.00 $17,000.00 $0.00 1.00 $17,000.00 74 84"FRP SANITARY MANHOLE EACH $20,000.00 1.00 $20,000.00 $0.00 1.00 $20,000.00 75 PRECAST SANITARY MANHOLE EACH $7,500.00 1.00 $7,500.00 $0.00 1.00 $7,500.00 76 CONNECT TO EXISTING SANITARY EACH $2,500.00 1.00 $2,500.00 $0.00 1.00 $2,500.00 FORCE MAIN 77 CONNECT TO EXISTING SANITARY EACH $3,000.00 1.00 $3,000.00 $0.00 1.00 $3,000.00 SEWER 78 CONNECT TO EXISTING MANHOLE EACH $5,000.00 1.00 $5,000.00 $0.00 1.00 $5,000.00 79 BYPASS PUMPING LUMP SUM $100,000.00 1.00 $100,000.00 $0.00 1.00 $100,000.00 WATER MAIN 80 6"WATER MAIN-DUCT IRON CL 52 LIN FT $40.00 400.00 $16,000.00 8.00 $320.00 397.00 $15,880.00 81 HYDRANT EACH $4,500.00 1.00 $4,500.00 $0.00 1.00 $4,500.00 82 6"GATE VALVE AND BOX EACH $1,500.00 2.00 $3,000.00 $0.00 2.00 $3,000.00 83 YARD HYDRANT WITH 4X4 EACH $350.00 1.00 $350.00 $0.00 2.00 $700.00 TREATED POST 84 CONNECT TO EXISTING WATER EACH $500.00 1.00 $500.00 $0.00 1.00 $500.00 MAIN 85 2"CORPORATION STOP EACH $350.00 1.00 $350.00 $0.00 1.00 $350.00 86 1"CORPORATION STOP EACH $200.00 1.00 $200.00 $0.00 1.00 $200.00 87 2"CURB STOP AND BOX EACH $550.00 1.00 $550.00 $0.00 1.00 $550.00 88 1"CURB STOP AND BOX EACH $240.00 1.00 $240.00 $0.00 2.00 $480.00 89 2"TYPE K COPPER PIPE LIN FT $50.00 110.00 $5,500.00 $0.00 94.00 $4,700.00 90 1"TYPE K COPPER PIPE LIN FT $40.00 150.00 $6,000.00 $0.00 169.00 $6,760.00 91 2"INSULATION SQ YD $17.00 150.00 $2,550.00 $0.00 64.00 $1,088.00 92 CONNECT TO EX WATER SERVICE EACH $500.00 3.00 $1,500.00 2.00 $1,000.00 3.00 $1,500.00 93 WATER MAIN FITTINGS POUND $5.00 500.00 $2,500.00 $0.00 319.00 $1,595.00 3 OWNER CONTRACTOR SEH APPLICATION FOR PAYMENT NO.10(FINAL) CONTRACTOR FOR: 2014 MAIN PUMP STATION &COLLECTION SYSTEM IMP PROJECT NO. STJOE 126869 AGREEMENT DATE: 01/16/15 OWNER CITY OF ST.JOSEPH,MN CONTRACTOR GEISLINGER&SONS,INC. FOR WORK ACCOMPLISHED THROUGH: 08/31/15 CONTRACT THIS PAYMENT I WORK TO DATE ITEM DESCRIPTION UNIT UNITCOST11 QUANTITY I AMOUNT I QUANTITY I AMOUNT I QUANTITY I AMOUNT TURF RESTORATION 94 INLET PROTECTION,MAINTAINED EACH $175.00 4.00 $700.00 $0.00 4.00 $700.00 95 SILT FENCE,HEAVY DUTY LIN FT $3.00 835.00 $2,505.00 $0.00 877.00 $2,631.00 96 BIOROLL BLANKET SYSTEM LIN FT $5.00 85.00 $425.00 70.00 $350.00 135.00 $675.00 97 SCREENED TOPSOIL BORROW(LV) CU YD $18.00 1,100.00 $19,800.00 24.00 $432.00 348.00 $6,264.00 98 SEEDING ACRE $2,500.00 1.60 $4,000.00 0.62 $1,550.00 1.60 $4,000.00 99 SEEDING(TEMPORARY) ACRE $300.00 1.60 $480.00 $0.00 0.50 $150.00 100 SEED MIXTURE 22-111 POUND $2.00 96.00 $192.00 $0.00 0.00 $0.00 101 SEED MIXTURE 25-131 POUND $3.00 704.00 $2,112.00 50.00 $150.00 500.00 $1,500.00 102 HYDRAULIC SOIL STABILIZER POUND $1.00 5,000.00 $5,000.00 600.00 $600.00 4,850.00 $4,850.00 103 COMMERCIAL FERTILIZER POUND $1.00 560.00 $560.00 50.00 $50.00 500.00 $500.00 TOTAL BASE BID $1,613,123.00 $29,664.00 $1,554,419.76 ALTERNATE A-RV DUMP STATION 104 BOLLARD EACH $500.00 2.00 $1,000.00 $0.00 2.00 $1,000.00 105 CURB DESIGN V(6") LIN FT $25.00 20.00 $500.00 $0.00 15.00 $375.00 106 6"CONCRETE PAVEMENT SQ YD $100.00 5.00 $500.00 $0.00 5.00 $500.00 107 4"PVC SANITARY SEWER,SDR26 LIN FT $100.00 10.00 $1,000.00 $0.00 12.00 $1,200.00 108 4"DI SANITARY SEWER LIN FT $100.00 2.00 $200.00 $0.00 0.00 $0.00 109 RV DUMP SIGN,WITH POST SQ FT $40.00 22.75 $910.00 $0.00 22.75 $910.00 110 RV DUMP 4"SANITARY HATCH EACH $600.00 1.00 $600.00 $0.00 1.00 $600.00 COVER 111 YARD HYDRANT WITH 4X4 EACH $750.00 1.00 $750.00 $0.00 1.00 $750.00 TREATED POST 112 1"TYPE K COPPER PIPE LIN FT $50.00 60.00 $3,000.00 $0.00 48.00 $2,400.00 TOTAL ALTERNATE A $8,460.00 $0.00 $7,735.00 CHANGE ORDER NO. 1 113 REPLACE GRADE ADJUSTMENT LS $1,098.25 1.00 $1,098.25 $0.00 1.00 $1,098.25 RINGS AND CASTING ON EXISTING SANITARY MANHOLE ON SOUTH SIDE OF CR 75. 