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08-27-12 CCevv---.. 7);1 Itl Out and about with New River Medical Center Every day you're making decisions that affect your health. New River Medical Center understands that each healthy choice you make today affects your overall well-being tomorrow. That's why we're out and about at farmers' markets, parades, libraries, health fairs, golf tournaments and city festivals encouraging you to make healthy choices each and every day and to remember that exceptional health care services are available right here, close to home, when you need them. Fne wriverme ic1 . l Otsego Festival, Otsego Becker Business Expo, Becker �7; - IN t 'i z s riv ed.0m l - New — NLe W Iver Lake Maria State Park Spud Fest Parade, Big Lake Riverfest Parade, Monticello _--.•L �m. 1013 - - R - F _ you 2 V-1 Iver Iscove� r health care choices h er M E D T CAL C E N T E R 2011 Annual Report Community Members, :al Center is committed to providing patient -centered care that improves the health and well-being of our r top priority is to ensure that you, our patients, receive quality, compassionate care each and every day. ,ing health needs of our patients and community, New River Medical Center is continually adding new ig processes and updating space to support the delivery of quality care. Last spring, New River Physician provide patients with Internal Medicine physician choices close to home, and our nationally accredited led into their new location in our Professional Building with comfortable, hotel -like private patient rooms. River Medical Center's Wound Care service was upgraded to include Hyperbaric Oxygen Therapy which chronic wounds, and we are currently in the process of expanding and updating our Laboratory to increase id work flow efficiency. e physical changes that are taking place on our campus, New River Medical Center's Board of Directors )cuments to change New River Medical Center to a non-governmental, nonprofit 501(c)(3) organization. of education, research and review, the Board of Directors determined this change will allow New River o grow increasingly efficient, competitive and strategic in order to position the organization to face the are and best serve the needs of our patients. Thank you to our board members, community representatives, nbers and cities/townships for your participation, questions and feedback during this educational process. a positive change that is imperative for the future success of health care in our community. future, New River Medical Center will remain focused on providing you with local access to high-quality ur health care team at New River Medical Center delivers care according to national quality standards, practices, participates in continuing education, implements national patient safety initiatives and monito ensure you receive exceptional care. Accreditation by the Joint Commission, the gold -seal health care is evidence of New River Medical Center's commitment and compliance with rigorous national quality- ,dical Center, we remain committed to our patients and community. Time and time again, we hear from ortant it is to receive care close to home. We understand the need to have excellent primary care providers sated on our campus so that you can choose to manage your health care needs while staying close to home nily and friends. That's why New River Medical Center continually invests in new services, evaluates 'iciencies and promotes quality initiatives - because we want to be here long into the future caring for your . In addition to inpatient and outpatient hospital services, New River Medical Center provides Internal mily Medicine care through in New River"Physician Clinic, Family Medicine care through the Big lon&ULQcare needs throug e Extended Care facility, emergency medical services through its own AnddYi „ nand radiation ncology services through the Monticello Cancer Center. to your care, we are proud to bring quality health care services to our community. New River s here to sup your health, your community and your choice. Chief Executive Officer 4,0)0a,VL,J-.,.� Ervin Danielowski Board Chair L esa Holland's life took an ected turn last summer when her nd heard her fall to the floor one morning in their Big Lake home. Her husband, Randy Holland, found her unresponsive and quickly called 911. The emergency dispatcher told Randy to begin CPR. He talked Randy through the process, and Randy started doing compressions to keep the blood flowing to Teresa's brain. "He said to start compressions right away and to be consistent," remembers Randy. Within minutes, Deputies with the Sherburne County Sheriffs Office arrived at the Holland house to assist with the incident. Minutes later, New River Medical Center EMS was on the scene to deliver life-saving care. Teresa had suffered from sudden cardiac arrest, a condition where the heart suddenly stops beating. Nationwide, victims of sudden cardiac arrest have less than an eight percent survival rate because the brain and vital organs quickly become deprived mow of oxygen. New River Medical Center's EMS intervened on Teresa's behalf by continuing CPR, administering emergency cardiac medications and defibrillating her heart. She was transferred by ambulance to the emergency department at New River Medical Center and then transferred by helicopter to Abbott Northwestern where she was cared for by Minneapolis Heart Institute cardiologists. During her first few hours at Abbott Northwestern, Teresa's body was cooled using therapeutic hypothermia in order to decrease her risk of brain damage. Teresa spent 11 days at Abbott Northwestern recovering. While she longed to be back home in Big Lake, her thorough care ensured a full recovery. "It all happened so fast," says Teresa. "Randy was right there to help. Everyone did an awesome job." In September, Teresa and her family visited New River Medical Center to help award Frank Zinken, Paramedic; Robert Kruck, EMT; and James Hessler, Dispatcher, with certificates of merit honoring their contributions to her sudden cardiac arrest save. "We wanted to give our praise to these people," says Randy. "They don't often get thanked even though they're doing this all the time." Teresa is one of the fortunate few who suffered a sudden cardiac arrest and lived to tell about it. The quick action of her husband and the local availability of advanced medical care saved Teresa's life. Today, Teresa is doing remarkably well. She went back to work in the fall, and this winter she's been enjoying her vintage snowmobile collection despite the lack of snow. Teresa is happy to be able to enjoy her hobby and has even regained the strength to walk through a number of vintage snowmobile shows this season. "I feel really good," says Teresa. 11 In tl�e United States, nearly eight million people suffer from chronic wounds as a result of medical conditions such as diabetes, radiation damage and other circulatory conditions. These chronic wounds are typically wounds that do not heal or improve within four weeks. Without proper treatment, chronic wounds can lead to infection and even amputation. For people suffering with chronic wounds, knowing where to find expert healing care is important. For six years, New River Medical Center's Wound Care and Hyperbaric Medicine team has been providing expert, individualized care to help heal wounds for community members, close to home. "When a patient comes in to receive wound care, we make sure they immediately feel comfortable," says Jennifer Storms, RN, WCC, CFCN, New River Medical Center's Wound Care and Hyperbaric Medicine Clinical Coordinator. "Providing a relaxed environment sets the stage for healing. Getting to know our patients helps us determine the most comprehensive treatment plan for them and helps create successful wound healing. We also work with nutrition education, podiatrists, vascular specialists and customized orthotics and prosthetics experts to provide the most complete care for patients in our community." Every wound is unique and therefore needs a treatment plan that is customized to meet the needs of each individual; providing the most comprehensive wound care plan not only includes compassion and medical expertise, it also requires state-of-the-art technology. In October, New River Medical Center introduced Hyperbaric Oxygen Therapy (HBOT) to our community. "HBOT is the gold standard to help heal certain wounds that do not respond to traditional wound care therapies," says William Scheig, MD, Medical Director of New River Medical Center's Wound Care and Hyperbaric Medicine services. "HBOT aids wound healing by increasing the level of oxygen to tissues in the body, which in turn promotes the body's ability to heal itself." Patients receiving HBOT treatments are placed comfortably in a hyperbaric chamber where they breathe in 10 to 20 times the normal amount of pure oxygen under pressure. The pressure causes the oxygen to be absorbed into the blood stream. By increasing the oxygen to the blood stream, new blood vessels form, swelling is reduced and infection is fought off to help the wound heal more effectively. "Having HBOT at New River Medical Center demonstrates our commitment to the well-being of our community," says Dr. Scheig. "New River Medical Center is the sixth location in Minnesota to offer HBOT to patients. People dealing with certain chronic wounds can now receive this healing service, along with traditional wound care therapies, close to home and start to live their lives more comfortably." Candy JJenoit Candy Benoit represents Monticello Township and began serving on the Board of Directors in 2011. Candy ` is a member of the board's Quality committee. a Ervin Danielowski Ervin Danielowski represents the City of Big Lake and has been a member of the Board of Directors since 2009. Ervin is the board's chair and a member of the board's Finance committee. Bob Dawson Bob Dawson represents Becker Township and has been a member of the Board of Directors since 1995. Bob is the board's treasurer and chair of the Finance committee. Linda Doerr Linda Doerr represents all of the District's cities and townships and has been a member of the Board of Directors since 1981. Linda is the board's vice chair and a member of the board's Finance committee. Brian Voyte Brian Doyle represents Silver Creek Township and has been a member of the Board of Directors since 2009. Brian serves as the board's secretary and is a member of the Finance and Quality committees. Richard Helms Richard Helms represents Big Lake Township and has been a member of the Board of Directors since 2005. Richard is a member of the board's Quality committee. Joseph Mahoney, MD Joseph Mahoney, MD, represents the City of Monticello and has been a member of the Board of Directors since 2009. Dr. Mahoney is chair of the board's Quality committee. Rob VanDenBerg Rob VanDenBerg represents the City of Otsego and began serving on the Board of Directors in 2011. 3 Adapting hospital governance to better meet the health needs of our community In October of 2012, New River Medical Center will change to a non-governmental, nonprofit 501(c)(3) organization in order to better meet the health needs of our community. Since 1965, when the hospital doors first opened, New River Medical Center (formerly Monticello -Big Lake Hospital) has operated as a public hospital district. Nonprofit status will allow New River Medical Center to grow increasingly efficient, competitive and strategic in order to position the organization to face the future of health care and meet the growing health needs of our community. Q. What will this governance change mean to patients? A. The daily delivery of care in our hospital will not change. You'll see the same caring nurses, be helped by the same friendly volunteers and have access to the same experienced physicians using the same facilities. What will change is the governance facet of our organization and the manner in which some business decisions are conducted.\' Q. How will New River Medical Center benefit from changing to a 501(c)(3) nonprofit organization? A. There are a number of advantages New River Medical Center will benefit from as a nonprofit organization. New River Medical Center will have the flexibility to choose members to serve on the new nonprofit board who have the talent, experience and education to run a health care business. New River Medical Center will have the ability to plan and strategize privately like all its competitors. Nonprofit governance also promotes physician inclusion on the Board of Directors and will allow for greater collaboration with physicians in the future. As a nonprofit organization, New River Medical Center will be able to respond more quickly to the changing health care environment and adapt accordingly in order to best serve the needs of our patients. Q. How will the community benefit from this change? A. This change will help ensure that New River Medical Center will continue to thrive in our community and provide a local option for health care that is tailored to our community's needs. The nonprofit status will also benefit our community through the cessation of the hospital district's discretionary tax levy and the nonprofit's inability to bond with the backing of local taxpayers. New River Medical Center's Board of Directors was very mindful to protect our community's health care assets as well as protect the financial interests of the residents who live within the hospital district. As part of this governance change, the hospital district board will remain intact to oversee legal agreements established as part of the transition. As in the past, residents of the hospital district will continue to elect representatives to serve on the district board. The district board will appoint three representatives to serve on the new nonprofit hospital board. Beginning in October, this new nonprofit board, comprised of the three district representatives and additional community members appointed by the nonprofit board, will be responsible for the operations of New River Medical Center. The Board of Directors and leadership of New River Medical Center are pleased with this change and believe it is imperative to the future success of health care in our community. This transition will help position New River Medical Center to ensure that our patients and community members are able to receive the highest quality health care services in our community now and into the future. '' .-W M fire][$ 0 "�� t I'm 4: tl a ..�PIP 411 a Encouraging healing through alternative therapies For patients receiving inpatient care, often the need for comfort and relaxation is just as essential to �hrough ing as the need for medicine. New River Medical Center's Healing Environment program, complementary therapies are provided to support the more traditional services that hospital patients typically experience. Inpatients at New River Medical Center may receive hand massages, enjoy aromatherapy, learn how to reduce anxiety through guided imagery and also experience quiet time when the hospital lights on the inpatient units are dimmed, interruptions minimized and voices lowered to complete rest and healing. "Our goal is to enhance recovery wellness by providing expert medical care corn in says Lynn Christian, RN, BSN, Inpatient Services Director at New River Medical Center. "Our employees formed a task force to research complementary therapies, and every member of our inpatient staff was extensively trained to provide these healing services to our patients. "By offering hand massage, aromatherapy, guided imagery and quiet time to our patients, we are providing care that supports emotional wellness to encourage the most complete healing. 