114 PRIVACY SLATS INSTALLED IN NEW LS $3,045.00 1.00 $3,045.00 $0.00 1.00 $3,045.00 FENCING TOTAL CHANGE ORDER NO.1 $4,143.25 $0.00 $4,143.25 CHANGE ORDER NO.2 115 EXISTING SANITARY SEWER LS $16,804.88 1.00 $16,804.88 $0.00 1.00 $16,804.88 TEMPOARY RE-ROUTE AND DOWN TIME RELATED TO A LEAK IN EXISTING STORM SEWER TOTAL CHANGE ORDER NO.2 $16,804.88 $0.00 $16,804.88 CHANGE ORDER NO.3 116 IFLOOR IN EXISTING WET WELL LS $3,150.00 1.00 $3,150.00 $3,150.00 1.00 $3,150.00 TOTAL CHANGE ORDER NO.3 $3,150.00 $3,150.00 $3,150.00 4 OWNER CONTRACTOR SEH APPLICATION FOR PAYMENT NO.10(FINAL) CONTRACTOR FOR: 2014 MAIN PUMP STATION &COLLECTION SYSTEM IMP PROJECT NO. STJOE 126869 AGREEMENT DATE: 01/16/15 OWNER CITY OF ST.JOSEPH,MN CONTRACTOR GEISLINGER&SONS,INC. FOR WORK ACCOMPLISHED THROUGH: 08/31/15 CONTRACT THIS PAYMENT WORK TO DATE ITEM DESCRIPTION UNIT UNIT COST QUANTITY AMOUNT I QUANTITY I AMOUNT QUANTITY I AMOUNT LIQUIDATED DAMAGES LIQUIDATED DAMAGES(SEE SEH LUMP SUM ($29,122.00) 1.00 ($29,122.00) 1.00 ($29,122.00) 1.00 ($29,122.00) LETTER TO CONTRACTOR DATED 08/07/15) SUMMARY TOTAL BASE BID $1,613,123.00 $29,664.00 $1,564,419.76 TOTAL ALTERNATE A $8,460.00 $0.00 $7,736.00 TOTAL BID $1,821,583.00 $29,664.00 $1,582,154.76 CHANGE ORDER NO.1 $4,143.25 $0.00 $4,143.25 CHANGE ORDER NO,2 $16,804.88 $0.00 $16,804.88 CHANGE ORDER NO,3 $3,150.00 $3,150.00 $3,150.OD LUQIDATED DAMAGES $29,122.Od $29,122.00 $29,122.00 TOTAL $1,816,569.13 $3,692.00 $1,557,130.89 The undersigned Contractor certifies that all previous payments received Gross Amount Due $1,557,130.89 from the Owner forwork done under this contract have been applied Less Retainage(0%) $0.00 to discharge in full all obligations the Contractor incurred in connection with the work covered by said progress payments.The undersigned Contractor Amount Eligible to Date $1,557,130.89 agrees to pay all subcontractors within 10 days of receipt of payment from Less Previous Payments $1,478,759.45 the municipality for undisputed services provided by the subcontractor. Amount Due This Application $78,371.44 The Contractor agrees to pay Interest as described under Minnesota state statute. SUBMITTED GEISLINGER&SONS,INC. BY: L/�-" "' DATE: PO BOX 437 WATKINS,MN 55389.0437 RECOMMENDED SEH BY: DATE: PO BOX 1717 ST.CLOUD,MN 56302-1717 APPROVED CITY OF ST.JOSEPH BY: DATE: PO BOX 668 ST.JOSEPH,MN 56374-0668 5 Page 1 of 1 MINNESOTA- REVENUE Contractor Affidavit Submitted Thank you,your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 0-902-625-152 Submitted Date and Time: 17-Sep-2015 8:57:31 AM Legal Name: GEISLINGER AND SONS Federal Employer ID: 26-0591820 User Who Submitted: geislinger Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 197836800 Minnesota ID: 9061277 Project Owner: CITY OF ST JOSEPH Project Number: 3211358 Project Begin Date: 01-Jul-2014 Project End Date: 03-Aug-2015 Project Location: CITY OF ST JOSEPH Project Amount: $1,557,130.89 Subcontractor Summary Name ID Affidavit Number RICE LAKE CONSTRUCTION GROUP 3211358 1229029376 CHAMPION COATINGS INC 4832515 1259880448 DESIGN ELECTRIC INC 6387590 1420607488 RICE LAKE BORING INC 2651563 23642112 NORTHERN DEWATERING INC 4515518 329924608 KNIFE RIVER CORP 9485354 739295232 NORTHSTAR LANDSCAPING 1521232 1104035840 Important Messages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us If you need further assistance,contact our Withholding Tax Division at 651-282-9999,(toll-free)800-657-3594,or(email) withholding.tax@state.mn.us.Business hours are 8:00 a.m.-4:30 p.m.Monday-Friday. Please print this page for your records using the print or save functionality built into your browser. https://www.mndor.state.mn.us/tp/eservices/ /Retrieve/O/b-/SBgC5uBObncW6XAoaAwfS... 9/17/2015 Au c.0 13 15 11:5 a North Star Landscaping 3205972525 p.3 3205972525 - p.2 Page 1 of 1 MiIdNF -S01.a• RIVC",it Contrai for Affidv9,la Thank you,ycz)turContractor Affidavit has been approved. Confirmation Summary Confimiatio r N Number. 