91.. Updating our campus to enhance your cage environment New River Medical Center is in the process of updating our campus to enhance your care environment. From adding new patient services to updating tired spaces, New River Medical Center is remodeling to provide a relaxing environment for patients to receive great care. __ Wound Care's Hyperbaric Oxygen Therapy opened in October to deliver «+ state -of the wound licaling srrvices, '7:2 p . RL kadw New River Physician Clinic opened in March of 2011 and provides personalized clinic care in a comfortable, healing environment. The newly updated Sleep Center provides nationally accredited sleep care in hotel -like privat —0 ti ;o w�- v& Mom helps improve community safety Kim Winegarner didn't know her 5 -year-old son Charlie had a severe allergy to peanuts. Charlie simply had never been exposed to them, but before the family got in their car at their home in Savage for a weekend trip to Brainerd, Charlie ate a green bean with peanut sauce. During the ride, Charlie told his mom his mouth itched; by the time they neared Monticello on 1-94, Charlie's eyes had swollen shut. "I called 911 and was told we were just miles away from the hospital in Monticello," recalls Kim. As the Winegarners exited the freeway, they watched for blue hospital "H" signs to direct them to the emergency room. Unfortunately, they didn't see a sign at the intersection of County Roads 18 and 75 in Monticello, and they continued driving in the wrong direction. After stopping for directions, the Winegarners turned around and were greeted by the waiting emergency department staff when they arrived at New River Medical Center. "I thought how horrible it would have been if we had gone two more miles down the road and it had been too late," says Kim. After the family's ordeal, Kim decided to send an email about their experience and the need for additional directional signs. With the help of Kim's story, New River Medical Center Kim Winegarner's son Charlie was rushed to New River Medical Center after having an allergic reaction. was finally able to get the approval necessary for signs to help send patients in the right direction. New River Medical Center had requested these signs in the past but had been denied. Thanks to Kim's quick reaction and the emergency care at New River Medical Center, Charlie received the medication he needed to counteract his allergic reaction. Kim was thrilled to hear that her email helped make a difference in the safety of our community. "I had tears in my eyes," says Kim. "It felt good to know that this would help others." • 0 • • • • • 0 0 • 0 • • • • • • 0 • • • • • • 0 • 0 • • • • • • 0 0 0 0 0 0 • • • • • • 0 0 0 0 • • • • • • • • • 0 • • • • • • • • • • • • O ger ck gir-,, gve o gi rt Hartfelt Gifts, giving back to patients and our community 1.1 Did you know that every time you make a purchase at New River Medical Center's gift shop, Hartfelt Gifts, you are giving the gift of quality health care to your community? Once a small shop with homemade crafts, Hartfelt Gifts has grown to become a place to not only pick up snacks and essentials but also unique and trendy gifts including jewelry, clothing and toys. New River Medical Center Auxiliary members, including Hartfelt Gift co - managers Sherie Danner and Linda Sherie Danner, Hartfelt Gifts co- manager, helps raise funds to give back to patient care. Larson, volunteer their time to work at the gift shop and provide convenient access to gifts and necessities for patients, families and visitors at New River Medical Center. "For years, Hartfelt Gifts has donated a portion of our proceeds to enhance quality health care locally," says Danner. "Gift shop proceeds have helped to purchase a van for extended care residents, patient lifts, wheelchairs and scholarships for local high school students pursuing a higher education in a medical profession. We look forward to continuing our tradition of giving back and supporting our community." New River Physician Clinic delivers top-quality Internal Medicine and Family Medicine clinical care close to home. Conveniently located on the campus of New River Medical Center, New River Physician Clinic offers a comforting and healing environment and delivers expert clinic care that is tailored to your individual needs. Since the Physician Clinic opened on March 1, 2011, patients have voiced their appreciation for the personal attention, friendly faces and thorough care they receive from New River Physician Clinic providers. Our providers are experts in preventative health, primary care, women's health, cardiovascular health, risk management and chronic conditions including diabetes; you can feel comfortable knowing your health care needs will be met with high-quality care. For more information, or to schedule an appointment, call New River Physician Clinic at 763.271.2200. PHYSICIAN C LI NIC n Let Ezzat Moussa, MD Family Medicine Matthias Jordan, MD Internal Medicine Maryam Rajablou, MD Internal Medicine Rabia Khan, MD (MBBS) Internal Medicine Ann Marie Burgeson, CNP Family Medicine 7 e -W ■ Iver M E D I C A L C E N T E R Discover your health care choices here New River Medical Center New River Medical Center is a Critical Access Hospital facility operating 2S beds iver. Monticello Cancer Center Monticello Cancer Center brings expert medical oncology and radiation oncology services to our community .iver Overview Community -owned health care delivery system Hospital District established in 1961 Governed by an eight -member, community -elected board of directors • Township of Becker: Bob Dawson • City of Big Lake: Ervin Dantelowski • Township of Big Lake: Richard Helms • Township of Monticello: Candy Benoit • City of Otsego: Rob vanDengerg • Township of SilverCreek: Brian Doyle • At -large: Linda Doerr • City of Monticello - Iver New River Medical Center Extended Care New River Medical Center Extended Care is an 89 -bed skilled nursing facility that provides a variety of rehabilitation programs Iver New River Physician Clinic New River Physician Clinic provides Internal Medicine and Family Medicine physician services to our community iver. New River Physician Clinic Rabia Khan, MD (MBBS) Matthias Jordan. MD Ezzat Moussa, MD Maryam Rajablo, MD Ann Marie Burgeson, CNP ® .,_ , iver Our Mission We provide patient -centered care that improves the health and well-being of our community iver Vital Statistics FY 2010 FY 2011 MW,caVSurgical and ICU inpatients 1,232 1,098 Emergency roam r,s,ts 13,054 13,072 Imaging procedures 19,705 17,703 Surgical procedures 1.666 1,837 Extended Care average day census 03.5 79.4 Mmticelb Cancer Center treatments 4,840 6,054 aftmoss..__ Cancer Center- Medial Oncdogy. ... , Hier Big Lake Clinic 9 -h 0Big- ake Clinic provides Family Medicine physician services and is a joint venture of New River Medical Center and CentraCare Services we have to offer oant Gre - IaboUtory MediUlfSurgical Inpatient Gnindl ng - Ambulatory Can- Trans fusions. IV Therapy S., Md, • eedUmclnpab Care Grdidogy- Consultations, Pacemaker Cl—, Intensive Care Strias Testing HospiUlist cart for inpatients Respiratory Care-Wlmonary Rehab Sleep Cenur- Adult and pediatric -I.— A—Rebabilmnon - untl Gre and llyperoad<M<dicine DUbe[es Education Emergenry Gre Community Education Cancer Center- Medial Oncdogy. Chemdh2m. Radiauon Therapy Ambulance Se -W HOW Sugica15<mces- Orthopedic, Wnert1. Extended Can Facility- RehabillU[ion Services, Gynecdogiol.EM, Podiatry.Ophmalmdogy. Extended Gn Urdogy.Dental, Endoscopies, Ws[roenterologV - In[emal Medicine/Family Medicine pdmary clinic Imaging -%Ray. U. MM, Dig,Ul Mammography. care Ultrasound, Me.nSU PET/ Revenue Where the dollars come from C.W-_-- � iver 2 Expenses Where the dollars go \Pvj River Introducing Hyperbaric Medicine New River Medical Center now offers Hyperbaric Medicine to promote healing of chronic wounds. Hyperbaric Medicine patients are exposed to pressurized oxygen which: Helps increase blood flow • Helps new blood vessels form • Reduces infection • Promotes healing mr;m. Mom helps improve community safety By sharing her personal experience, Kim Winegarner helped New River Medical Center get approval for a Hospital directional sign at the intersection of County Roads 18 and 75 in Monticello. Iver Healing Environment New River Medical Center promotes rest, wellness and healing by offering complementary therapies to patients who are admitted to the hospital. Healing is encouraged through: • Hand massage • Aromatherapy • Guided imagery �7�� •Quite time q6flllfiUllllliwt49 Ner. Introducing Hyperbaric Medicine New River Medical Center is one of just a handful of facilities in the State to offer the technologically advanced healing ;•.,� option of Hyperbaric Medicine therapy. Iver Community Outreach As your community hospital, New River Medical Center participates in community events to promote and encourage healthy choices and healthy living. 3 Legal Status Update In October 2012, New River Medical Center will change to a non-governmental, nonprofit 501(c)3 organization in order to best meet the health needs of our community. Nonprofit status will allow New River Medical Center to grow increasingly efficient, competitive and strategic in order to face the future of health care. iver Legal Status Update How will New River Medical Center benefit from changing to a nonprofit organization? New River Medical Center will have flexibility to choose members to serve on the new nonprofit board who have the talent, experience and education to run a health care business. • New River Medical Center will have the ability to plan and strategize privately like all our competitors. • Nonprofit governance also promotes physician inclusion on the Board of Directors and allows for greater collaboration with physicians in the future. Iver. Legal Status Update The Board of Directors and leadership of New River Medical Center are pleased with this change and believe it is imperative to the future success of health care in our community. This transition will help position New River Medical Center to ensure that our patients and community members are able to receive the highest quality health care services in our community now and into the future. eiA -- iver Legal Status Update What will this governance change mean to patients? • The daily delivery of care will not change. You will see the same caring nurses, be helped by the same friendly volunteers and have access to the same experienced physicians. Iver Legal Status Update How will the community benefit from this change? This change will help New River Medical Center continue to thrive in our community and provide a local option for health care. • The nonprofit will not be able to bond with the backing of local taxpayers. • The Hospital District board will remain in tact to oversee the legal agreements and will appoint three representatives to serve on the nonprofit board. N&Y.V Kiver Affiliation Task Force New River Medical Center's nonprofit board has established an Affiliation Task Force to research potential health system affiliation opportunities. As an independent hospital, New River Medical Center partners with a number of hospitals, health systems and providers to deliver top-quality care; the taskforce will consider the potential benefits partnerships may bring to our patients and community. ver. 0 CLAIMS LIST CITY COUNCIL MEETING AUGUST 27, 2012 TO: Tami Loff ITEM 3-7 Attached is the Claims List for the City Council. For more detail, please refer to the check detail registers. CLAIMS REGISTERS: VOIDED CHECKS: PAYROLL: 08-22-2012 $ 650,498.65 Check # 51973 - # 52041 NONE 08-22-2012 $ 39,086.94 ELECTRONIC PYMTS FOR AUGUST: Bldg Permit Surcharge $ 0.00 Century Link $ 303.78 Centerpoint Energy $ 228.32 Dept. of Revenue -Fuel Tax $ 149.91 Dept. of Revenue -Sales Tax $ 931.00 Elk River Utilities $ 2,119.69 Wright -Hennepin $ 17,058.69 Delta Dental $ 1,220.17 Aflac $ 1,400.72 Total: $ 23,412.28 GRAND TOTAL $ 712,997.87 If you have any questions or if you would like to review this list further, please let me know. Sue Frisch Finance Assistant CITY OF OTSEGO *Check Summary Register© AUGUST 2012 Name Check Date Check Amt 10100 BANK OF ELK RIVER RELOCATE SIREN Paid Chk# 051973 READY WATT ELECTRIC 8/16/2012 Paid Chk# 051974 PEARSON BROS INC 8/16/2012 Paid Chk# 051975 US BANK CORPORATE PYMT SY 8/16/2012 Paid Chk# 051976 ASTECH 8/16/2012 Paid Chk# 051977 FEHN COMPANIES 8/16/2012 Paid Chk# 051978 UNITED STATES POSTAL SERVI 8/16/2012 Paid Chk# 051979 ADVANCED ENGINEERING AND 8/22/2012 Paid Chk# 051980 AFFORDABLE SANITATION 8/22/2012 Paid Chk# 051981 FLEX ONE - AFLAC 8/22/2012 Paid Chk# 051982 AIRGAS NORTH CENTRAL 8/22/2012 Paid Chk# 051983 ALLIANCE BENEFIT GROUP HSA 8/22/2012 Paid Chk# 051984 BALD EAGLE BUILDERS, INC. 8/22/2012 Paid Chk# 051985 BATTERIES PLUS 8/22/2012 Paid Chk# 051986 BEAUDRY OIL & SERVICES INC. 8/22/2012 Paid Chk# 051987 BRAUN INTERTEC 8/22/2012 Paid Chk# 051988 CENTRAL HYDRAULICS, INC. 8/22/2012 Paid Chk# 051989 CITY OF MONTICELLO 8/22/2012 Paid Chk# 051990 CITY OF OTSEGO 8/22/2012 Paid Chk# 051991 CLEAR WATERS OUTFITTING C 8/22/2012 Paid Chk# 051992 THOMAS CONSTANT 8/22/2012 Paid Chk# 051993 CROW RIVER FARM EQUIPMEN 8/22/2012 Paid Chk# 051994 DARRELL R. ERVASTI 8/22/2012 Paid Chk# 051995 DAKOTA SUPPLY GROUP 8/22/2012 Paid Chk# 051996 ELECTION SYSTEMS & SOFTWA 8/22/2012 Paid Chk# 051997 G & K TEXTILE LEASING SYSTE 8/22/2012 Paid Chk# 051998 GENERAL RENTAL CENTER 8/22/2012 Paid Chk# 051999 GIS RANGERS, LLC 8/22/2012 Paid Chk# 052000 GRAINGER 8/22/2012 Paid Chk# 052001 HAKANSON ANDERSON ASSOC 8/22/2012 Paid Chk# 052002 HANSON TIRE SERVICE, INC. 8/22/2012 Paid Chk# 052003 HEALTH PARTNERS 8/22/2012 Paid Chk# 052004 HOME DEPOT CREDIT SERVICE 8/22/2012 Paid Chk# 052005 ICMA RETIREMENT CORP 8/22/2012 Paid Chk# 052006 INK WIZARDS, INC. 8/22/2012 Paid Chk# 052007 JOHN DEERE GOVERNMENT SA 8/22/2012 Paid Chk# 052008 TAMI LOFF 8/22/2012 Paid Chk# 052009 MARTIES FARM SERVICE INC 8/22/2012 Paid Chk# 052010 MENARDS 8/22/2012 Paid Chk# 052011 METRO WEST INSPECTION SVC 8/22/2012 Paid Chk# 052012 BETTE MEYER 8/22/2012 Paid Chk# 052013 MN NATIVE LANDSCAPES, INC. 8/22/2012 Paid Chk# 052014 MONTICELLO ANIMAL CONTROL 8/22/2012 Paid Chk# 052015 NATIONAL BUSINESS FURNITUR 8/22/2012 Paid Chk# 052016 NEXTEL COMMUNICATIONS 8/22/2012 Paid Chk# 052017 NOVAK-FLECK INC 8/22/2012 Paid Chk# 052018 OFC OF THE SECRETARY OF ST 8/22/2012 Paid Chk# 052019 OFFICEMAX INCORPORATED 8/22/2012 Paid Chk# 052020 OMANN BROTHERS INC. 8/22/2012 Paid Chk# 052021 OTSEGO FESTIVAL INC 8/22/2012 Paid Chk# 052022 OTSEGO ROD & CUSTOM 8/22/2012 Paid Chk# 052023 PEOPLE SERVICE INC. 8/22/2012 Paid Chk# 052024 POMP S TIRE SERVICE INC 8/22/2012 Paid Chk# 052025 JOHN P. HOPKO 8/22/2012 Paid Chk# 052026 PUBLIC EMPLOYEES RETIREME 8/22/2012 Paid Chk# 052027 RECDESK LLC 8/22/2012 Paid Chk# 052028 RICOH AMERICAS CORPORATIO 8/22/2012 08/22/12 11:01 AM Page 1 $2,582.00 RELOCATE SIREN $284,939.47 2012 STREET MAINT PROJ $523.53 LUNCH MTG W/CONSULTANT $168,471.41 2012 STREET MAINT PROJ $450.00 ISLAND VIEW ESTATES DRAINAGE $1,806.47 POSTAGE FOR NEWSLETTER $1,055.63 1 & C SERVICES $1,704.30 PORTA RENTALS $42.00 FLEX FEES $45.64 OXYGEN/HAZMAT $577.24 PPE 8/18/12 CH DTD 8/22/12 $2,500.00 11384 71ST - LNDSCP/DRWY ESC R $136.27 BATTERY $10,163.60 GAS & OIL $2,204.00 70TH ST - MF TO MARLOWE $86.22 GRADER PARTS $865.69 JULY ANIMAL CONTROL $4,194.92 7551 LANCASTER -WEST WWTF $375.00 8/20 CANOE TRIP $16.60 HPC SUPPLIES - WOOD $634.67 REPAIR/MAINT SUPPLY $2,134.29 PAINT SPRAYER $12,798.92 WATER METERS & REPAIR PARTS $213.75 MODEM FOR ELEC MACHINE $592.09 UNIFORMS & MATS $94.85 TRENCHER FOR PARKING LOT $1,200.00 2011 HOSTING $116.08 RECYCLE CONTAINERS $34,279.71 GATEWAY NORTH - DUKE $2,516.91 TIRES JD TRACTOR $6,481.20 SEPT MEDICAL $46.67 SHEETROCK ANCHORS $675.00 PLAN #304185 $219.75 T -BALL SHIRTS $6,549.55 Z925A COMMERCIAL ZTRAK $72.09 MILEAGE $664.76 GRASS SEED $87.98 BLEACH, TAPE $6,562.50 BLDG INSP SVCS (SEPTIC) 5.75 H $10.69 SHELTER RENTAL REFUND $615.60 SEED - BEAUDRY PK DRAINAGE $270.00 ANIMAL CONTROL $722.37 LITERATURE RACK & CAROUSEL $526.91 CELL PHONES $1,000.00 11661 75TH - LNDSCP ESC REFUND $240.00 NOTARY RENEWAL - KATHY GROVER $280.26 OFFICE SUPPLIES $95.63 AC FINES MIX $3,273.03 TEDDY BEAR BAND $400.00 FESTIVAL SPONSORSHIP $48,365.00 MONTHLY SERVICE $229.29 TIRES - MOUNT/DISMOUNT $267.19 FERTILIZER APPLICATION $4,995.47 #677600 PPE 8/18/12 CH DTD 8/2 $2,999.00 SUBSCRIPTION 8113/12 - 8/12/13 $311.70 WIDE FORMAT PRINTER Paid Chk# 052029 Paid Chk# 052030 Paid Chk# 052031 Paid Chk# 052032 Paid Chk# 052033 Paid Chk# 052034 Paid Chk# 052035 Paid Chk# 052036 Paid Chk# 052037 Paid Chk# 052038 Paid Chk# 052039 Paid Chk# 052040 Paid Chk# 052041 CITY OF OTSEGO *Check Summary Register© AUGUST 2012 Name Check Date RICOH AMERICAS CORPORATIO 8/22/2012 SIGNS & BANNERS 8/22/2012 ST. CROIX RECREATION CO. 8/22/2012 THE UPS STORE #5093 8/22/2012 TRYCO LEASING INC. 8/22/2012 VANCE BROTHERS INC 8/22/2012 VERNON KOLLES & SONS 8/22/2012 W.W. GOETSCH ASSOCIATES IN 8/22/2012 KIMBERLY A. WELTER 8/22/2012 CHRIS WILSON 8/22/2012 XCEL ENERGY 8/22/2012 XCEL ENERGY 8/22/2012 YALE MECHANICAL 8/22/2012 RIVERPOINTE LIGHTS Total Checks 08/22/12 11:01 AM Page 2 Check Amt $379.43 RICOH COPIER LEASE $117.56 SIGN MAT'L $1,417.16 6' TABLES $27.14 POSTAGE FOR ELEC SUPPLIES $57.55 ESTUDIO 282 COPIER $219.31 BLACKTOP SUPPLIES $262.50 STRAW FOR PARKING LOT $19,177.65 PUMPS FOR RWN LS $600.00 FALL NEWSLETTER $10.14 HPC SUPPLIES - FRAME $3,295.02 5740 RANDOLPH - WELL #8 $201.26 RIVERPOINTE LIGHTS $1,451.03 SUMMER MAINT - CITY HALL $650,498.65 CITY OF OTSEGO 08/22/12 11:02 AM Page 1 *Check Detail Register© AUGUST 2012 Check Amt Invoice Comment ARMS - 10100 BANK OF ELK RIVER Paid Chk# 051973 8/16/2012 READY WATT ELECTRIC E 414-42000-390 Contracted Services $2,582.00 96625 RELOCATE SIREN Total READY WATT ELECTRIC $2-582 00 Paid Chk# 051974 8/16/2012 PEARSON BROS INC E 201-43100-400 Repairs & Maint - Cont $284,939.47 PAY EST 1 2012 STREET MAINT PROJ Total PEARSON BROS INC $284,939.47 Paid Chk# 051975 8/16/2012 US BANK CORPORATE PYMT SYSTEMS E 101-45250-440 Recreation Programming $56.38 LUNCH MTG W/CONSULTANT E 101-45200-210 Operating Supplies (GENERAL) $20.48 ICE FOR EMPLOYEES E 101-41100-801 CONTINGENCY $340.00 MRPA CONFERENCE E 101-41400-201 Office Supplies and Expenses $14.95 MEMORY CARD E 101-41400-201 Office Supplies and Expenses $21.36 MEMORY CARD E 101-41600-201 Office Supplies and Expenses $1.00 ADDRESS CHANGE - POST OFFICE E 101-41600-201 Office Supplies and Expenses $25.56 TAB INSERTS E 101-41400-201 Office Supplies and Expenses $43.80 BANKER BOXES :al US BANK CORPORATE PYMT SYSTEMS $523.53 Paid Chk# 051976 8/16/2012 ASTECH E 201-43100-400 Repairs & Maint - Cont $168,471.41 PAY #1 2012 STREET MAINT PROJ Total ASTECH $168.471.41 Paid Chk# 051977 8/16/2012 FEHN COMPANIES E 414-49490-390 Contracted Services $450.00 AMENDED FI ISLAND VIEW ESTATES DRAINAGE POSTAGE FOR NEWSLETTER I & C SERVICES PORTA RENTALS PORTA RENTAL -BASEBALL TOURNAMENT Paid Chk# 051981 8/22/2012 AFLAC -FLEX ONE E 101-41400-390 Contracted Services $42.00 456237ER FLEX FEES Total AFLAC -FLEX ONE $42.00 Paid Chk# 051982 8/22/2012 AIRGAS, INC. E 101-43100-210 Operating Supplies (GENERAL) $45.64 9903538328 OXYGEN/HAZMAT Total AIRGAS, INC. $45.64 Paid Chk# 051983 8/22/2012 ALLIANCE BENEFIT GROUP G 101-21706 Hospitalization/Medical Ins $577.24 Total ALLIANCE BENEFIT GROUP $577.24 Paid Chk# 051984 8/22/2012 BALD EAGLE BUILDERS, INC. E702-41400-310 Miscellaneous $2,500.00 Total BALD EAGLE BUILDERS, INC. $2,500.00 'Paid Chk# 051985 8/22/2012 BATTERIES PLUS PPE 8/18/12 CH DTD 8/22/12 11384 71 ST - LNDSCP/DRWY ESC REFUND Total FEHN COMPANIES $450.00 Paid Chk# 051978 8/16/2012 UNITED STATES POSTAL SERVICE E 101-41400-347 Newsletter $1,806.47 Total UNITED STATES POSTAL SERVICE $1,806.47 Paid Chk# 051979 8/22/2012 AE2S E 602-49450-500 Capital Outlay (GENERAL) $1,055.63 31550 Total AE2S $1,055.63 Paid Chk# 051980 8/22/2012 AFFORDABLE SANITATION E101-45200-410 Rentals (GENERAL) $1,592.08 10730 E 101-45250-440 Recreation Programming $112.22 10735 Total AFFORDABLE SANITATION $1.704.30 POSTAGE FOR NEWSLETTER I & C SERVICES PORTA RENTALS PORTA RENTAL -BASEBALL TOURNAMENT Paid Chk# 051981 8/22/2012 AFLAC -FLEX ONE E 101-41400-390 Contracted Services $42.00 456237ER FLEX FEES Total AFLAC -FLEX ONE $42.00 Paid Chk# 051982 8/22/2012 AIRGAS, INC. E 101-43100-210 Operating Supplies (GENERAL) $45.64 9903538328 OXYGEN/HAZMAT Total AIRGAS, INC. $45.64 Paid Chk# 051983 8/22/2012 ALLIANCE BENEFIT GROUP G 101-21706 Hospitalization/Medical Ins $577.24 Total ALLIANCE BENEFIT GROUP $577.24 Paid Chk# 051984 8/22/2012 BALD EAGLE BUILDERS, INC. E702-41400-310 Miscellaneous $2,500.00 Total BALD EAGLE BUILDERS, INC. $2,500.00 'Paid Chk# 051985 8/22/2012 BATTERIES PLUS PPE 8/18/12 CH DTD 8/22/12 11384 71 ST - LNDSCP/DRWY ESC REFUND CITY OF OTSEGO Paid Chk# 051991 8/22/2012 CLEAR WATERS OUTFITTING CO E 101-45250-440 Recreation Programming $375.00 514 8/20 CANOE TRIP Total CLEAR WATERS OUTFITTING CO $375.00 Paid Chk# 051992 8/22/2012 CONSTANT, THOMAS OR DIANE E 101-45300-310 Miscellaneous $16.60 HPC SUPPLIES - WOOD Total CONSTANT, THOMAS OR DIANE $16.60 Paid Chk# 051993 8/22/2012 CROW RIVER FARM EQUIPMENT E101-43100-220 Repair/Maint Supply (GENERAL) $273.76 155656 REPAIR/MAINT SUPPLIES E 101-43100-220 Repair/Maint Supply (GENERAL) $360.91 155788 REPAIR/MAINT SUPPLY Total CROW RIVER FARM EQUIPMENT $634.67 Paid Chk# 051994 8/22/2012 D. ERVASTI SALES CO E 101-45200-240 *Check Detail Register© $1,918.41 11658 AUGUST 2012 E 101-45200-210 Operating Supplies (GENERAL) $215.88 Check Amt Invoice Comment ra Total D. ERVASTI SALES CO. $2,134.29 n: E101-43100-210 Operating Supplies (GENERAL) $136.27 033-843583 BATTERY Total BATTERIES PLUS $136.27 $12,462.27 Paid Chk# 051986 8/22/2012 BEAUDRY OIL & SERVICES INC. Other Supplies E 101-43100-202 Fuel $3,468.73 772474 GAS & OIL E 101-43100-202 Fuel $6,694.87 772475 GAS & OIL Total BEAUDRY OIL & SERVICES INC. $10,163.60 Paid Chk# 051987 8/22/2012 BRAUN INTERTEC $213.75 822581 E 403-43100-302 Engineering Fees $2,204.00 356328 70TH ST - MF TO MARLOWE Total BRAUN INTERTEC $2,204.00 Paid Chk# 051988 8/22/2012 CENTRAL HYDRAULICS, INC. E 101-43100-220 Repair/Maint Supply (GENERAL) $86.22 22556 GRADER PARTS Total CENTRAL HYDRAULICS, INC. $86.22 Paid Chk# 051989 8/22/2012 CITY OF MONTICELLO E 101-42710-390 Contracted Services $865.69 13193 JULY ANIMAL CONTROL Total CITY OF MONTICELLO $865.69 Paid Chk# 051990 8/22/2012 CITY OF OTSEGO E 602-49450-322 Utilities $8.55 7551 LANCASTER -WEST WWTF E 101-45200-322 Utilities $566.18 11313 77TH - IRRIG E 101-45200-322 Utilities $547.20 10400 71 ST - IRRIG E 101-45200-322 Utilities $688.10 6480 MASON - IRRIG E 101-45200-322 Utilities $697.17 15501 83RD - IRRIG E 101-45200-322 Utilities $807.98 5400 RANDOLPH - IRRIG E 602-49450-322 Utilities $543.38 7551 LANCASTER -WEST WWTF E 602-49450-322 Utilities $8.55 7551 LANCASTER -WEST WWTF E 602-49450-322 Utilities $105.68 7551 LANCASTER -WEST WWTF E 602-49450-322 Utilities $222.13 5850 RANDOLPH - EAST WWTF Total CITY OF OTSEGO $4,194.92 Paid Chk# 051991 8/22/2012 CLEAR WATERS OUTFITTING CO E 101-45250-440 Recreation Programming $375.00 514 8/20 CANOE TRIP Total CLEAR WATERS OUTFITTING CO $375.00 Paid Chk# 051992 8/22/2012 CONSTANT, THOMAS OR DIANE E 101-45300-310 Miscellaneous $16.60 HPC SUPPLIES - WOOD Total CONSTANT, THOMAS OR DIANE $16.60 Paid Chk# 051993 8/22/2012 CROW RIVER FARM EQUIPMENT E101-43100-220 Repair/Maint Supply (GENERAL) $273.76 155656 REPAIR/MAINT SUPPLIES E 101-43100-220 Repair/Maint Supply (GENERAL) $360.91 155788 REPAIR/MAINT SUPPLY Total CROW RIVER FARM EQUIPMENT $634.67 Paid Chk# 051994 8/22/2012 D. ERVASTI SALES CO E 101-45200-240 Small Tools/Equipment $1,918.41 11658 PAINT SPRAYER E 101-45200-210 Operating Supplies (GENERAL) $215.88 11658 WHITE PAINT Total D. ERVASTI SALES CO. $2,134.29 Paid Chk# 051995 8/22/2012 DAKOTA SUPPLY GROUP E 601-49400-203 Other Supplies $12,462.27 7467540 WATER METERS & REPAIR PARTS E 601-49400-203 Other Supplies $336.65 7482991 WATER METERS & REPAIR PARTS Total DAKOTA SUPPLY GROUP $12,798.92 Paid Chk# 051996 8/22/2012 ELECTION SYS & SFTWR - CHICAGO E 101-41410-205 Election Supplies $213.75 822581 MODEM FOR ELEC MACHINE 08/22/12 11:02 AM Page 2 CITY OF OTSEGO *Check Detail Register© AUGUST 2012 Check Amt Invoice Comment Total ELECTION SYS & SFTWR - CHICAGO $213.75 Paid Chk# 051997 8/22/2012 G & K TEXTILE LEASING SYSTEM E 101-43100-225 Uniforms/Clothing Allowance $47.52 1043212478 E 101-43100-225 Uniforms/Clothing Allowance $76.99 1043217432 E 101-41940-390 Contracted Services $138.80 1043217433 E 101-43100-225 Uniforms/Clothing Allowance $47.52 1043222407 E 101-43100-225 Uniforms/Clothing Allowance $140.20 1043227361 E 101-41940-390 Contracted Services $141.06 1043227362 Total G & K TEXTILE LEASING SYSTEM $592.09 E 201-43100-302 Paid Chk# 051998 8/22/2012 GENERAL RENTAL CENTER 30581 ROADWAY MGMT E 414-41945-203 Other Supplies $94.85 176375 Total GENERAL RENTAL CENTER Paid-Chk#7 051999 8/22/2012 GIS RANGERS, LLC E 101-41400-391 GIS Services G 701-22462 DUKE Total GIS RANGERS, LLC Paid Chk# 052000 8/22/2012 GRAINGER E 101-41400-201 Office Supplies and Expenses CUP Total GRAINGER 3aµ.00 $1,200.00 452 $1,200.00 UNIFORMS & MATS UNIFORMS & MATS MATS UNIFORMS & MATS UNIFORMS & MATS MATS TRENCHER FOR PARKING LOT 2011 HOSTING $116.08 9897633401 RECYCLE CONTAINERS $116.08 Paid Chk# 052001 8/22/2012 HAKANSON ANDERSON ASSOC INC G 701-22315 RIVERWOOD NATIONAL $182.84 30576 RIVERWOOD NAT'L G 701-22462 DUKE REALTY $270.09 30577 GATEWAY NORTH - DUKE G 701-22275 KALEIDOSCOPE CUP $125.00 30578 KALEIDOSCOPE G701-22279 KITTREDGE CROSSING 11TH $187.50 30578 KITTREDGE 11TH R 101-34330 Grading Reviews $1,500.00 30579 GRADING REVIEWS E 403-43100-302 Engineering Fees $2,940.81 30580 70TH ST (MARLOWE TO MF) E 201-43100-302 Engineering Fees $8,715.17 30581 ROADWAY MGMT E 101-41560-302 Engineering Fees $240.00 30582 WETLAND CONS ACT 1991 E 222-49490-302 Engineering Fees $574.88 30583 NPDES PHASE II E 203-45210-530 Improvements Other Than Bldgs $1,894.70 30584 SHADE STRUCTURE E 203-45210-302 Engineering Fees $131.90 30584 PR PK WINTER AREA E 602-49450-302 Engineering Fees $568.75 30585 MISC SEWER E 601-49400-302 Engineering Fees $680.89 30585 MISC WATER E 101-41560-302 Engineering Fees $50.00 30585 MISC GRADING & SS E 101-41560-302 Engineering Fees $1,799.95 30585 MISC ENG E 414-42000-302 Engineering Fees $264.98 30585 SIREN E 250-42410-302 Engineering Fees $512.20 30585 PERMITS E 101-41560-302 Engineering Fees $983.25 30586 STAFF MTGS E 101-41560-348 Utility Locates $4,909.33 30587 LOCATES E 414-41945-302 Engineering Fees $7,580.28 30588 PW PARKING LOT E 601-49400-391 GIS Services $64.43 30589 GIS E 101-41560-302 Engineering Fees $38.33 30589 CITY MAPS E 602-49450-391 GIS Services $64.43 30589 GIS Total HAKANSON ANDERSON ASSOC INC $34,279.71 Paid Chk# 052002 8/22/2012 HANSON TIRE SERVICE, INC E 101-43100-210 Operating Supplies (GENERAL) $2,516.91 547078 TIRES JD TRACTOR Total HANSON TIRE SERVICE, INC. $2,516.91 Paid Chk# 052003 8/22/2012 HEALTH PARTNERS E 250-42410-123 Health $347.90 41063288 SEPT MEDICAL E 101-45250-123 Health $205.10 41063288 SEPT MEDICAL E 101-43100-123 Health $3,781.60 41063288 SEPT MEDICAL E 101-41400-123 Health $1,048.30 41063288 SEPT MEDICAL 08/22/12 11:02 AM Page 3 CITY OF OTSEGO *Check Detail Register© AUGUST 2012 Paid Chk# 052014 8/22/2012 MONTICELLO ANIMALvCONTROLW- E 101-42710-390 Contracted Services $270.00 644 ANIMAL CONTROL Total MONTICELLO ANIMAL CONTROL $270.00 Paid Chk# 052015 8/22/2012 NATIONAL BUSINESS FURNITURE 08/22/12 11:02 AM Page 4 Check Amt Invoice Comment E 101-41600-123 Health $1,098.30 41063288 SEPT MEDICAL Total HEALTH PARTNERS $6,481.20 Paid Chk# 052004 8/22/2012 HOME DEPOT E 101-43100-402 Repairs/Maint Buildings $24.99 5090353 SHEETROCK ANCHORS E 203-45210-530 Improvements Other Than Bldgs $12.83 6022511 STAKES FOR SHADE STRUCTURE E 203-45210-530 Improvements Other Than Bldgs $8.85 6092168 TUBE FOR CONCRETE Total HOME DEPOT $46.67 Paid Chk# 052005 8/22/2012 ICMA RETIREMENT CORP G 101-21705 Other Retirement $675.00 PPE 8/18/12 PLAN #304185 Total ICMA RETIREMENT CORP $675.00 Paid Chk# 052006 8/22/2012 INK WIZARDS, INC. E 101-45250-440 Recreation Programming $122.25 62113 T -BALL SHIRTS E 101-45250-440 Recreation Programming $97.50 62214 T -BALL SHIRTS Total INK WIZARDS, INC. $219.75 Paid Chk# 052007 8/22/2012 JOHN DEERE GOVERNMENT SALES E 206-45200-501 Equipment ($3,650.00) 112223614 EXMARK MOWER TRADE IN E 206-45200-501 Equipment $10,199.55 112223614 Z925A COMMERCIAL ZTRAK Total JOHN DEERE GOVERNMENT SALES $6,549.55 Paid Chk# 052008 8/22/2012 LOFF, TAMI E 101-41410-321 Mileage/Travel $72.09 MILEAGE Total LOFF, TAMI $72.09 Paid Chk# 052009 8/22/2012 MARTIES FARM SERVICE INC E 101-45200-210 Operating Supplies (GENERAL) $82.29 831108 GRASS SEED E 101-45200-210 Operating Supplies (GENERAL) $82.29 831281 GRASS SEED E 414-41945-203 Other Supplies $166.73 831568 GRASS SEED - PARKING LOT AREA E 414-41945-203 Other Supplies $83.36 831588 GRASS SEED - PARKING LOT AREA E 414-41945-203 Other Supplies $166.73 833122 GRASS SEED - PARKING LOT AREA E 414-41945-203 Other Supplies $83.36 833139 GRASS SEED - PARKING LOT AREA Total MARTIES FARM SERVICE INC $664.76 Paid Chk# 052010 8/22/2012 MENARDS E 101-45200-210 Operating Supplies (GENERAL) $19.16 249 BLEACH, TAPE E 414-41945-203 Other Supplies $68.82 651 PARKING LOT IRRIG Total MENARDS $87.98 Paid Chk# 052011 8/22/2012 METRO WEST INSPECTION SVC INC. E 250-42410-390 Contracted Services $6,275.00 BLDG INSP SVCS - 125.50 HRS E 250-42410-390 Contracted Services $287.50 BLDG INSP SVCS (SEPTIC) 5.75 HRS Total METRO WEST INSPECTION SVC INC. $6,562.50 Paid Chk# 052012 8/22/2012 MEYER, BETTE._ R 101-34710 Recreation Fees $10.69 SHELTER RENTAL REFUND Total MEYER, BETTE $10.69 Paid Chk# 052013 8/22/2012 MN NATIVE LANDSCAPES, INC. E 408-43100-220 Repair/Maint Supply (GENERAL) $615.60 8260 SEED - BEAUDRY PK DRAINAGE Total MN NATIVE LANDSCAPES, INC. $615.60 Paid Chk# 052014 8/22/2012 MONTICELLO ANIMALvCONTROLW- E 101-42710-390 Contracted Services $270.00 644 ANIMAL CONTROL Total MONTICELLO ANIMAL CONTROL $270.00 Paid Chk# 052015 8/22/2012 NATIONAL BUSINESS FURNITURE 08/22/12 11:02 AM Page 4 CITY OF OTSEGO *Check Detail Register© AUGUST 2012 Check Amt Invoice Comment E 250-42410-201 Office Supplies and Expenses $388.44 ZJ793713-DU LITERATURE RACK & CAROUSEL E 101-41400-201 Office Supplies and Expenses $333.93 ZJ793713-DU LITERATURE RACK & CAROUSEL Total NATIONAL BUSINESS FURNITURE $722.37 Paid Chk# 052016 8/22/2012 NEXTEL COMMUNICATIONS E 101-43100-320 Telephone $526.91 184430382-05 CELL PHONES Total NEXTEL COMMUNICATIONS $526.91 Paid Chk# 052017 8/22/2012 NOVAK-FLECK INC 08/22/12 11:02 AM Page 5 E 702-41400-310 Miscellaneous $1,000.00 11661 75TH - LNDSCP ESC REFUND Total NOVAK-FLECK INC $1,000.00 Paid Chk# 052018 8/22/2012 OFC OF THE SECRETARY OF STATE .