0-357-345.152 Submitted pate and Time: 13-Aug-2015 12:51:o5 pM Legal Name- NORTH STAR LANDSCAPING INC Federal Emp toyer 10: 41-1776393 User Who Sr�rbmitted: NSlar1 Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Nunn ber. 1104035s4o Account Number. 1521232 Project Owne r: CITY OF ST.JOSEPH Project Numb: 126869 Project Begin Vale: 11-Jul-2014 Project End Date 13-M2y-2015 Project Location: St.JOSEPH Project Amount: $14,192.50 Subcontractors: No Subcontractors fmPortant Mtossages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us Ineed nenneoh � lRDNisionat651-22-9999,Wthholding taxstatem assistance,Business 0011-fe)800-657-3594,Or(email)are8!OOa 4:30 p.m.Monday-Friday. Please print this confirmation oaQe for your records using the print or save functionality built into your browser. 9 !ns iaid iter e Page 1 of 1 MINNESOTA-REVENUE Contractor Affidavit Submitted Thank you,your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 0-381-052-800 Submitted Date and Time: 13-Aug-2015 3:24:29 PM Legal Name: KNIFE RIVER CORPORATION-NORTH CEN Federal Employer ID: User Who Submitted: 32MNTAX Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 739295232 Account Number: 9485354 Project Owner: CITY OF ST.JOSEPH Project Number: KRC NO.32-42048 Project Begin Date: 23-Sep-2014 Project End Date: 20-May-2015 Project Location: ST.JOSEPH-2014 MAIN PUMP STATION AND COLLECTION SYSTEM IMPROVEMENTS Project Amount: $113,870.52 Subcontractors: No Subcontractors Important Messages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us If you need further assistance,contact our Withholding Tax Division at 651-282-9999,(toll-free)800-657-3594,or(email) Withholding.tax@state.mn.us.Business hours are 8:00 a.m.-4:30 p.m.Monday-Friday. Please print this confirmation page for your records using the print or save functionality built Into your browser. I https://www.mndor.state.inn.ush,D/eservices/ /Retrieve/0/b-/6U1sLUXILp_ezMENRBerig... 8/13/2015 A u g. 12. 2 015 3: 4 2 PM Northern Dewatering, INC ieiittps://www.mndor.state.mnus/tp/esurv6s/ /Reir>eve/O/b-/lA_Zi... MINNISOTA-PLEVENUt Contractor Affidavit Submitted Thank you,your Contractor Affidavit has been approved. Confirmation Summary) Confirmation Number: 1-937-811320 Submitted Oats and Time: 12-Au9-2016 141;07 PM Legal Name: NORTHERN DEWATERING INC Pederat Employer ID: 41.1433544 User Me Submitted: thayer Type or Request Submitted; Contractor Aftevii Affldavit Summary Affidavit Number; 320924600 Account Number: 4515518 Project Owner: CITY OF ST JOSEPH Project Number: 126869 Project Bealn Date: 18-Aug-2014 Project End Date: 2&Oc1-2014 Project Location; ST JOSEPH Project Amount: $26,684.04 Subcontractors: No Subcontractors Important Messages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us If you need further assistance,contact our Ofthotding Tax Division at 651-282-9999,(loll-free)800.657-5504,or(email) Withhoiding.taX®state,mmus.Business hours are 8:00 a.m.-a:30 p.m,Monday•Friday. Please print this confirmation cabs for your records using the print or save rvnetionalily built into your browser. ( i 'G i i (a L1115 Page 1 of 1 M I N,`N!f..SO I A- R \/I-:`(11- 7C)'rac"o Thank you,your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 0-850-290-560 Submitted Date and Time: 13-Aug-2015 3:11:52 PM Legal Name: RICE LAKE BORING INC. Federal Employer ID: 46-0594692 User Who Submitted: k.hentges Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 23642112 Account Number: 2651563 Project Owner: CITY OF ST JOSEPH Project Number: 126869 Project Begin Date: 01-Jul-2014 Project End Date: 31-Jul-2014 Project Location: ST.JOSEPH Project Amount: $106,834.50 Subcontractors: No Subcontractors Important Messages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us If you need further assistance,contact our Withholding Tax Division at 651-282-9999,(toll-free)800-657-3594,or(email) With holding.tax@state.mn.us.Business hours are 8:00 a.m.