� E 101-41600-201 Office Supplies and Expenses $120.00 NOTARY RENEWAL - KATHY GROVER E 101-41400-201 Office Supplies and Expenses $120.00 NOTARY RENEWAL - SANDY LINDENFELSER Total OFC OF THE SECRETARY OF STATE $240.00 Paid Chk# 052019 8/22/2012 OFFICEMAX E 101-41400-201 Office Supplies and Expenses $49.16 249561 OFFICE SUPPLIES E 101-41400-201 Office Supplies and Expenses $18.76 258201 OFFICE SUPPLIES E 101-41410-205 Election Supplies $8.49 476814 OFFICE SUPPLIES E 101-41400-201 Office Supplies and Expenses $112.76 476814 OFFICE SUPPLIES E 101-41400-201 Office Supplies and Expenses $18.72 477036 OFFICE SUPPLIES E 101-41400-201 Office Supplies and Expenses $72.37 623346 OFFICE SUPPLIES Total OFFICEMAX $280.26 Paid Chk# 052020 8/22/2012 OMANN BROTHERS INC. E 101-43100-434 Blacktop Supplies $95.63 9848 AC FINES MIX Total OMANN BROTHERS INC. $95.63 Paid Chk# 052021 8/22/2012 OTSEGO FESTIVAL INC E 101-45250-445 Community Events $500.00 WALTONS HOLLOW E 101-45250-445 Community Events $588.03 OAKWOOD INS E 101-45250-445 Community Events $685.00 TEDDY BEAR BAND E 101-45250-445 Community Events $1,500.00 FUN JUMPS Total OTSEGO FESTIVAL INC $3,273.03 Paid Chk# 052022 8/22/2012 OTSEGO ROD & CUSTOM E 101-45250-445 Community Events $400.00 FESTIVAL SPONSORSHIP Total OTSEGO ROD & CUSTOM $400.00 Paid Chk# 052023 8/22/2012 PEOPLE SERVICE INC. E 602-49450-390 Contracted Services $33,323.48 19751 MONTHLY SERVICE E 601-49400-390 Contracted Services $15,041.52 19751 MONTHLY SERVICE Total PEOPLE SERVICE INC. $48,365.00 Paid Chk# 052024 8/22/2012 POMP S TIRE SERVICE INC E 101-43100-400 Repairs & Maint - Cont $229.29 700001822 TIRES - MOUNT/DISMOUNT Total POMP S TIRE SERVICE INC $229.29 Paid Chk# 052025 8/22/2012 PROFESSIONAL TURF & RENOVATION E 101-45200-400 Repairs & Maint - Cont $267.19 239331 FERTILIZER APPLICATION )tal PROFESSIONAL TURF & RENOVATION $267.19 Paid Chk# 052026 8/22/2012 PUBLIC EMPLOYEES RETIREMENT FD E 101-43100-121 PERA $1,153.55 #677600 PPE 8/18/12 CH DTD 8/22/12 G 101-21704 PERA $2,312.72 #677600 PPE 8/18/12 CH DTD 8/22/12 E 101-41600-121 PERA $529.05 #677600 PPE 8/18/12 CH DTD 8/22/12 E 250-42410-121 PERA $128.85 #677600 PPE 8/18/12 CH DTD 8/22/12 CITY OF OTSEGO *Check Detail Register© AUGUST 2012 08/22/12 11:02 AM Page 6 Check Amt Invoice Comment E 601-49400-121 PERA $50.17 #677600 PPE 8/18/12 CH DTD 8/22/12 E 602-49450-121 PERA $50.16 #677600 PPE 8/18/12 CH DTD 8/22/12 E 101-41400-121 PERA $770.97 #677600 PPE 8/18/12 CH DTD 8/22/12 )tal PUBLIC EMPLOYEES RETIREMENT FD $4,995.47 Paid Chk# 052027 8/22/2012 RECDESK LLC E 205-45250-501 Equipment $2,999.00 399 SUBSCRIPTION 8/13/12 - 8/12/13 Total RECDESK LLC $2,999.00 Paid Chk# 052028 8/22/2012 RICOH AMERICAS CORPORATION E250-42410-410 Rentals (GENERAL) $311.70 15285647 WIDE FORMAT PRINTER Total RICOH AMERICAS CORPORATION $311.70 Paid Chk# 052029 8/22/2012 RICOH AMERICAS CORPORATION E 101-41400-413 Office Equipment Rentals $379.43 15285646 RICOH COPIER LEASE Total RICOH AMERICAS CORPORATION $379.43 Paid Chk# 052030 8/22/2012 SIGNS & BANNERS E 101-43100-393 Sign & Signal Mat I Purchased $117.56 111752 SIGN MAT'L Total SIGNS & BANNERS $117.56 Paid Chk# 052031 8/22/2012 ST. CROIX RECREATION CO. E 205-45210-501 Equipment $1,417.16 17288 6' TABLES Total ST. CROIX RECREATION CO. $1,417.16 Paid Chk# 052032 8/22/2012 THE UPS STORE #5093 E 101-41410-205 Election Supplies $27.14 6688 POSTAGE FOR ELEC SUPPLIES Total THE UPS STORE #5093 $27.14 Paid Chk# 052033 8/22/2012 TRYCO LEASING INC. E 101-43100-413 Office Equipment Rentals $57.55 6340 ESTUDIO 282 COPIER Total TRYCO LEASING INC. $57.55 Paid Chk# 052034 8/22/2012 VANCE BROTHERS INC E 101-43100-434 Blacktop Supplies $219.31 23386 BLACKTOP SUPPLIES Total VANCE BROTHERS INC $219.31 Paid Chk# 052035 8/22/2012 VERNON KOLLES & SONS E 414-41945-203 Other Supplies $262.50 STRAW FOR PARKING LOT Total VERNON KOLLES & SONS $262.50 Paid Chk# 052036 8/22/2012 W.W. GOETSCH ASSOCIATES INC E 602-49450-400 Repairs & Maint - Cont $19,177.65 88995 PUMPS FOR RWN LS Total W.W. GOETSCH ASSOCIATES INC $19,177.65 Paid Chk# 052037 8/22/2012 WELTER, KIM E 101-41400-347 Newsletter $600.00 FALL NEWSLETTER Total WELTER, KIM $600.00 Paid Chk# 052038 8/22/2012 WILSON, CHRIS E 101-45300-310 Miscellaneous $10.14 HPC SUPPLIES - FRAME Total WILSON, CHRIS $10.14 Paid Chk# 052039 8/22/2012 XCEL ENERGY E 601-49400-322 Utilities $2,882.28 5740 RANDOLPH - WELL #8 E 601-49400-322 Utilities $179.53 16575 61 ST - WT #3 E 101-45200-322 Utilities $201.46 5400 RANDOLPH - PARK E 101-43160-322 Utilities $31.75 16501 53RD -ST LIGHT CITY OF OTSEGO *Check Detail Register© AUGUST 2012 Check Amt Invoice Comment Total XCEL ENERGY $3,295.02 Paid Chk# 052040 8/22/2012 XCEL ENERGY E 101-43160-322 Utilities $201.26 RIVERPOINTE LIGHTS Total XCEL ENERGY $201.26 Paid Chk# 052041 8/22/2012 YALE MECHANICAL j�--�- E 101-41940-402 Repairs/Maint Buildings $992.53 131070 E 101-43100-402 Repairs/Maint Buildings $458.50 132487 Total YALE MECHANICAL $1,451.03 10100 BANK OF ELK RIVER $650,498.65 Fund Summary 10100 BANK OF ELK RIVER 101 General Fund $57,876.56 201 Street Pavement Management $462,126.05 203 Park Development $2,048.28 205 Park Equipment Capital Fund $4,416.16 206 Capital Equipment Revolving $6,549.55 222 Citywide Stormwater(NPDES II) $574.88 250 Comm. Dev. & Bldg Safety $8,251.59 403 Collector Roads Fund $5,144.81 408 Otsego Creek Watershed $615.60 414 Revolving Capital Improvements $11,803.61 601 Water Fund $31,697.74 602 Sewer Fund $55,128.39 701 Development Eascrows Fund $765.43 702 Builders Escrow Fund $3,500.00 $650,498.65 SUMMER MAINT - CITY HALL AC ADJUSTMENTS - PW 08/22/12 11:02 AM Page 7 ITEM 3-2A OTSEGO CITY COUNCIL MEETING OTSEGO CITY HALL August 13, 2012 6:00 PM Call to Order. Mayor Jessica Stockamp called the meeting to order at 6:02 PM. Roll Call: Mayor Jessica Stockamp; Councilmembers: Vern Heidner, Dan Scharber, Doug Schroeder and Tom Darkenwald. Staff: Lori Johnson, City Administrator; Dan Licht, City Planner, Andy MacArthur, City Attorney and Sandy Lindenfelser, Special Licensing Clerk. Pledge of Allegiance: Mayor Stockamp led in the Pledge of Allegiance. 1. Open Forum. Teresa Ellis, 6506 Mackenzie Avenue NE, approached the City Council regarding neighborhood issues. City Administrator Johnson said arrangements will be made to meet with City staff. Ms. Ellis was asked to leave her contact information. 2. Consider agenda approval. City Administrator Johnson requested Item 3.4 C show the amount as $450.00 and to change Item 4.4 from Cowboy Jack's to Rockwood's Grill and Backwater Bar. CM Heidner motioned to approve as amended. Seconded by CM Scharber. All in favor. Motion carried. 3. Consent Agenda. (Non -controversial items. 3.1 Approve Claims List. 3.2 Approve City Council Meeting Minutes. A. July 23, 2012 6:00 PM Meeting. B. July 23, 2012 Special City Council Meeting. 3.3 Received Commission Meeting Minutes. A. Parks & Recreation Commission July 11, 2012. B. Planning Commission July 16, 2012. 3.4 Pay Estimates/Requests: A. Approve Pay requests from Ready Watt Electric in the amount of $2,582 for the siren relocation. B. Approve Pay Estimate #1 in the amount of $168,471.41 to ASTECH for placement of micro -surfacing, fog seal and striping. C. Approve Final Pay Estimate #2 in the amount of $450.00 to Fehn Companies for construction of storm water utilities within Island View Estates. D. Approve Pay Estimate #1 in the amount of $284,939.47 to Pearson Bros, Inc. for placement of seal coat and striping. 3.5 Approve the Albertville fire contract. 3.6 Approve Civic Systems software upgrade. 3.7 Approve Final Plat agreement for Kittredge Crossings 10th Addition and Resolution 2012-51 approving a Development Agreement. CM Scharber motioned to approve the consent agenda Seconded by CM Schroeder. All in favor. Motion carried. 4. Community Development. 4.1 Sign Ordinance update. City Planner Licht presented the Request for Council Action. CM Heidner motioned to direct the Planning Commission to consider amendments to the Sign Ordinance in response to comments from the Otsego Business Group meetings based on the outline presented by the City Planner. Seconded by CM Schroeder. All in favor. Motion carried. 4.2 Lawful Gambling Ordinance Amendment. City Planner Licht presented the Request for Council Action. CM Darkenwald asked if this needs to be in place to approve Item 4.4 on the agenda. City Planner Licht said yes. Mayor Stockamp asked if the changes will enable the PTO to have raffles at Otsego Elementary. City Planner Licht said yes and added that the City may be more restrictive than the State regarding lawful gambling. CM Scharber motioned to adopt Ordinance 2012-09 amending the City Code related to lawful gambling. Seconded by CM Schroeder. All in favor. Motion carried. 4.3 SAC/WAC Fee Structure Amendment. City Planner Licht presented the Request for Council Action. CM Heidner asked about expansions of existing uses. City Planner Licht said that provisions have been included in the City Code to allow for additional utility charges to be collected. CM Heidner noted that the change in the fee structure could affect the City's ability to fund oversizing of trunk facilities within a development. City Planner Licht said that there are premature subdivision provisions in the Subdivision Ordinance that will protect the City's budget and CIP from unanticipated expenditures. CM Darkenwald asked if the City would refund utility charges if a less intensive use locates in an existing building. City Planner Licht said that the charges are based on the maximum potential impact of a use to the City's utility systems to account for the capacity required to provide peak service. City Administrator Johnson said that a system to refund utility charges for a less intensive use would be difficult to establish and maintain over time. CM Scharber motioned to approve Ordinance 2012-10 amending the City Code regarding municipal utilities. Seconded by CM Heidner. All in favor. Motion carried. 4.4 Consideration of the gambling permit for Rogers Hocke_y_/Rockwood's Bar and Back Water Grill. City Planner Licht presented the Request for Council Action. Based on the previous actions, City staff recommends approval of premises permit for Rogers Youth Hockey Association noting the background check and $100.00 fee have been received. CM Scharber motioned to approve a premises permit allowing Rogers Youth Hockey Association to sell pull tabs at Rockwood's Bar and Back Water Bar. Seconded by CM Schroeder. All in favor. Motion carried. 5. Administration. 5.1 Appoint City Representative to MnDOT Special Committee. City Administrator Johnson presented the Request for Council Action. CM Darkenwald motioned to appoint Council member Heidner to represent Otsego on the Region 7W Special Committee and that Mayor Stockamp serve as the City's alternate. Seconded by CM Schroeder. All in favor. Motion carried. 6. City Council Reports and Updates. No Items. 7. Staff Reports and Updates. 7.1 Proposed Wright County's Social Host Ordinance. City Administrator Johnson stated that Wright County is proposing to adopt a Social Host Ordinance that is similar to the previously adopted Otsego Social Host Ordinance. City Administrator Johnson received an email from Representative Michelle Bachman regarding a listening session scheduled for August 21, 2012 for elected officials. Ms. Johnson requested that any Council members planning to attend contract her. City Administrator Johnson stated that the primary election is tomorrow. Otsego residents vote at Prairie Center and Otsego Elementary School. CM Scharber noted that page two of the agenda needs to reflect the correct time and location of the City Council meeting to read Monday, August 27, 2012, 7:00 PM at Otsego Prairie Center. Distribution area of the Elk River Star Newspaper was discussed noting that residents with the Rogers zip code of 55374 are not receiving the paper without a paid subscription as they had in the past. 8. Adjourn. CM Scharber motioned to adjourn. Seconded by CM Darkenwald. All in favor. Motion carried. Adjourned at 6:54 PM. ATTEST: Sandy Lindenfelser, Special Licensing Mayor Jessica Stockamp ITEM 3-2B OTSEGO SPECIAL CITY COUNCIL MEETING OTSEGO CITY HALL AUGUST 13, 2012 *6:00 PM Call to Order. Mayor Jessica Stockamp called the meeting to order at 7:26 PM. Roll Call: Mayor Jessica Stockamp; Councilmembers: Vern Heidner, Dan Scharber, Doug Schroeder and Tom Darkenwald. Staff: Lori Johnson, City Administrator; Gary Groen, Finance Director; Brad Belair, Maintenance Supervisor; Ross Demant, Parks and Recreation Manager; and Sandy Lindenfelser, Special Licensing Clerk. 1. 2013 Budget. City Administrator Johnson presented a summary of items discussed at the previous budget meeting held July 9, 2012. City Administrator Johnson stated the Recreation, Parks, and Public Works departments will be reviewed at this meeting. She and Finance Director Gary Groen reviewed the proposed budgets beginning with the Recreation department. Staff reiterated that the Recreation department budget is subject to change depending upon weather, participation, and other factors such as program trends and demand. The programs listed are examples and the actual programs will vary slightly with the end result remaining within the approved budget. Parks and Recreation Manager Demant reviewed summer programs and events that are upcoming, now in progress or completed. The proposed parks staffing structure for 2013 was discussed. Parks upkeep was discussed including turf maintenance, ball field maintenance and mowing. There was discussion of allocating fees for field usage to assist in the maintenance of the ball fields. The need to establishea fee structure instead of asking for a donation was proposed by staff. Council agreed and requestedthat a new park fee structure be added to an upcoming Parks and Recreation Commission agenda for discussion and a recommendation to the City Council. The public works department budgets were discussed including the changes in department allocation to allow for more accurate tracking of department expenditures in the future. There was discussion of salt and sand carryover from the light winter of 2011-2012 and the resulting savings of approximately $35,000 in that line item. The Council agreed that the 2013 budget amount for salt and sand should remain at $75,000 and the savings should be taken in 2012 either as an additional funding source for the 2013 budget or as a year end transfer per the City's fund balance policy. There was discussion of turf and dead trees and replacement costs for Frankfort Park. City Administrator Johnson reviewed property tax comparison data. She stated the City Council needs to approve the levy at the September 10, 2012 meeting or call a special meeting for later that week in order to have the levy resolution to the County by September 17, 2012. She requested input from the Council on the proposed levy amount and requested direction to prepare a levy resolution for adoption on September 10. The Council discussed the levy including reserve fund levies and what cuts would need to be made to reduce the levy to last year's levy amount. City Administrator Johnson stated that general fund cuts of that amount would only be possible by cutting staff, service levels, and programs which is in conflict with previous Council direction. The Council agreed and stated if the levy was reduced, it would need to come from reserve fund levies. The reserve fund levy most likely to be reduced is the fire reserve. The concerns of reducing reserve fund levies were discussed including the difficulty in reinstating the levy at a future date. The need to fund water and sewer debt was raised. Staff indicated the water and sewer study that will be complete by the end of October will provide direction on the future need for levies for water and sewer debt. The Council directed staff to prepare a resolution with the levy as proposed. The Council stated that the proposed levy could be reduced before final adoption in December. 