-4:30 p.m.Monday-Friday. Please t�,iu �, .,_�,; m t,�,H jlcl.ji_for your records using the print or save functionality built into your browser, https://www.nindor.state.mn.us/tp/eservices/_/Retrieve/0/b-/I6lsl-o6LsDbheyHG_AFOQQ... 8/13/2015 W211120115 MN ei-Services iL Contractor Affidavit Submitted Enter intofmation Review and Submit COMPIQU Thank you,your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number. 0-506-795-904 Submitted Date and Time: 21-Aug-2015 2:62:08 PM Legal Name: DESIGN ELECTRIC INC Federal Employer ID: 411-11223438 User Who Submitted: clasignelect Type of Request Submitted: Contractor Afldavit Affidavit Summary A"Idavit Number: 1420607488 Minnesota ID: 6387590 P(ojectOwner: CITY OF ST,JOSEPH Project Number: 126869 Project Begin Date: 06-Sep-2014 Project End Date: 12-Jan-2015 ProjWLocadon: ST.JOSEPH.MN Project Amount: $268,604.08 Subcontractors: No Subcontractors Important Messages A copy of this page must be provided to the contractor or government agency that hired you, Contact Us If you need further assistance,contact our Withhotding Tax Division at 651-282-9999,(boil-free)800.657.3594,or(email) WthholdingtaxCstate.m.us,Business hours are 8:00 a.m.-4:30 p.m.Monday-Friday. How to View and Print this Request You can see Copies Cifyourrequests;by going to the History Tab,or by clicking the link below.To Print or email a copy ofthis oonlinnation page,click one ofthe buttons Wow. Click here to go to the History Tab Printer Friendly �E�it Cw0;,m"!J•, 2641owil., T"q;;,—":,I.!ti i i Pow Mps.-IAwm.mrKior.state.mn.usApleservices/—/#i i 1/1 9/1/2015 https://www.mndor.state.mn.us/tpleservices/ /RetrievetO/b-/b3pDk52RQEcwPgElSvaObw ?FILE =Print2 MINNESOTA• REVENUE Contractor Affidavit Submitted Thank you,your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 1-476-056-960 Submitted Date and Time: 1-Sep-2015 1:54:44 PM Legal Name: CHAMPION COATINGS INC Federal Employer ID: 41-1970119 User Who Submitted: coatings5150 Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 1259880448 Minnesota ID: 4832515 Project Owner: CITY OF ST.JOSEPH Project Number: 126869 Project Begin Date: 01-Oct-2014 Project End Date: 31-Jul-2015 Project Location: ST.JOSEPH MN Project Amount: $65,900.00 Subcontractors: No Subcontractors Important Messages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us If you need further assistance,contact our Withholding Tax Division at 651-282-9999,(toll-free)800-657-3594,or(email) Withholding.tax@state.mn.us.Business hours are 8:00 a.m.-4:30 p.m.Monday-Friday. Please print this confirmation nage for your records using the print or save functionality built into your browser. https://www.mndor.state.mn.us/tpleservices//Retrieve/0/b-/b3pDk52RQEcwPgElSvaObw_?FILE =Print2 1/1 r-(Jc? MINNESOTA,- REVENUE j I Contractor Affidavit Submitted Thank you,your Contractor Affidavit has been approved. I Confirmation Summary Confirmation Number: 1-354-595-968 Submitted Date and Time: 10-Nov-2014 1:51:07 PM Legal Name: RICE LAKE CONTRACTING CORP Federal Employer ID: 41-1505802 User Who Submitted: ricelakecon Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 1229029376 Account Number: 3211358 Project Owner: CITY OF ST.JOSEPH Project Number: 126869 Project Begin Date: 01-Aug-2014 Project End Date: 15-Sep-2014 Project Location: ST. JOSEPH,MN Project Amount: $79,750.00 Subcontractors: No Subcontractors Important Messages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us If you need further assistance,contact our Withholding Tax Division at(Metro Area) 651-282-9999, (Greater Minnesota) 800-657-3594, (TTY Users) Call 711 for Minnesota Relay,or(email)Withholding.tax@state.mn.us.Business hours are 8:00 a.m. -4:30 p.m.Monday-Friday. How to View and Print this Request You can see copies of your requests by going to the History Tab. Please print this confirmation page for your records using the print or save functionality built into your browser. i T - - Document G707id — 1994 Consent Of Surety to Final Payment Bond No. 106085435 PROJECT:(Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: 2014 Main Pump Station and Collection System Improvements,St.Joseph, CONTRACT FOR: Construction ARCHITECT: Minnesota;STJOE 126869 CONTRACTOR: SURETY: TO OWNER:(Name and address) CONTRACT DATED: 5/1/2014 OTHER: City of St. Joseph 25 College Avenue N., PO Box 668 St.Joseph, MN 56374 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (Insert name and address oj'Sur•ety) Travelers Casualty and Surety Company of America One Tower Square Hartford, CT 06183 SURETY, on bond of (Insert name and address ofContraetoi) Geislinger& Sons, Inc. 511 Central Avenue South, P.O. Box 437 Watkins, MN 55389-0437 ,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 Ownet) City of St. Joseph 25 College Avenue N., PO Box 668 St. Joseph, MN 56374 OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: September 14, 2015 (Insert in writing the month followed by the numeric date azul year.) Travelers Casualty and Surety Company of America (Sureq) (Sig lure au sized representative) test; Brian J.Oestreich,Attorney-in-Fact (Printed name and title) AIA Document G70711—1994.Copyright©1982 and 1994 by The American Institute of Architects.All rights reserved.WARNING:This AIAT Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA'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. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER 11 p e ,AS POWER OF ATTORNEY 5� u u A P ELG RS J Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 229351 Certificate No. 006434776 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company,St.Paul Fire and Marine Insurance Company,St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint John E.Tauer,Linda K.French,R.W.Frank,Craig Remick,Rachel Thomas,Nicole Stillings,Joshua R.Loftis,Brian J.Oestreich,Sandra M.Doze, Jerome T.Ouimet,D.R.Dougherty,Jack Cedarleaf Il,Kurt C.Lundblad,Melinda C.Blodgett,R.C.Bowman,R.Scott Egginton,Ted R.Jorgensen, Emily Keiser,and Lin Ulven of the City of Minneapolis State of Minnesota their true and lawful Attorneys)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 30th day of July 2015 Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company p/.SU,q �t�(p,. FIAE 6 e Tf M,�$ •w INSU"' SY AhO ,y,O SVq� W}IYAI� O So��MJb° (1 {" � WCC6RpggTfUG� EOP 'Y� 1 oPPORA>F t='1 iYii C�RPORAlf,cies a 9� 3+ � � �IAC 1 9 8 2 0 1977 a E F E .n- HARTFORD, � tiNTF6F4J, a 1951 = ;SEAI io3 SBRL;%3 0 [\ NCEc d:.........�y1`j State of Connecticut By: City of Hartford ss. Robert L.Raney, enior Vice President On this the 30th day of July 2015 before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G• In Witness Whereof,I hereunto set my hand and official seal. My Commission expires the 30th day of June,2016. AU86�� * Marie C.Tetreault,Notary Public 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President..any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing j is a true and correct copy of the Power of Attorney executed by said Companies,which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 14tH day of September ,20 15_ Gam• Kevin E.Hughes,Assistant Sect tary `'o�o� � COY-•�°•�u' G moo, .Q�•;.........q �+•',rP...........'Qy-; 9J� S� ,dNa �Yoq �p� 'WO .5 �' (1 � tlfCOR G F£ j:�0 A>Cm �Wi OpPOR i b t 9.8 2S; $ 1977 � PORAt[D � "�"� co; ••• S -'i t° _.Atf �t a HARTFOFD, i 3 fKATFOPA,� a � � �ccr�' a 1951 ,E +.SEAI.,ip" �'•SEAL::3t �y� A� �.� t•� °�r'tinNcY d�S.AH'SD�r �fS„�•�r`'aD 661 t�+Di • ��� ��'!/ To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. i WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER i I i i 511 Central Ave.S. PO Box 437 1 Watkins,MN 55389 Phone—320.764.2006 Fax—320.764.2007 "OEISLINGER AND SONS, INC. General Contractors RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. I I 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. I DATE: 08/07/15 The undersigned hereby acknowledges receipt of the sum of$94,682.50 CHECK ONLY ONE 1. ❑ As partial payment for labor, skill, and material furnished or to be furnished. 