2. Any other items. City Administrator Johnson presented information regarding the water damage to Otsego Prairie Center and stated she would like to get a quote from Kinghorn on the HVAC repair. The City Council directed City Administrator Johnson is to move forward with this item. She will report back to the Council with the recommended repair solution and cost. City Administrator Johnson presented additional repairs needed to the City Hall/Public Works Building. She stated that the building out project is approximately $11,000 under budget at this time. Repairs to the existing water system increased to $3,400 because of additional eye wash stations that need check valves. All agreed it was unfortunate this issue wasn't identified and resolved when the building was constructed five years ago and that it must be fixed now. A similar issue is a mezzanine door that needs to be installed in mechanics bay at a cost of $1,612. The Council agreed to proceed with both items. City Administrator Johnson stated that City Engineer Ron Wagner got quotes for parking lot lights. The lights similar to the existing lights cost around $9,000 while the shoe box lights cost around $3,200. It was agreed that shoe box lights at a cost of approximately $3,200 are to be installed with white light bulbs like the ones in the existing parking lot. City Administrator Johnson presented quotes for signs identifying City Hall. The City Council directed to proceed with the signs but to have only one logo placed on the outside. City Administrator Johnson presented information regarding a request by Kaleidoscope Charter School to assess the SAC/WAC fees for the temporary classroom unit. The City Council directed preparation of an agreement with Kaleidoscope Charter School for the fees of $95,424 to be paid on a five (5) year, 3.4% amortization schedule with the first payment beginning in 2013. The agreement will be on the August 27, 2012, consent agenda. 3. Adjourn. CM Scharber motioned to adjourn. Seconded by CM Darkenwald. All in favor. Motion carried. Adjourned at 10:05 PM. ATTEST: Sandy Lindenfelser, Special Licensing Mayor Jessica Stockamp *immediately following the adjournment of the City Council meeting at 6:00 PM. OHPC 6-12-12 Meeting Otsego Heritage Preservation Commission June 12, 2012 1 -1 -EM 3.3A Present: Toni Seroshek, Jamie Plantenberg-Silbitschka, Chris Wilson, Tom Constant, Gail Anderson, Mayor Jessica Stockamp, City Planner Dan Licht Meeting called to order by Chair Toni Seroshek at 7:05pm. Minutes of the last meeting were approved. Agenda was approved with the addition of Chris Wilson presenting the display she had made of the square nails which came from the John McDonald house. Another new agenda item was the sale of the McDonald property to a private party. Mayor Stockamp states that it is possible there could be some funds from that sale to assign for historical park signs depending on the City Council's decisions. Toni reiterated that we will also file a quick grant request for sign implementation from Legacy Amendment monies. Most likely they will want matching funds from the City. Gail presented the most updated Park draft content together with a new general Otsego history. Dan worked with a graphic artist to present two different versions of possible sign content and a cost estimate and he received our opinions on design. Those Commissioners who can will meet June 22"d at 9am at the OHPC office to pick pictures for the graphics. Dan has heard from Dr. Rothaus who states he will have the report on the McDonald house completed and sent by the end of this month. At Dan's suggestion, we agreed to focus our Otsego Festival (Sept. 15) display on the McDonald house. We can display the joist and the flat nails which Chris rescued, information about John McDonald and his family and the conclusions on the house by Dr. Rothaus. We may be able to develop an interactive narrative and/or to show the footage WCCO television station had shot on the archeological dig and house analysis. Dan has the archival website. By the next meeting we need to decide who the two (minimum) Commissioners will be who attend the State Historical Preservation Office annual conference which is necessary for us to keep our HPC designation. Commissioners who have 1 OHPC 6-12-12 Meeting attended agree it is excellent and inspiring. It is September 13 and 14 in Fergus Falls, MN. Commissioners pay their own accommodations, but the City will pay for the conference fee and mileage. Those wanting more information can check at: www.mnhs.org/shpo/conference. This site states that the information will be onsite soon. Our next meeting needs to be changed due to a conflict on the usual second Tuesday of the month. Next meeting will be: Tuesday, July 10 and the August meeting has been changed to Thursday, August 16 due to a conflict. Gail Anderson, Recorder 2 Otsezo MINNESOTA DEPARTMENT INFORMATION Request for City Council Action ORIGINATING DEPARTMENT: REQUESTOR: MEETING DATE: Public Works City Engineer Wagner August 27, 2012 PRESENTER(s): REVIEWED BY: ITEM #: City Engineer Wagner City Administrator Johnson 3.4A AGENDA ITEM DETAILS RECOMMENDATION: City Staff Recommends payment in the amount of $54,480.33 for the construction of 70th Street from Marlowe Avenue to Martin Farms Avenue. Payment is to Fehn Companies. ARE YOU SEEKING APPROVAL OF A CONTRACT? IS A PUBLIC HEARING REQUIRED? No No BACKGROUND/JUSTIFICATION: 70th Street is substantial complete. All that remains is verification that the boulevards' establish acceptable turf. Retainage is being held for that and also for completion of paper work. The street is open to the public. SUPPORTING DOCUMENTS: X ATTACHED ❑ NONE • Pay Estimate #3 MOTION: (Please word motion as you would like it to appear in the minutes.) Motion to approve payment to Fehn Companies in the amount of $54,480.33 for construction of 70th St from Marlow Avenue to Martin Farms Avenue. BUDGET INFORMATION FUNDING: BUDGETED: X YES Municipal State Aid ❑ NO ACTION TAKEN ❑ APPROVED AS REQUESTED ❑ DENIED ❑ TABLED ❑ OTHER (List changes) COMMENTS: PARTIAL PAY ESTIMATE #3 CITY OF OTSEGO 70th Street Construction Project August 22, 2012 Honorable Mayor & City Council City of Otsego 8899 Nashua Avenue NE Otsego, MN 55330 RE: 70th Street Construction Contractor: Fehn Companies, Inc. Contract Amount: $350,657.51 Award Date: February 17, 2012 Completion Date: August 1, 2012 Dear Honorable Mayor and Council Members: The following work has been completed on the above -referenced project by Fehn Companies, Inc. Bid Schedule "A" ITEM NO. ITEM DESCRIPTION ESTIMATED QUANTITY UNIT CONTRACT UNIT PRICE CONTRACTAMOUNT USED TO DATE EXTENSION 1 MOBILIZATION 1 LUMP SUM $4,892.00 $ 4,892.00 1 $ 4,892.00 2 REMOVE CONCRETE CURB 121 LIN FT $3.50 $ 423.50 130 $ 455.00 3 REMOVE WATERMAIN 40 LIN FT $15.30 $ 612.00 25 $ 382.50 4 REMOVE BITUMINOUS PAVEMENT 210 SQ YD $3.50 $ 735.00 210 $ 735.00 5 REMOVE CONCRETE PAVEMENT 17 SQ YD $20.00 $ 340.00 28 $ 560.00 6 REMOVE PERMANENT BARRICADE 2 EACH $50.00 $ 100.00 2 $ 100.00 7 SAWING BITUMINOUS PAVEMENT FULL DEPTI 77 LIN FT $4.50 $ 346.50 77 $ 346.50 8 SALVAGE SIGN 1 EACH $25.50 $ 25.50 1 $ 25.50 9 COMMON EXCAVATION P 6,364 CU YD $5.50 $ 35,002.00 6,364 $ 35,002.00 10 MUCK EXCAVATION EV 200 CU YD $10.00 $ 2,000.00 910 $ 9,100.00 11 AGGREGATE BASE CLASS 3 MODIFIED 9,746 TON $5.92 $ 57,696.32 7,109 $ 42,085.28 12 AGGREGATE BASE CLASS 5 100% CRUSHED 2,386 TON $14.56 $ 34,740.16 2,442 $ 35,555.52 13 MILL BITUMINOUS SURFACE 2" 18 SQ YD $35.70 $ 642.60 $ 14 BITUMINOUS MATERIAL FOR TACK COAT 296 GALLON $2.50 $ 740.00 220 $ 550.00 15 TYPE SP 9.5 WEARING COURSE MIXTURE 3,13 717 TON $62.73 $ 44,977.41 $ 16 TYPE SP 12.5 NON WEARING COURSE MIXTUR 896 TON $61.71 $ 55,292.16 1,430.94 $ 88,303.31 17 4" PERF PE PIPE DRAIN 123 LIN FT $15.30 $ 1,881.90 180 $ 2,754.00 18 15" RC PIPE SEWER DESIGN 3006 CLASS V 570 LIN FT $26.52 $ 15,116.40 570 $ 15,116.40 19 18" RC PIPE SEWER DESIGN 3006 CLASS III 754 LIN FT $28.56 $ 21,534.24 754 $ 21,534.24 20 21" RC PIPE SEWER DESIGN 3006 CLASS III 10 LIN FT $40.80 $ 408.00 8 $ 326.40 21 CONNECT TO EXISTING STORM SEWER 1 EACH $357.00 $ 357.00 1 $ 357.00 22 6" DUCTILE IRON PIPE SEWER CLASS 52 10 LIN FT $51.00 $ 510.00 20 $ 1,020.00 23 8" DUCTILE IRON PIPE SEWER CLASS 52 100 LIN FT $57.63 $ 5,763.00 80 $ 4,610.40 24 16" DUCTILE IRON PIPE SEWER CLASS 52 90 LIN FT $95.12 $ 8,560.80 92 $ 8,751.04 25 4" INSULATION 4 SQ YD $38.76 $ 155.04 4 $ 155.04 26 DUCTILE IRON FITTINGS 1,035 POUND $3.06 $ 3,167.10 1,035 $ 3,167.10 27 CONNECT TO EXISTING WATERMAIN 1 EACH $510.00 $ 510.00 1 $ 510.00 28 6" GATE VALVE AND BOX 1 EACH $1,020.00 $ 1,020.00 1 $ 1,020.00 29 8" GATE VALVE AND BOX 1 EACH $1,479.00 $ 1,479.00 1 $ 1,479.00 30 HYDRANT 1 EACH $2,754.00 $ 2,754.00 1 $ 2,754.00 31 CONSTRUCT DRAINAGE STRUCTURE DESIGN 23 LIN FT $266.22 $ 6,123.06 23 $ 6,123.06 32 CONSTRUCT DRAINAGE STRUCTURE DESIGN 6 LIN FT $214.20 $ 1,285.20 6 $ 1,285.20 33 CONSTRUCT DRAINAGE STRUCTURE DESIGN 6 LIN FT $257.04 $ 1,542.24 6 $ 1,542.24 P334 CASTING ASSEMBLY 8 EACH $581.40 $ 4,651.20 8 $ 4,651.20 5 6" CONCRETE WALK 105 SQ FT $6.60 $ 693.00. 207 $ 1,366.20 S:\Municipal\AOTSEGO\385\Pay Estimates\ot385pe PE - 1 PARTIAL PAY ESTIMATE #3 CITY OF OTSEGO 70th Street Construction Project Rid Srhadi la "A" ITEM NO. ITEM DESCRIPTION ESTIMATED QUANTITY UNIT CONTRACT UNIT PRICE CONTRACTAMOUNT USED TO DATE EXTENSION 36 CONCRETE CURB & GUTTER DESIGN B618 2,334 LIN FT $9.03 $ 21,076.02 2,354 $ 21,256.62 37 TRUNCATED DOMES 16 SQ FT $30.60 $ 489.60 8 $ 244.80 38 PERMANENT BARRICADES 168 LIN FT $10.00 $ 1,680.00 168 $ 1,680.00 39 GUIDE POST TYPE B 2 EACH $38.251 $ 76.50 2 $ 76.50 40 TRAFFIC CONTROL 1 LUMP SUM $510.00 $ 510.00 1 1 $ 510.00 41 SIGN PANELS TYPE C 32 SQ FT $29.89 $ 956.48 32.25 $ 963.95 42 INSTALL SIGN 1 EACH $96.90 $ 96.90 1 $ 96.90 43 SILT FENCE, TYPE MACHINE SLICED 2,425 LIN FT $1.48 $ 3,589.00 2,414 $ 3,572.72 44 STORM DRAIN INLET PROTECTION 8 EACH $102.00 $ 816.00 8 $ 816.00 45 TEMPORARY ROCK CONSTRUCTION ENTRAN 1 EACH $1,000.00 $ 1,000.00 0 $ 46 EROSION CONTROL BLANKETS CATEGORY 3 100 SQ YD $2.04 $ 204.00 0 $ 47 EROSION CONTROL 1 LUMP SUM $1,500.00 $ 1,500.00 1 $ 1,500.00 48 TURF ESTABLISHMENT 1.6 ACRE $816.00 $ 1,305.60 1.60 $ 1,305.60 49 4" SOLID LINE WHITE - EPDXY 2,119 1 LIN FT 1 $0.30 $ 635.70 2,097 $ 629.10 50 4" DOUBLE SOLID LINE YELLOW- EPDXY 1,058 1 LIN FT 1 $0.61 $ 645.38 1,055 $ 643.55 Total Bid Schedule "A" Bid Schedule "A" TOTAL Total Work Completed to Date LESS 5% RETAINAGE: LESS PAY ESTIMATE # 1 LESS PAY ESTIMATE # 2 WE RECOMMEND PAYMENT OF: APPROVALS: CONTRACTOR: FEHN COMPANIES, INC. $ 350,657.51 $ 350,657.51 Certification by Contractor: I certify that all items and amounts are correct for the work completed to date. Signed: Title: Date ENGINEER: HAKANSON ANDERSON Certification by Engineer: We recommend payment for work and quantities as shown. Signed: Title: Date OWNER: CITY OF OTSEGO Signed: S:\Municipal\HOTSEGO\385\Pay Estimates\ot385pe PE - 2 $ 329,910.87 $ 329,910.87 $ 329,910.87 $ 329,910.87 $ 16,495.54 $ 106,344.94 $ 152,590.06 $ 54,480.33 10 0tsTe" Co MINNESOTA DEPARTMENT INFORMATION Request for City Council Action ORGINATING DEPARTMENT: REQUESTOR: MEETING DATE: Finance Department Finance Director Groen August 27, 2012 PRESENTER(s): REVIEWED BY: ITEM #: Consent City Administrator Johnson 3.413 AGENDA ITEM DETAILS RECOMMENDATION: The Finance Department requests the City Council approve the request for payment from Kinghorn Company subcontractors for work completed to date for the build out of the public works facility for city offices. ARE YOU SEEKING APPROVAL OF A CONTRACT? IS A PUBLIC HEARING REQUIRED? The contract was approved on May 29, 2012 N/A BACKGROUND/JUSTIFICATION: The City Council approved the contract with Kinghorn Company on May 29, 2012 to build out the public works facility to house the offices of the city staff. Kinghorn Company has provided the attached approved application and certificate for payment from the following subcontractors: Acoustics Associates, Inc. $1,208.00 J. Becher & Assoc., Inc. $9,564.01 AM Painting of Princeton, Inc. $8,384.00 Lefebvre's Carpet $8,264.18 Classic Glass & Mirror $3,850.00 Light FX Window Coverings, LLC $4,229.04 GR Mechanical $7,325.00 Twin City Hardware $9,050.00 Kinghorn Company $14,058.02 TCW Flooring $2,140.00 Interior Components Group, Inc. $18,389.00 Total 586,461.25 SUPPORTING DOCUMENTS: X ATTACHED ❑ NONE • Contractor invoices MOTION: (Please word motion as you would like it to appear in the minutes.) Motion to approve the payment for work completed to date for the build out of the public works facility. BUDGET INFORMATION FUNDING: BUDGETED: X YES Revolving Capital Improvement Fund ❑ NO ACTION TAKEN ❑ APPROVED AS REQUESTED ❑ DENIED ❑ TABLED ❑ OTHER (List changes) COMMENTS: Aqnghorn COMPANY GENERAL CONTRACTORS Job: Otsego City Office Location: Otsego Prepared For: Lori Johnson Architect: HTG Site Engineer: NA Request for Payment Prepared By: Structural Engineer: Date: Kinghorn Construction 14198 Northdale Blvd Rogers, MN 55374 NA No. Description Contract Amount Previously Pd Draw #2 Add ons Total Cost "Contract Bal. 01-0 General requirements $ 7,880.00 $ 3,515.00 $ 4,365.00 $ - $ 7,880.00 $ - 06-0 Wood & Plastics $ 26,007.00 $ 935.00 $ 19,454.00 $ - $ 20,389.00 $ 5,618.00 08-0 Doors & Windows $ 23,712.00 $ 2,338.96 $ 21,373.04 $ 1,612.00 $ 25,324.00 $ 1,612.00 09-0 1 Finishes $ 38,897.00 $ 16,740.00 $ 22,157.00 $ 2,140.00 $ 41,037.00 $ 2,140.00 15-0 Mechanical $ 10,050.00 $ 5,125.00 $ 4,925.00 $ 3,350.00 $ 13,400.00 $ 3,350.00 16-0 Electrical $ 16,230.00 $ 11,545.00 $ 3,000.00 $ - $ 14,545.00 $ 1,685.00 17-0 Design /Interior Design $ 4,900.00 $ 3,395.00 $ 5.00 $ - $ 3,400.00 $ 1,500.00 18-0 Profit & Overhead $ 8,299.00 $ 4,199.00 $ 4,100.00 $ - $ 8,299.00 $ - 19-0 Owners Contingency 7% $ 9,520.00 $ - $ - $ 9,520.00 TOTAL BUILDING COST $ 145,495.00 $ 47,792.96 $ 79,379.04 $ 7,102.00 $ 134,274.00 $ 11,221.00 Total Payments Due (Draw Request #2 & Add ons) $ ** Project under budget $11,221.00 86,481.04 ZJV S C=ad`.: ®ata 14198 Northdale Blvd. - Rogers, MN 55374 - Tel: 763-428-8088 - Fax: 763-428-8090 PAYMENT APPLICATION _.._ !