2. ❑ As payment for all labor, skill, and material furnished or to be furnished (except the sum of retainage or holdback.) I 3. Os full and final payment for all labor, skill, and material furnished or to be furnished. I To the following described real property: (legal description, street address, or project name) 2014 Main Pump Station and Collection System Improvements Project, St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill, or material furnished to said real property (only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.)The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: Hobas., Signature CFO Title 511 Central Ave.S. PO Box 437 Watkins,MN 55389 Phone—320.764.2006 Fax—320.764.2007 SEISLINGER AND SONS, INC. General Contractors .RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN, 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. DATE: 08/07/15 The undersigned hereby acknowledges receipt of the sum of$105,392.03 CHECK ONLY ONE 1. ❑ As partial payment for labor, skill, and material furnished orto be furnished. 2, ❑ As payment for all labor, skill, and material furnished or to be furnished (except the sum of retainage or holdback.) 3. MAs full and final payment for all labor,skill, and material furnished or to be furnished. To the following described real property: (legal description, street address, or project name) 2014 Main Pump Station and Collection System Improvements Project,St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill, or material furnished to said real property(only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.)The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: k- Signature -I &1- Title i i 511 Central Ave.S. PO Box 437 i Watkins,MN 55389 Phone—320.764.2006 00 Fax-320.764,2007 3EISLINGER AND SONS, INC. General Contractors RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. DATE: 08/07/15 The undersigned hereby acknowledges receipt of the sum of$4010.50 CHECK ONLY ONE I. As partial payment for labor,skill, and material furnished or to be furnished. 2. ❑ As payment for all labor,skill,and material furnished or to be furnished (except the sum of retainage or holdback.) 3. [-]As full and final payment for all labor,skill, and material furnished or to be furnished. I To the following described real property: (legal description,street address, or project name) 2014 Main Pump Station and Collection System Improvements Project, St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor,skill, or material furnished to said real property(only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.)The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: Cretex n'l Signa re Title I i DOCUMENT 00660 RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL INSTRUMENT and must be executed accordingly by officers of corporations and by ! i partners in co-partnerships. j 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. A receipt similar to this or legal waiver of lien rights will be required for all plumbing,heating, plastering materials,etc. 4. NO ERASURES OR ALTERATIONS MUST BE MADE. DATE: 8/13/15 The undersigned hereby acknowledges receipt of the sum of$ 113,870.52 CHECK ONLY ONE 1. M as partial payment for labor,skill,and material furnished or to be furnished 2. as payment for all labor,skill,and material furnished or to be furnished or to be furnished(except the sum of$ retainage or holdback) I I 3. ❑X as full and final payment for all labor,skill,and material furnished or to be furnished to the following described real property: (legal description,street address,or project name) St.Joseph-2014 Main Pump Station and Collection System Improvements KRC No.32-42048 Project Number 1266869 and for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor,skill, or material furnished to said real property(only for the amount paid if Box 1 is checked,and except for retainage shown if Box 2 is checked). The undersigned affirms that all material furnished by the undersigned has been paid for,and all subcontractors employed by the undersigned have been paid in full, EXCEPT: i i Knife River Corporation-North Central (Com ame) (Signature) (Title) 4787 Shadow Wood Drive NE (Address) Sauk Rapids, MN 56379 (Address) I F (Address) I i Aug. 12, 2015 3:43PM Northern Dewatering, INC. No. 0763 P. 2 I 511 Central Ave.S. PO Box 437 1 Watkins,MN 55389 Phone w 320.764.2006 Fax—320.764.2007 i 3EISLINGER AND SONS, INC. General Contractors i I i RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS I 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. DATE: 07/29/15 The undersigned hereby acknowledges receipt of the sum of$26,684.04 I CHECK ONLY ONE 1. ❑ As partial payment for labor,skill, and material furnished or to be furnished. 2. ❑ As payment for all labor, skill, and material furnished or to be furnished (except the sum of retainage or holdback.) 3. gAs full and final payment for all labor, skill, and material furnished or to be furnished. To the following described real property: (legal description, street address, or project name) 2014 Main Pump Station and Collection System Improvements Project, St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill, or material furnished to said real property (only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.)The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: Dewate ing.7rn re V I.u. Title i i 511 Central Ave.S. PO Box 437 1 Watkins,MN 55389 Phone—320.764.2006 • Fax—320.764.2007 r6"7"EISLINGER AND SONS, INC. General Contractors RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. DATE: 08/26/15 The undersigned hereby acknowledges receipt of the sum of$65,900.00 CHECK ONLY ONE 1. ❑ As partial payment for labor, skill, and material furnished or to be furnished. 2. ❑ As payment for all labor, skill, and material furnished or to be furnished (except the sum of retainage or holdback.) 3. As full and final payment for all labor, skill, and material furnished or to be furnished. To the following described real property: (legal description, street address, or project name) 2014 Main Pump Station and Collection System Improvements Project, St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill, or material furnished to said real property (only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.)The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: Champi atings Inc. Si atVIt Title i 511 Central Ave.S. PO Box 437 Watkins,MN 55389 Phone—320.764.2006 Fax—320.764.2007 �C�,O�f�Of C�C(� AND SOBS, WC W . Genera0 Contractors RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. DATE: 08/07/15 The undersigned hereby acknowledges receipt of the sum of$79,750.00 CHECK ONLY ONE 1. ❑ As partial payment for labor, skill, and material furnished or to be furnished. 2. ❑ As payment for all labor, skill, and material furnished or to be furnished (except the sum of retainage or holdback.) 3. E]As full and final payment for all labor, skill, and material furnished or to be furnished. To the following described real property: (legal description, street address, or project name) 2014 Main Pump Station and Collection System Improvements Project, St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill, or material furnished to said real property (only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.) The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: i �k1 onst tion Group Signa ure Title 511 Central Ave.S. PO Box 437 Watkins,MN 55389 Phone—320.764.2006 Fax—320.764.2007 '.3"'EISLINGER AND SONS, INC. General Contractors RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. DATE: 08/07/15 The undersigned hereby acknowledges receipt of the sum of$8'5- 1.08 <DO CHECK ONLY ONE 1. ❑ As partial payment for labor, skill, and material furnished or to be furnished. 