_��1' Cr '';� _�� Page 1 TO: KINGHORN COMPANY PROJECT QTSEGG PUBLIC WORKS APPLICATION it 1 Distribution to: 14198 NORTHDALE SLVa NAME AND LOCATION OTSEGO PUBLIC WORKS PERIOD THRU; C]0&14=2 OWNER ROGERS, MN 55374 $0-00 PROJECT ft: JOHNS ❑ARCHITECT OTSEGt7, MN DATE OF CONTRACT: 87131*012 ❑❑ CONTRACTOR FROM; ACOUSTICS ASSOCIATES, INC ARCHITECT; 1250 ZANE AVE N ❑ MINNF_APpLIS, MN 65422 FOR: ACMSTICAL CEILINGS CONTRACTOR'S SUMMARY OF WORK Appllcalion is made for payment as shown glow, Continuation Page is attached, 1. CONTRACT AMOUNT $1,209.00 2_ SUM OF ALL CHANGE ORDERS $0.00 3. CURRENT CONMCT AMOUNT (Line 1 +l- 2) $1,208,00 4. TOTAL COMPLETED AND STORED (Column G on Conlinuation Page) 5. RETAINAGE: a. 0.00% of Completed work (Columns D + E on Continuation Page) b. 0.00% of Materlal Stored (Column F on Continuation Page) Total Retainage (Une 6a + 5b or Column I on Continuation Page) $1,208,00 $0.00 $0.00 $0.00 6. TOTAL COMPLETED AND STORED LESS RETAINAGE $1,208.40 (Line d nhinus Line 5 Total) 17, LESS PREVIOUS PAYMENT APPLICATIONS 9_ PAYMENT OUE `9- BALANCE TO COMPLETION (Line 3 minus Line 8) $0.00 $0.00 SUMMARY Of CHANGE ORDERS ADDITIONS DEDUCTIONS Total changes approved in previous months $0.06 $0-00 Total approved this month $0.00 $0-00 TC?TALS $4.00 1 $0.00 NET CHANGES $0-00 PAYMENT APPLICATION � � 4 rti14 ► � nlnnoura hwlew is his assurance to Owner, concerning the payment herein applied for, t required in the Contract Documents, (2) all sums previously been used to pay Contract 's costs for labor, materials er Work previously paid for, and (3) Contractor Is legally r Lo FES, INC &W_0,V% Date: Subscribed and swom to before HARON LYNN JANUSZEWS� rr 11 ' 1 ryeNotary Public me this `t day of � l2— Minnesma 111 hl Commis5ron Expire . s, Jan. 31 20: Notary Public: Q" My Commission Expires: JANUARY 31, 2013 ARCHITECT'S CERTIFICATION Archite t'5 signature below K his assurance to Owner, oonceming [he payment herein applied for, that: (1) Archiloat has inspected the Work represented by this Application, (2) such Work has been completed to the rodent indicated in this Application, and the que lits of workmanship and materials conforms with the Contract Documents, (3) this Appllcation for Payment accurately stales the amount of Work completed and payment due therefor, and (4) Architect knows of no reason why paymerrt should not be made. CERTIFIEDAMOUNT......................................................................................... (if the cervF#ed am unt is aftrent fiurrr the payawt due, you should attach an explanation. bulls0 all the itgures mat are changed to match tho 0010ed amotmf.) ARChfFFECP Date' , Neither this Application nor payment applied for herein is assignable or negotiable. Payment shall be made only to Contractor, and is without prejudioe to any rights of Owner or Contractor under the Contract Documents or otherwise. Quantum Software Solutions, Inc. Document �o'h -} 'i�q C" I �t CONTINUATION PAGE Page 2 of 2 PROJECT: OTSEGO PUBLIC WORKS APPLICATION #: 1 OTSEGO PUBLIC WORKS DATE OF APPLICATION: 6814J2012 Payment Application oonlaining Contractor's sipalurs is attached. PERIOD THRU: 08114!2012 PROJECT at : .JOHNS A D C D E F G H I COMPLETED WORK STORED TOTAL 4fi BALANCE ITEM #t WORK DESCRIPTION SCNEIJtJ AMOUNTT AMOUNT AMOUNT MATERIALS COMPLETED AND COMP. TO RI=TAfNAGE PREVIOUS THIS PERIOD (NOT IN D OR E) STORED (G I C) COMPLETION (If Variable) PERIODS (D + E + F) (C -G) 01 PATCH EXISTING CEILINGS $1,268.00 $0.04 $1,208,00 $0.00 $1,208.04 100% $O.4o TOTALS $1,208.00 $0.00 $1,208.04 $0.00 51,208.00 1 100%1 $0.00 CONTINUATION PAGE Quantum Software Solutions, Inc. Document 41q -(41 %45-390 APPLICATION AND CERTIFICATE FOR PAYMENT AIA (fDOCUMENT G702 (instructions on reverse side) PAGE ONE OF PAGES TO OWNER: n PROJECT: b4 Sent p �c �tU wo V'�CS APPLICATION NO.: Distribution to: b\Ol dam^ �� - PERIOD TO: _1 -73k -\Q El OWNER �� 3�� PROJECT NOS.: ❑ ARCHITECT I Vh ❑ CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: CONT"' ❑ El CONTRACT FOR -5, �S,"`�-�� ►^'� 5S 3� 1 e CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certi s knowledge, infor- mation and belief the Work cover is been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which pt a issued and pay - 3 ments received from the Owner, , �Liown herein is now due. 1. ORIGINAL CONTRACT SUM .................. $ 2. Net change by Change Orders ............... $ 3. CONTRACT SUM TO DATE (Line I t 2) ........$ �' 4. TOTAL COMPLETED & STORED TO DATE ...... $ (Column G on G703) 5. RETAINAGE:' a. % of Completed Work $ (Columns D + E on G703) b. % of Stored Material $ (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) ............ • • • • • $ 6. TOTAL EARNED LESS RETAINAGE ............ E' `f (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) .................8 8. CURRENT PAYMENT DUE ................. 1 $ 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) f 11 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS NET CHANGES by Change Order CONTRACTOR: r n Y State of: County of: Subscribed and sworn to before me this I q+,-- day of Notary Public: My Commission expires: Date TINA MARTIN NOTARY PUBLIC -MINNESOTA My Commission Expires Jan. 31, 2015 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, 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. AMOUNT CERTIFIED ............................... S (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Application: and on the Continuation Sheet that are changed to conform to the amount certified.) hRE+H+FrET:a i BY: Date: I1"� This Certificate is not neg Liable. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owncr or Contractor tinder this Contract. Ht=OrtcK:r r. I;rJl ,frlrit_ i 1 C� ® r G702-1992 LU 1�1G��L F 1 Dol S a CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. APPLICATION NO.: APPLICATION DATE: PERIOD TO: ARCHITECT'S PROJECT NO.: A B C D E F G if I ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (D+E+F) % (G _ C) BALANCE TO FINISH (C - G) RG'I'AINAGE (IF VARIABLE) RAPE) FROM PREVIOUS APPLICATION (D + E) THIS PERIOD J U AIA DOCUMENT G703 - CONTINUATION SHERT FOR 6702 - 1992 EDITION - AIAO - ©1992 - THE AMERICAN INSTITUTE OF ARCIIITEC-rs, 1735 NEW YORK AVENUE. NW. WASHINGTON, ON, D.C. 20006-5292 -WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G703-1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. . Jultl7.2012 06:07 AM PAINTING AM Painting of"Princeton, Inc. 32015 1281h St. NW - Suite A Princeton, MN 55371 Bill To kinghorn Construction Co 14199 Northdale Blvd Rogers, M N 55374 Attn: John S 7638562921 PAGE. 1/ 1 Invoice Date Invoice # 7/11/2012 3554 P.O. No. Terms Project Net 10 Otsego Maintenance Item Description Est Amt Prior Amt Prior % Qty Rate Curr % Total % Amount Painting Mask as necessary, . Prime. point A walls and ceilings per print. 7,822.00 7,822.00 100.00%, 100,00',ro 7.922.00 Finish any new frames. Painting Additional walls and door framcy, 562.00 562.00 100.00% 100.00% 562.00 Total U9 194 uu Payments/Credits Vn.txl Balance Due $M,3941.00 ArrLII.A � ww ru�u 1 `.CONTRACTOR: Kingborn Construction 14198 Northdale Blvd. Rogers, MN 55374 FROM SUBCONTRACTOR: GDS ENTERPRISES; DBA CLASSIC GLASS & MIRROR PROJECT: VIA ARCHITECT: Otsego Public Works Otsego, MN APPLICATION NO: PERIOL 19920 Industrial Drive Big Lake, MN 55309 CONTI ALUMINUM STOREFRONT &GLASS: Distribution to: =OWNER =ARCHITECT CONTRACTOR 0 0 CONTRACT FOR. CONTRACTOR'S APPLICATION FOR PAYMENT .e Contractor's knowledge, The undersiginformation the Work covered oy till., �+Y�=. tion for Payment has been Application is made for payment, as shown below, in connection with the Contract. and belief completed in accordance with the Contract Documents, that all amounts have been paid by Continuation Sheet, AIA Document G703, is attached. the Contractor for Work for which previous Certificates for Payment were issued and shown herein is now due. payments received from the Owner, and that current payment 1. ORIGINAL CONTRACT SUM $ 3,850$ 0 CONTRACTOR: 2. Net change by Change Orders $ 3,850 3. CONTRACT SUM TO DATE (Line 1 f 2) $ 3,850 Date: 7/15/2012 4. TOTAL COMPLETED & STORED TO By: James C. Draack / CEO DATE (Column G on G703) County of: 5. RETAINAGE: 0 a. loco 5o % of Completed Work $ State of: Minnesota Subscribed and sworn to before me this day of (Column D + E on G703) Notary Public: b. % of Stored Material $ My Commission expires: N/A (Column F on G703) Total Retainage (Lines 5a+5b or ARCHITECT'S CERTIFICATE FOR PAYMENT Total in Column I of G703) $ $ 0 3,850 In accordance with the Contract Documents, based on on-site observations and the data to the Owner that to the best of the 6. TOTAL EARNED LESS RETAINAGE comprising the application, the Architect certifies belief the Work has progressed as indicated, (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and the of the Work is in accordance with the Contract Documents, and the Contractor $ PAYMENT (Line 6 from prior Certificate) $ 0 5 quality is entitled to payment of the AMOUNT CERTIFIED. 8. CURRENT PAYMENT DUE C. 0 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED ........... $ �Y►�� (Line 3 less Line 6) ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all figures on this to conform with the amount certified.) CHANGE ORDER SUMMARY Application and onthe Continuation Sheet that are changed Total changes approved $0 00 in months by Owner $0.00 A Remi -eT: ^^ } C1 — Date: `'� 11 "1) 1 '� previous Total approved this Month $0.00 $0.00 $0.00 $0.00 is to Thisand acceptance ote is not gotiable. The AMOUNT lt payment fare withoute TOTALS Contractorclnamed herein. issuance, aymentt prejudice to any rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order :?,0.00 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 AIA DOCUMENT G702 - APPLICATION AND CERTIFICATION FOR PAYMENT • 1992 EDITION • AIA - 01992 AIA Document D401 - Certification of Document's Authenticity from the Licensee. Users may obtain validation of this document by requesting a completed Classic Glass *Mirror 19920 Industrial Drive Big Lake, MN 55309 Ph: 763-262-2881 Fax: 763-262-2882 A B ITEM DESCRIPTION OF WORK NO. SCHEDULE OF VALUES 1 PROJECT MANAGEMENT 2 ENGINEERING & SHOP DRAWINGS MATERIAL 3 ALUMINUM CHANNELS & RAILS 4 GLASS LABOR 5 SHOP LABOR 6 FIELD LABOR CHANGE ORDERS Totals Billing No. 1 APPLICATION DATE: 15 - Jul -12 PERIOD 'r0: 31 -Jul -12 ARCHITECT'S PROJECT NO: Otsego Public Works CLASSIC GLASS PROJECT NO: 1253-12 D E WORK COMPLETED F MATERIALS G TOTAL % H BALANCE I RETAINAGE (IF ( C SCHEDULED VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G'- C) TO FINISH RATE) STORED AND STORED (C - G) 0% (D + E) (NOT IN TO DATE D ORE) (D+E+F) 100 100 100.00% 0 0 100.00 0 100.00 0 100 100 100.00% 1,500.00 0 1,500 1""1'0-'00 0 0 1,200.00 0 1,200 1,200 100.00% 100.00 0 100 100 100.00% 0 850.00 0 850 850 100.00% 0 0 0 0 0 3,850.00 0 3,850 0 3,850 100.00% 0 CGM Classic Glass & Mirror 19920 Industrial Drive Big Lake, MN 55309 Bill ..• Kinghom Construction 14198 Northdale Blvd Rogers, NIN 55374 Invoice Date Invoice # 7/19/2012 41072 Federal ID: EIN68-0553448 State ID: 6486877 Balance Due $3,850.00 P.O. No. Terms Due Date Rep Project Per Contract Net 30 8/18/2012 JD Otsego Public Works Quantity Description Amount 1 PM 100.00 1 Shop Drawings 100.00 1 Aluminum 1,500.00T 1 Glass 1,200.00T 1 Shop Labor 100.00 1 Field Labor 850.00 Tax Included Above 0.00 If you have any questions concerning this invoice please call 763-262-2881 Total $3,850.00 Federal ID: EIN68-0553448 State ID: 6486877 Balance Due $3,850.00 H1�l-q1qq5-L--'-P0 APPLICATION AND CERTIFICATE FOR PAYMENT Journal Date: PAGE 1 OF 2 SUBMITTED TO: Kinghom Construction PROJECT: Otsego Public Works APPLICATION NO: 1 14198 Northdale Blvd 13400 90th Street NE APPLICATION DATE: 7/2 012 01 2 Rogers, MN 55374 Otsgeo, MN PERIOD TO: 07-31-2012 by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for PROJECT NO: Otsego PW SUBMITTED FROM: GR Mechanical ARCHITECT: CONTRACT DATE: 5% OF COMPLETED WORK $ 12401 Ironwood Circle #500 COMMITMENT: Rogers, MN 55374 CONTRACT FOR: VENDOR NO.: CONTRACT NO: 2011-07-0316 I hereby certify that the work performed and the material supplied to date, as shown here, represent the actual ORIGINAL CONTRACT SUM $ 3,975.00 value of accomplishment under the terms of the Contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above -referenced project. I further certify that no labor or NET CHANGE BY CHANGE ORDERS TO materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any type whatsoever, other than the contract duly authorized and executed change orders, and the undersigned CONTRACT SUM TO DATE $ 3,975.00 does hereby releases RJM Construction from any claim or liability therefor for the period covered by this application. I also certify that payments, less applicable retention, have been made through the period covered TOTAL COMPLETED AND STORED TO DATE $ 3,975.00 by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for RETAINAGE: all material and labor used in or in connection with the performance of this Contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation 5% OF COMPLETED WORK $ Laws and Workman's Compensation laws insofar as applicable to the performance of this contract. 5% OF STORED MATERIAL TOTAL RETAINAGE PARTIAL WAIVER OF LIEN TOTAL EARNED LESS RETAINAGE $ 3,975.00 NOW THEREFORE, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER $ all mechanic's liens or other liens against the above real estate or any part thereof for any of the materials LESS PREVIOUS CERTIFICATES FOR PAYMENT $ and/or labor therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor and/or materials furnished after said date. CURRENT PAYMENT DUE $ 3,975.00 The person signing below does hereby certify that he/she is fully authorized and empowered to execute this instrument and to bind the Undersigned hereto, and does in fact so execute this instrument. GR Mechanical 12401 Ironwood Circle #500 Rogers, MN 55374. Signed: Printed or Typed d Name,Title: BALANCE TO FINISH INCLUDING RETAINAGE $ State of: Minnesota County of: Hennepin ��p�[,1�,��( V, �. . E KAE filo%.". i'. i. l c' H I g O N Subscribed and sworn to before me ttt�s:�'��</•>;,;;..\ , ; t-„ �, , .�. 20 day of July 2'•IOtRf;l i' Ublic-Minnesotp '•asr....:: My Commission Expires Jan 31, 2015 iv!N�fT</4"•F.A.zf•An nn r,nr,/\M!!�.M'�/�+'��1/�Mf%- NOTARY PUPLIC: _ Signed: My Con CONTINUATION SHEET Otsego Public Works APPLICATION NUMBER: 1 APPLICATION DATE: 7/20/2012 PERIOD TO: 7/31/2012 ARCHITECT'S PROJECT NO: A B C D I E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE PRESENTLY COMPLETED (G -C) TO FINISH FROM PREVIOUS THIS PERIOD APPLICATION STORED AND STORED (C -G) (D+E) (NOT IN TO DATE 5% D OR E) (D+E+F) Permits $ 150.00 $ 150.00 $ 150.00 100% $ $ Mobilization $ 150.00 $ 150.00 $ 150.00 100% $ $ San Waste & Vent M $ 500.00 $ 500.00 $ 500.00 100% $ $ San Waste & Vent L $ 975.00 $ 975.00 $ 975.00 100% $ $ Water Pipe M $ 500.00 $ 500.00 $ 500.00 100% $ $ Water Pipe L $ 800.00 $ 800.00 $ 800.00 100% $ $ Fixtures M $ 400.00 $ 400.00 $ 400.00 100% $ $ Fixtures L $ 500.00 $ 500.00 $ 500.00 100% $ $ $ 3,975.00 $ $ 3,975.00 $ $ 3,975.00 1 100% $ $ G R MECHANICAL PLUMBING & HEATING INC 12401 IRONWOOD CIRCLE, SUITE 500 ROGERS, MN 55374 TEL: 763-428-2663 FAX: 763-428-7656 BILL TO Kinghorn Construction 14198 Northdale Blvd Rogers, MN 55374 INVOICE DATE INVOICE # 7/16/2012 10967 P. O. NO. TERMS PROJECT Net 30 8825-OTSEGO PUBLIC WORKS DESCRIPTION AMOUNT PLUMBING LABOR AND MATERIALS FOR OTSEGO PUBLIC WORKS 3,975.00 AMOUNT DUE $3,975.00 PLEASE PAY FROM THIS INVOICE, NO STATEMENT WILL BE MAILED. 1-1/2% SERVICE CHARGE WILL BE ADDED EACH MONTH TO ALL UNPAID ACCOUNTS. yly-yig45 ala Journal Date: APPLICATION AND CERTIFICATE FOR PAYMENT PAGE 1 OF 2 SUBMITTED TO: Kinghorn Construction PROJECT: Otsego Public Works APPLICATION NO: 2 14198 Northdale Blvd 13400 90th Street NE APPLICATION DATE: 8/16/2012 PERIOD TO: 08-31-2012 Rogers, MN 55374 Otsgeo, MN PROJECT N0: Otsego PW ARCHITECT: CONTRACT DATE: SUBMITTED FROM: GR Mechanical COMMITMENT: 12401 Ironwood Circle #500 Rogers, MN 55374 CONTRACT FOR: VENDOR NO.: CONTRACT NO: 2011-07-0316 I hereby certify that the work performed and the material supplied to date, as shown here, represent the actual ORIGINAL CONTRACT SUM $ 3,975.00 value of accomplishment under the terms of the Contract (and all authorized changes hereto) between the undersigned and RJM Construction relating to the above -referenced project. l further certify that no labor or NET CHANGE BY CHANGE ORDERS TO $ 3,350.00 materials have been supplied under contracts, agreements, verbal or written, or any other arrangement of any executed change orders, and the undersigned CONTRACT SUM TO DATE $ 7,325.00 type whatsoever, other than the contract duly authorized and does hereby releases RJM Construction from any claim or liability therefor for the period covered by this m TOTAL COMPLETED AND STORED TO DATE $ 7,325.00 application. I also certify that payments, less applicable retention, have been made through the period covered by previous payments received from the contractor to 1) all my subcontractors (sub -subcontractors) and 2) for RETAINAGE: all material and labor used in or in connection with the performance of this Contract. I further certify that I have complied with Federal, State, and local tax laws, including Social Security laws, Unemployment Compensation 5% OF COMPLETED WORK Laws and Workman's Compensation laws insofar as applicable to the performance of this contract. 