2. ❑ As payment for all labor, skill, and material furnished or to be furnished (except the sum of retainage or holdback.) 3. F]As full and final payment for all labor, skill, and material furnished or to be furnished. To the following described real property: (legal description, street address, or project name) 2014 Main Pump Station and Collection System Improvements Project, St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill, or material furnished to said real property (only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.) The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: Ri e Lake Borin Inc. Sig ature �'Us&n4c/bo Title 511 Central Ave.S. PO Box 437 Watkins,MN 55389 Phone—320.764.2006 ' Fax-320.764.2007 3EISLINGER AND SONS, INC. General Contractors RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS 1. This is a LEGAL DOCUMENT and must be executed accordingly by officers of corporations and by partners in co-partnerships. 2. It is important that ALL the blanks be completed and the AMOUNT PAID BE SHOWN. 3. ERASURES OR ALTERATIONS MUST NOT BE MADE. DATE: 08/07/15 The undersigned hereby acknowledges receipt of the sum of$268,604.08 CHECK ONLY ONE 1. ❑ As partial payment for labor, skill, and material furnished or to be furnished. 2. ❑ As payment for all labor, skill, and material furnished or to be furnished (except the sum of retainage or holdback.) 3. XAs full and final payment for all labor, skill, and material furnished or to be furnishedA. MX To the following described real property: (legal description, street address, or project name) 2014 Main Pump Station and Collection System Improvements Project, St Joseph, MN And for value received hereby waives all rights acquired by the undersigned to file or record mechanic's liens against said real property for labor, skill, or material furnished to said real property (only for the amount paid if Box 1 is checked, and except for retainage shown in Box 2 is checked.)The undersigned affirms that all material furnished by the undersigned has been paid for, and all subcontractors employed by the undersigned have been paid in full, EXCEPT: Desi lectrical Contractors Signature r Title FINAL STATEMENT DATE OF ISSUANCE October 15, 2015 OWNER City of St. Joseph, MN CONTRACTOR Geislinger and Sons, Inc. Project Location St. Joseph Project Description 2014 Main Pump Station and Collection System Improvement Owner's Contract No. NIA ENGINEER'S Project No. STJOE 126869 Agreement Date 05/01/14 Notice to Proceed Date 06/02/14 Date Punch List Corrected 10/06/15 Substantial Completion Date 03/27/15 Expiration Date of Vegetation Maintenance Period 10/06/15 Contractor's Statement: To the best of my knowledge and belief: 1. the above information is true and correct as indicated; 2. all items of work have been completed in accordance with the Contract Documents; 3. all progress payments received from the Owner for work under this Contract have been applied to discharge in full all obligations of the Contractor incurred in connection with said work; and 4. title to all materials and equipment incorporated in said work will pass to the Owner at the time of final payment free and clear of all liens, claims, security interests, and encumbrances. In accordance with the Minnesota Uniform Transaction Act, an electronic signature on this document is binding and afforded the same effect as if the document was signed by hand. [Authorized Signatures] RECOMMENDED ACCEPTED SEH Geislinger&Sons, Inc. BY leAW4 By: Title: Project Engineer Title: Date: 10/15/15 Date: 1,57 P 1PT%SXSTJOE112B86M7-Const573.0-PaymenIXFINAL STATEMENT.dou