5% OF STORED MATERIAL PARTIAL WAIVER OF LIEN NOW THEREFORE, upon receipt of the payment of the current payment due on this application the undersigned does hereby irrevocably release and waive any and all mechanic's liens or rights to claim any and all mechanic's liens or other liens against the above real estate or any part thereof for any of the materials and/or labor therefore furnished or performed in connection with this project, reserving, however, all lien rights for labor andlor materials furnished after said date. The person signing below does hereby certify that he/she is fully authorized and empowered to execute this Instrument and to bind the Undersigned hereto, and does in fact so execute this instrument. GR Mechanical 12401 Ironwood role #50 Rogers, MN 5374 T Signed: %� Printed or Typed Name,Title: TOTAL RETAINAGE TOTAL EARNED LESS RETAINAGE $ 7,325.00 LESS OWNER DIRECT PAYMENT BY PURCHASE ORDER $ - LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 3,975.00 CURRENT PAYMENT DUE $ 3,350.00 BALANCE TO FINISH INCLUDING RETAINAGE State of: Minnesota County of: Hennepin Subscribed and sworn to before me 16 day of August NOTARY Signed: My Commission yp `fit_ P. JOHNSON R 2r\1Of,ry Public-Mirin.W°ota My Commission Expires.1-1, 01. 2015 ^d+n.•Md..+�han;�n 7 :e'ri,,i+�+4�'c✓•frr1/�M/�l .. w�✓ CONTINUATION SHEET Otseqo Public Works APPLICATION NUMBER: 2 APPLICATION DATE: 8/1612012 PERIOD TO: 8/31/2012 ARCHITECT'S PROJECT NO: D WORK COMPLETED E F MATERIALS PRESENTLY STORED (NOT IN G TOTAL COMPLETED AND STORED TO DATE % (G -C) H BALANCE TO FINISH (C -G) I RETAINAGE 5% A B C ITEM NO DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS APPLICATION (D+E) THIS PERIOD D OR E) (D+E+F) $ 150.00 $ 150.00 $ 150.00 $ 150.00 100% 100% $ $ $ $ Permits $ 150.00 Mobilization $ 150.00 San Waste &Vent M $ 500.00 San Waste & Vent L $ 975.00 $ 500.00 $ 975.00 $ 500.00 $ 975.00 100% 100% $ $ _ $ $ - Water Pipe M $ 500.00 Water Pipe L $ 800.00 $ 500.00 $ 800.00 $ 500.00 $ 800.00 100% 100% $ $ _ $ $ - Fixtures M $ 400.00 Fixtures L $ 500.00 $ 400.00 $ 500.00 $ 400.00 $ 500.00 100% 100% $ $ _ $ $ - Check valves $ 2,150.00 $ - $ 2,150.00 $ 2,150.00 100% $ $ Istallation of check valves $ 1,200.00 $ - $ 1,200.00 $ 1,200.00 100% $ $ $ 3,975.00$ 3,350.00 $ $ 7,325.00 100% $ - $ $ 7,325.00 G R MECHANICAL PLLJMBIN(:T & HEATING INC 12401 IRONWOOD CIRCLE, SUITE 500 ROGERS, MN 55374 TEL: 763-428-2663 FAX: 763-428-7656 BILL TO Kinghorn Construction 14198 Northdale Blvd Rogers, MN 55374 INVOICE DATE INVOICE # 8/17/2012 11020 P. O. NO. TERMS PROJECT Net 30 8825-OTSEGO CITY HALL DESCRIPTION AMOUNT PAY APP #2 -LABOR AND MATERIALS TO INSTALL CHECK VALVES AT OTSEGO CITY HALL 3,350.00 AMOUNT DUE $3,350.00 PLEASE PAY FROM THIS INVOICE, NO STATEMENT WILL BE MAILED. 1-1/2% SERVICE CHARGE WILL BE ADDED EACH MONTH TO ALL UNPAID ACCOUNTS. qlq-q R APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER: PROJECT: Otsego Public Works APPLICATION NO.: 2 Distribution to: City of Otsego PERIOD TO: 8/15/2012 ❑ OWNER 13400 90 Street NE., Otsego, MN 55330 PROJECT NOS.: ❑ ARCHITECT ❑ CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: HTG Architects CONTRACT DATE: ❑ Kinghorn Company 0 co4iv1�9, 4oAVale Blvd., Rogers, MN 55374 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application Is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay - 1. ORIGINAL CONTRACT SUM .................. f 26,102.02 ments received from the Owner, and that current payment shown herein is now due. 2. Net change by Change Orders ............... S 3. CONTRACT SUM TO DATE (Line 1 t 2) ........ S26,102.02 4. TOTAL COMPLETED & STORED TO DATE ...... s26,102.02 (Column G on G703) 5. RETAINAGE: a. % of Completed Work so (Columns D + E on G703) 0 b. % of Stored Material $ ADDITIONS (Column F on G703) Total changes approved in previous months by Owner Total Retainage (Line 52 + 5b or 'Ibtal in Column I of G703) ................. $Q 6. TOTAL EARNED LESS RETAINAGE ............ s26,102.02 (Line 4 less Line 5 Total) 7, LESS PREVIOUS CERTIFICATES FOR PAYMENT 12,044.00 (Line 6 from prior Certificate) ................. i S. CURRENT PAYMENT DUE ................. F S 14.058.02 9. BALANCE TO FINISH, INCLUDING RETAIN (Line 3 less Line 6) t V CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS NET CHANGES by Change Order Ff."ORU£Ft f•fllthl 414cit-`'t CONTRACTOR: By: State of: vv -\V'\ County of: W Date: Subscribed and sworn to before me this 1-14-- day of moi Y=; TINA MARTIN NOTARY PUBLIC -MINNESOTA j✓✓. ` ��t/ t¢/-��✓�— My Commission Expires Jan. 31, 2015 Notzry Pubilc;Na My Commission expires•. APGH4-T-EGT—!S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, 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. AMOUNT CERTIFIED ........................ , ...... S (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this App(icativn and on the Continuation Sheet that are changed to conform to the ansount certified.) B�y.,�� Dace: This Certificate is not negotiable. The AMOUNT CERTIFIED Is payable only to the Con• tractor name herein. ls%uance. payment and acceptance of payment are without prejudice to any rights of the Oxvncr or Contractor under this Contract. G702-1992 �� r V s -i CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) Wil: OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification, is attached. APPLICATION DATE: 8/15/2012 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 8/15/2012 Llsc Column I on Contracts where variable rctainagc for fine Items may apply. ARCHITECT'S PROJECT NO.: A C D E F G it [ ITEM SCIIEDULED WORK COMPLETED MATERIALS TOTAL CDMPLF.TF.b % BALANCEPRESENTLY TO RE'T'AINAGFE, 1)ESCRli'TtON OF WORK VALUE FROM PREVIOUS APPLICATION THIS PERIOD 5TORF.D (NOT IN AND STORED 10 DATE (G t C) FINISIT (IF VARIABLE)NO ItK]'E) (D + E) D OR E) (1)+E+F) (C 01 General Requirements $7,880.00 $3,515.00 $4,365.00 0 $7,880.00 100% $0 06 Wood & Plastics $2,000.00 $935.00 $1,065.00 0 $2,000.00 100% $0 08 Doors & Windows $3,521.03 $0 $3,521.03 0 $3,521.03 100% $0 09 Finishes $51.99 $0 $51.99 0 $51.99 100° $0 15 Mechanical $950.00 $0 $950.00 0 $950.00 100% $0 17 Design & Engineering $3,400.00 $3,395.00 $5.00 0 $3,400.00 100% $0 18 Profit & Overhead $8,299.00 $4,199.00 $4,100.00 0 $8,299.00 1o0% $0 1$26,102.02 1$12.044.00 1$14.058.02 10.00 1$26.102.02 1100% $0 AIA DOCUMENT 6703 - CONTINUATION 511111 T FOR 07112 ■ Ic)9)2 EDITION - AtA* - 01992 - 1711i AItERICAN IWITUTE OF ARCI IITE(:I�, 1735 NEW YORK AVFM IE, NW., WADI IING ION, TH. 21'(Wq -5292 - WARNING: Unlicensed photocopying violate* U.S. copyright laws and wlp vA*ct the violator to legal prosemAlon. G703-1992 `CAUTION: You h..Id use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. APPLICATION AND CERTIFICATE FOR PAYMENT arQ nnC'r1MF.NTCr702/CMa TO OWNER: City of Otsego 13400 90th Street NE Otsego, MN 55330 FROM CONTRACTOR: Interior Components Group, Inc. 1646 Highway 23 East Saint Cloud, MN 56304 PROJECT: Otsego Public Works Expansion and Remodel q1q-q1q45-390 CONSTRUCTION MANAGER -ADVISER EDITION APPLICATION NO: PERIOD TO: 7/31/2012 PROJECT NO: CONTRACT DATE: PAGE 1 OF 1 PAGES Distribution to: OWNER GENERAL CONTRACTOR ARCHITECT =CONTRACTOR VIA CONSTRUCTION MANAGER: CONTRACT FOR: Otesgo Public Works VIA ARCHITECT: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached. 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 is now due. I. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line 1 f 2) 4. TOTAL COMPLETED & STORED TO DATE (Column 0 on G703) 5. RETAINAGE: a. 5 %of Completed Work (Column D + E on U70 ) b. 5 % of Stored Material (Column F on Total Retainage (Lines 5a + 5b or Total in Colum I of G703) 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line -)Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE CE TO FINISH INCLUDING RETAINAGE 18,389.00 $ CONTRACTOR: By: Date: $ 0.00 State of- Subs f: Subscribed and wo to of a ay of I $ 0.00 Notary Publi 1181 My Commis xpires: , MY CCI . 0.00 $ 18,389.00 .................................. 0.00 In accordance with the Contract Documents, based on on-site observations and the data comprising this application, 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 the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALAN W (Line 3 less Line 6) AMOUNT CERTIFIED $ l'otal changes approve in previous months by Owner $0.00 Total approved this Month $0.00 TOTALS $0.00 $0.00 NET CHANGES by Change Order 1 $0.00 (Attach explanation if'amount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet that changed to conform to the amount certified.) CONSTRUCTION MANAGER: By: Date: By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractornamed herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702/CMa APPUCATION AND CERTIFICATION FOR PAYMENT - CONSTRUCTION MANAGER -ADVISER EDITION 1992 EDITION - AIA® ®1992 G7021CMa-1082 THE AMERICAN INSTITUTE OF ARCHITECTS. 1745 NEW YORK AVE.. N.W., WASHINGTON, DC 20005-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity `v� Interior Components Group, Inc. 1646 Hwy 23 E St Cloud, MN 56304 Billed To: Kinghorn Construction 14198 Northdale Blvd Rogers MN 55374 interior --'TComponents -Group, Inc. 4', Corn;nerdai Cas -,work Ri Aai'. Fixtures (r op"'m Furniture 1646 Hwy 23 E St Cloud, MN 56304 320.230.9525 Phone 320.230.9527 Fax Invoice Invoice#: 201404 Date: 07/30/2012 Project: Otsego Public Works Otsego MN Job # 2915 Due Date: 08/30/2012 Terms: ODY Client PO# Sales Rep2001 Description Caseworks; Installed Notes: Thank you for your prompt payment! A service charge of 1.5 % per month will be charged on all amounts overdue on regular statement dates. Amount 18, 389.00 Non -Taxable Amount: 18,389.00', Taxable Amount: 0.00' Sales Tax: 0.00 Total 18,389.00' Amount Due 18,389.00 J. Becher . rpila; - & Assoc. Inc. ELECTRICAL CONTRACTORS 6 INTEGRATION SPECIALISTS 20610 Commerce Boulevard Rogers MN 55374 763-428-8630 License: EA000246 Owner: KINGHORN COMPANY 14198 Northdale Blvd Rogers MN 55374 Job Location: Otsego Public works HV 13400 90th St NE Otsego MN 55330 Application For Payment On Contract Original Contract ...................................... 14,545.00 Net Change by Change Orders ................ 0.00 Contract Sum to Date ............................... 14,545.00 Total Complete to Date ............................ 14,545.00 Total Retained .......................................... 0.00 Total Earned Less Retained .................... 14,545.00 Less Previous Billings .............................. 11,545.00 Current Payment Due ............................. 3,000.00 Balance on Contract ................................. 0.00 Progress Billing Application: 2 Period: 07/28/2012 Contractor's Certification of Work The undersigned contractor certifies that, to the best of the contractor's knowledge, the work on the above named job has been completed in accordance with the plans and specifications to the level of completion indicated on the attached schedule of completion. Contractor:—WA A4k— Date: �— 731-1Z Terms: Invoices are due and payable 15DY from the date of invoice. All overdue amounts will be charged a service charge of 18.00 % per anum. Please make checks payable to: J. Becher & Assoc. Inc. Thank you for your prompt payment. PROGRESS BILLING Schedule of Work Completed Description of Work Scheduled 10100.000 Permit/ inspectio 250.00 10500.000 Rough -in 11,295.00 10600.000 Finish wiring 2,000.00 10700.000 Fixture 1,000.00 Totals: 14,545.00 Application: 2 Period: 07/28/2012 Changes Contract previous Current Comp. Stored Mat. Total Comp. 250.00 % 100.00 250.00 250.00 11,295.00 100.00 11,295.00 11,295.00 2,000.00 2,000.00 100.00 2,000.00 1,000.00 1,000.00 100.00 1,000.00 14,545.00 11,545.00 3,000.00 14,545.00 100.00 Page 2 of 2 Balance Retained U J.Becher WL,-• s; iL>�- & Assoc. Inc. ELECTRICAL CONTRACTORS & INTEGRATION SPECIALISTS 20610 Commerce Boulevard Rogers MN 55374 763-428-8630 License: EA000246 Billed To: KINGHORN COMPANY Kinghorn Company 14198 Northdale Blvd Rogers MN 55374 Contract Invoice Invoice#: 3785 Date: 07/28/2012 Project: Otsego Public works HV 13400 90th St NE Otsego MN 55330 Due Date: 08/12/2012 Terms: 15DY Order# Description Progress Billing# 2 Notes: Quantity Price 1.00 3,000.00 / A service charge of 18.00% per annum will be charged on all amounts overdue on regular statement dates. Thank you for your prompt payment! Amount 3,000.00 Non -Taxable Amount: 3,000.00 Taxable Amount: 0.00 Sales Tax: 0.00 Amount Due 3,000.00 J. Becher ._ a' -in! r -& Assoc. Inc. ELECTRICAL CONTRACTORS & INTEGRATION SPECIALISTS 20610 Commerce Boulevard Rogers MN 55374 763-428-8630 License: EA000246 Owner: KINGHORN COMPANY 14198 Northdale Blvd Rogers MN 55374 Job Location: Otsego Public Works LV 13400 90th St Otsego MN 55330 Application For Payment On Contract Original Contract ...................................... 6,564.01 Net Change by Change Orders ................ 0.00 Contract Sum to Date ............................... 6,564.01 Total Complete to Date ............................ 6,564.01 Total Retained .......................................... 0.00 Total Earned Less Retained .................... 6,564.01 Less Previous Billings .............................. 0.00 Current Payment Due ............................. 6,564.01 Balance on Contract ................................. 0.00 q (q -H Progress Billing Application: 1 Period: 08/09/2012 Contractor's Certification of Work The undersigned contractor certifies that, to the best of the contractor's knowledge, the work on the above named job has been completed in accordance with the plans and sped i ations to the level of completion indicated on the attached schgdulcompletion. Contractor:r l V--' `v'-'� Date: 0 C Terms: Invoices are due and payable 20DY from the date of invoice. All overdue amounts will be charged a service charge of 0.00 % per anum. Please make checks payable to: J. Becher & Assoc. Inc. Thank you for your prompt payment. PROGRESS BILLING Schedule of Work Completed Description of Work Scheduled 21300.000 4 door of Access 6,564.01 Totals: 6,564.01 Application: 1 Period: 08/09/2012 Changes Contract Previous Current Comp. Stored Mat. Total Comp. % 6,564.01 6,564.01 6,564.01 100.00 6,564.01 6,564.01 6,564.01 100.00 Page 2 of 2 Balance Retained J.Becher __.._—�!.rruw_BAssoc.lnc. ELECTRICAL CONTRACTORS a INTEGRATION SPECIALISTS 20610 Commerce Boulevard Rogers MN 55374 763-428-8630 License: EA000246 Billed To: KINGHORN COMPANY Kinghorn Company 14198 Northdale Blvd Rogers MN 55374 Due Date: 08/29/2012 Terms: 20DY Contract Invoice Invoice#: 3850 Date: 08/09/2012 Project: Otsego Public Works LV 13400 90th St Otsego MN 55330 Order# Description Quantity Price Amount Progress Billing# 1 1.00 6,564.01 / 6,564.01 Notes: A service charge of 0.00 % per annum will be charged on all amounts overdue on regular statement dates. Thank you for your prompt payment! Non -Taxable Amount: 6,564.01 Taxable Amount: 0.00 Sales Tax: 0.00 Amount Due 6,564.01 L11LI-Ll1QH5-?9.0 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) MAGE ONE OF PAGES TO OWNER: PROJECT: /��"� Q / ' // APPLICATION NO.: Distribution to: L/� `pWL'+'C.�-'�.PERIOD TO: y �� ❑OWNER �� ( _ �� ✓ �� PROJECT NOS.: j= ❑ARCHITECT FROM CONTRACTOR: `310 V\F_ S-75-3� 4 VIA ARCHITECT: CONTRACT DATE: 1 CONTRAC'TOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM .................. 2. Net change by Change Orders ............... s 3. CONTRACT SUM TO DATE (Line I t 2) ... • • • • • 4. TOTAL COMPLETED & STORED TO DATE ...... S�yfL (Column G on G703) 5. RETAINAGE: _ -- a. % of Completed Work S (Columns D + E on G703) _ b. % of Stored Material S. (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) ................. S 5..L 6, TOTAL EARNED LESS RETAINAGE ........ " ... S /�• (Line 4 less Line 5 Total) LESS PREVIOUS CERTIFICATES FOR PAYMENT r' _ (Line 6 from prior Certificate) ................. $ 8. CURRENT PAYMENT DUE S ,��- I e BALANCE TO FINISH, INCLUDING RETAINAGE _ • (Line 3 less Line 6) $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TUFA LS NET CHANGES by Change Ordcr ❑ CONTRACTOR _t�Lf0 The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation 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 pay- ments received from the Owner, and that current payment shown herein is now due. CONTRACTOR: / 1 i : , , c / Date: State' of: 1� ' Z ;&6uncy of:,,G62o' t -fir Subscribed and sworn to before J. -A. BAKER / F me this day of NOTARY PUBLIC C�C[ MINNESOTA fMCommiss!on Expires Jan. 31, 2016 Notary Public: My Commission expires:/ -31-1,52, ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, 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. y1't AMOUNT-•GERTIFIED ............................... S (Attacb entplanctlion if amount certified differs from the amount applied for. Initial all fiRur•es on this Application and on the Continuation Sheet that are changed to conform to the aniount certified.) ''rte" -ICT' 1�� l �-�. By: Date: This Certificate is not negt le. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are without hrciudice to any rights of the (_)%vncr or C:tmtractor under this Contract. G702-1992 CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES AIA Diwurnent G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractors signed CcrtiCic tion, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Use Column 1 on Contracts where variable retainage for line items may apply. ARCFIITECI ; PROJECT NO.: A It C D F F G E I I ITF:A1 NO. hE SCRIPTION OF WORK SCIIF•.DtILFp VALUE WORK COMPLIi'iTD MATERIALS PRESENTLY STORED 'TOTAL COMPLETFD AND STORED % BALANCE f0 RETAINAGE (IF VARIABLE) , FROM PREVIOUS APPLICATION-__ (D + E) _ 11JIV; PERIOD_ --- N -(' 07`1Pi`-__.___._ TO DAT!: F1N1SIt - (C - (;) -" ItAI'tir D Olt E) (1)+E.fF) �� F Y1 L AIA VCX:UMLNr 6703 • CONTINIIATION SIIHI•.T FOR 6701 • IY)L EDITION • AIA° CS)I'r)1 • TI IE AMI: ItICAN INSI'l111TH OI` AW:IIVIT(T5, 1735 NEW YORK A�'FNI IF:. N W • WASI IIN(;'i'()N, I Lc 200fI6-S21)2 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G703-1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. Lefeb� re's Carpet 9310 Parrish Ave NE Flk River. NiN 551,0 Name / Address KINGHORN COMPANY 14198 NOR IHDALE BI_\'D ROGE..RS. \1N 55374 Es nate Date Estimate # : 21;2012 413; Phone # Fax # 763 X141-1181 763 441-6820 Page 1 Project Item Area Description Total PROJECT: OTSF(;O PUBLIC "<\ ORKS FACILITY 1'� •• l.PPLR LEVE 1. VOCAI ION 11128 UZ e CULUR IM) INS l',U.LED 7.59050 OFFICES ETC UPI ION I (Rooms 201.202.203.204.-705.206.207.'-)08.211.212.2 1.' .214.215.216.2 17, 218. 219) �1;z« \lisc Labor CPT BASE VOCATION 111 28 OL CULUR TBDr1NSTALLED Misc Labor 38760 200.00 Subtotal 8.178.10 S II . LOCA ER RECEPTION ARFs1 BASE VOCATION 111 2807 `COLOR TBD : INSTALU-1) 86.08 OPTION 1 (103. 104 - Dcsk Area,1-IC Counter) Subtotal 86.08 ESTIMATF AC CEPTEI) PLEASE SIGN BELOW THAT 11115 TS 1711F. A(iRT=1i1) PRICE AND PRODI TCT. ANY CI IANGES ADDED TO'111tS WTI J. RE AN ADDITIC)NAL COST DAI ETotal Phone # Fax # 763 X141-1181 763 441-6820 Page 1 4 14 - 4 X9 45 39 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (instructions on reverse side) PAGE ONE OF PAGES TO OWNER: FROM CONTRACTOR: Ltght/%C , [7_oJ L. bei CONTRACT FOR: 7a` 1 fit, r'—I•�F� PROJECT b�tJ+aG(C3 ; YuOl c�. Ks t )1j0WCOV eCl Q?RCHITECT l (�,{ v S(�_,571 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, In connection with the Contract. Continuation Sheet, AIA Document G703, is attached. �i 1. ORIGINAL CONTRACT SUM .................. $ 2. Net change by Change Orders ............... 3. CONTRACT SUM TO DATE (Line 1 t 2) ........ s z Api 4. TOTAL COMPLETED & STORED TO DATE ...... $ / � : S (Column G on G703) 5. RETAINAGE: �— a. U % of Completed Work 8 �-- (Columns D + E on G703) b. D % of Stored Material E C� (Column F on G703) Total Retainage (Line 52 + 5b or Total in Column I of G703) ................. S � 5 6. TOTAL EARNED LESS RETAINAGE ............ (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) ............ • . . • • S 8. CURRENT PAYMENT DUE ................. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) S Z—) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 24, ZX;)ZC] OWNER Total approved this Month ❑ ARCHITECT TOTALS XCONTRACTOR NET CHANGES by Change Order APPLICATION NO.: 'I Distribution to: PERIOD TO: 3,o y 24, ZX;)ZC] OWNER PROJECT NOS.: 1 ❑ ARCHITECT XCONTRACTOR CONTRACT DATE: Cl The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed in accordance ith the Contract Documents, that all amounts have been paid by the Contractor f ork for which previous Certificates for Payment were issued and pay- ments recei e from the Owner, and that current payment shown herein is now due. CONTRA O By: Date: State of: County of: Subscribed and sworn to before me this day of Notary Public: My Commission expires: ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, 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. AMOUNT CERTIFIED ............................... S LZt. %1 _ (Attach explanation iJ' amount certified differs from the amount applied for. Initial all figures on this Application and on the Continuation Sheet that are changed to conform to the amount certified.) Al1CA4WX*Q'& By, �,�i�c� �Date: This Certificate is not nego ' ale. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. issuance, payment and acceptance of Payment are without prejudice to any rights of the Owner or i OMMCIOC under this Contract. to :5i;t�r:}t r;.:Itr+t ;rt•t�,i G702-1992 `�- tM Ct _D. � 0 CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractors signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Usc Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: A Il C D F. F G H 1 ITEM NO DF,SCRIPTION OF WORK SCHEDULED VALUE WORK COMPLFTF.D MATERIALS PRESENTLY STORED (NOT IN DOR F) T07AL COMPLETED AND S'T'ORED TO DAl'E D+E+l:) ,y (C _ C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE) (IF FROM PREVIOUS APPLICATION (D +F) THIS PERIOD AIA DOCUMENT 6703 • (:ONl'INUATION Sfililil' FOR (i7fll I�Y)1 EVITION • AIA" • C)I1Y)2 • Till: AMERICAN INST11111 i OF AHC:I11"I'E('Cti, 173,; NliW l'oiw A%'ItNt IP:, N 1V., WASHINGTON, t).0 2unfKr5242 • WARNING: Unlicensed photocopying violates U.S, copyright laws and will subject the violator to legal prosecution. G703-1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. LIG WINDOW COVERINGS, LLC 1206 Liberty Court Sartell, MN 56377 Phone # 320.654.0567 Bill to City of Otsego 13400 90th St. N.E. Otsego, MN 55330 Invoice Date Invoice # 7/11/2012 1223 Fax # 320.654.6327 Email: Elicht6508@aol.com Terms Project Description Qty Cost Total Bali Solar Shading Systems Sheerweave 2500 72.75x99 4 199.00 796.00T Bali Solar Shading Systems Sheerweave 2500 82.25x99 3 225.00 675.00T Bali Solar Shading Systems Sheerweave 2500 84.5x99 1 232.00 232.00T Bali Solar Shading Systems Sheerweave 2500 58x99 1 159.00 159.00T Bali Solar Shading Systems Sheerweave 2500 42.5x99 1 116.00 116.00T Bali Solar Shading Systems Sheerweave 2500 50x99 1 137.00 137.00T Bali Solar Shading Systems Sheerweave 2500 100x99 1 274.00 274.00T Bali Solar Shading Systems Sheerweave 2500 90.5x99 1 248.00 248.00T Bali Solar Shading Systems Sheerweave 2500 91.5x99 2 250.00 500.00T Bali Solar Shading Systems Sheerweave 2500 80.509 1 220.00 220.00T Installation 1 600.00 600.00T Permit Plan Date 6-1-12 Subtotal $3,957.00 Sales Tax (7.375%) $291.83 Total $4,248.83 Payments/Credits $0.00 Balance Due $4,248.83 APPLICATION AND CERTIFICATE FOR PAYMENT TO OWNER: Kinghorn Company Inc 14198 Northdale Blvd Rogers, MN 55374 FROM CONTRACTOR: Twin City Hardware 723 Hadley Ave N Oakdale, MN 55128 CONTRACT FOR: Doors, Frames and Hardware 41H _q IqH,5- ��qo AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF TWO PAGES PROJECT: Otsego Public Works Building 13400 90th SI NE Otsego, MN 55330 VIA ARCHITECT: CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attatched. 1. ORIGINAL CONTRACT SUM $11,388.96 2. Net change by Change Orders $0.00 3. CONTRACT SUM TO DATE (Line 1 t 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on 6703) 5. RETAINAGE: a. 0% % of Completed Work (Columns D + E on G703) b. 0% % of Stored Material (Column F on G703) Total Retainage (Line 5a + 5b or Total in Column I of G703) $0.00 $0.00 $11,388.96 $11,388.86 $0.00 ----------------- 6. TOTAL EARNED LESS RETAINAGE (Line 4 less Line 5 Total) 7, LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) $2,338.96 8. CURRENT PAYMENT DUE $9,050.00 APPLICATION NO: 2 PERIOD TO: 8/10/2012 PROJECT NOS.: CONTRACT DATE: 12/16/2011 INVOICES: Distribution to: ❑ OWNER j] ARCHITECT ■ CONTRACTOR 13 528535 529379 530289 530543 530575 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 recieved from the Owner, and that current payment shown herein Is now due. CONT ACTO}:V.,�Z TWIN CITY H. WARE / By: j�/� �� %�' �--�/ Date: 8110/2012 State of: MN County of: WASHINGTON Subscribed and swom to before me this to day of /41_1� 0-1* � Nolary PtibliGZ My Commission Expires: ��,y. • � 1, -7-R t 20 is— ARCHITECT'S s— ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising this application, the Architect certifies to the Owner that to the best of the Architects 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. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $0.00 AMOUNT CERTIFIED _ fAttach explanation if amount certified differs from the amount applied for. Initial all figures CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous month by Owner $0.00 50.00 Total approved this Month $0.00 TOTALS $0.00 1 $0.00 NET CHANGES by Change Order $0.00 on this Application and on the Continuation Sheet that are changed to conform to the amount 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 AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT . 1992 EDITION • AIA® - 01992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G702-1992 d (A CAUTION: You should use and original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. (t \ w �� CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE TWO OF TWO PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification, is attached. APPLICATION DATE: 8/1012012 in tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 811012012 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO,: 0 A B C D E F G H I ITEM No. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED Total Completed and Stored To Date (D+E+F) % (GIC) Balance To Finish (C -G) Retainage (If Variable Rate) Previous Applications This Application Work in Place Stored Materials (not in D or E) 1 2 Doors, Frames and Hardware 511,388.96 50.00 $2,338.96 $0.00 $9,050.00 50.00 $11,388.96 100% 50.00 $0.00 $0.00 $0.00 $11,388.96 $2,338.96 59,050.00 $0.00 $11,388,96 101)%l $0.00 $0.00 AIA DOCUMENT G702 • APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA® ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G702-1992 CAUTION: You should use and original AIA document which has this caution printed in red, An original assures that changes will not be obscured as may occur when documents are reproduced. qIYA1905-S90 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (instructions on reverse side) NAGE ONE of PAGES TO OWNER: `\q � i;.i'r `s� �3 {�Ih�` PROJECT. p(T � Q �'C Z)V\" APPLICATION NO.: Distribution to: 1 t U \Av� `e QIIVCS PERIOD 7O: ❑ OWNER PROJECT NOS.: ❑ ARCHITECT ❑ CONTRACTOR FROM CONTRACTOR: NIODVEI VIA ARCHITECT: CONTRACT DATE: ❑ 553@ -S CONTRACT FOR: �jk tQ CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, In connection with the Contract. Continuation Sheet, AIA Document G703, is attached. nn 1 1. ORIGINAL CONTRACT SUM .................. f d I TtU o 2. Net change by Change Orders ...............s 3. CONTRACT SUM TO DATE (Line 1 t 2) ........ fLIM 4. TOTAL COMPLETED & STORED TO DATE ...... i '�1" (Column G on G703) 5. RETAINAGE: a. % of Completed Work f (Columns D + E on G703) b. % of Stored Material $ (Column F on G703) -btai Retainage (Line 52 + 5b or q�( Total in Column I of G703) . • ............... $ Jt 6. TOTAL EARNED LESS RETAINAGE ..... _ ...... S i. (Line 4 less Line 5 Tbtal) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT *,( (Line 6 from prior Certificate) ................. f 5� 8. CURRENT PAYMENT DUE ................. I s � 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS NET CHANGES by Chani;c Order ki{lf;Gf:iS f C.�tilul ;�7•i�d_ti The undersigned Contractor certifies that to the hest of the Contractor's knowledge, infor- mation 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 pay- ments received from the Owner, and that current payment shown herein is now duc CONTRACTOR: State of: County of: Subscribed and sworn to before me this day of Notary Public: My Commission expires: ARGMITS=S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, 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 %brk is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ............................... s (Attach a planalion if amount certified differs from the atnount applied for. Initial all figures on This Application and on The Continuation Sheet that are changed to couforrn to the amount certified.) �T. A l 1 By: �t_ '�� Date: _ 1 1 -1 )-L- This 'LPhis Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contactor under this Contract. G702-1992 CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) I'AGF OF PAGF,S AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulations below, amounts are stated to the nearest dullar. tice Column 1 on Contracts where variable rclalnagc far line items may apply. APPLICATION NO.: APPLICATION DAT£: PERIOD TO! ARCHITECT'S PROJECT NO.: A ri C D E F G }I 1 ITEM SCIIFf)111.ED WORK COMPLETRD MATERIALS PRESENTLY 'TOTAL COMPLrTFD % BALANCE TO RETAINAGE Ntl t)F_SCAIPI fON OF WORK VAIAIF FROM PREVIOUS APPLICATION THIS PERIOD STORED AND S'PDRED TO DATE (G t CJ FINISH (IF VARIABLE) RATE) (D + E) D OR g) (13+12+1J) (C - G) i le At VV4 a I LM - ("'/. Z � AIA DOCURI NT G709 - MHTINVATION 5111iFT FY)R (;7112 • PY)2 }:I)MON - AIA* - 01992 - 1•III: AMERICAN INSVITI)TIt OF AIU:111'rF<:1X 1715 NKW YORK Iff AVFh)I �I:, N W., WAti111Nt:'It )N, t)•(: 2OWNi2w - WARNING: Unlicensed photocopying violates I.I.S. copyright laws and will aubleG MM violator to legal prosecution_ 6703-1992 CAUTION: You should use an original AIA document which has this caution printed In red. An original assures that changes will not be obscured as may occur when documents are reproduced. BILL TO Kinghorn Company 14198 Northdale Blvd. Rogers, MN 55374 SHIP TO Otsego Public Works P.O. NO. TERMS DUE DATE SHIP DATE AMOUNT Porcelain tile Otsego tile Due on receipt 8/1/2012 8/ 1/2012 ITEM DESCRIPTION QTY RATE AMOUNT Porcelain tile Porcelain the *Caesar Wildlands Canyon 1 1,940.00 1,940.00 12x12, Schluter, rubber transition & standard grout Tearout Tearout existing carpet & grind floor 1 200.00 200.00 *Materials, tax & installation included* Total $2,140.00 Payments $0.00 Thank you f oil your business!!! Ba nnce Due $2 .140.00 W OtsTeF o MINNESOTA DEPARTMENT INFORMATION Request for City Council Action ORIGINATING DEPARTMENT: REQUESTOR: MEETING DATE: Administration Lori Johnson, City Administrator August 27, 2012 PRESENTER(s): REVIEWED BY: ITEM #: Consent Lori Johnson, City Administrator 3.5 AGENDA ITEM DETAILS RECOMMENDATION: Recommend approval of the Agreement Between the City of Otsego and Kaleidoscope Charter School Regarding Payment and Assessment of City SAC and WAC Fees to assess SAC and WAC charges of $95,424.00 to Kaleidoscope over a term of five years at 3.4 percent interest for the connection of temporary classrooms to water and sewer. ARE YOU SEEKING APPROVAL OF A CONTRACT? IS A PUBLIC HEARING REQUIRED? No No BACKGROUND/JUSTIFICATION: The Kaleidoscope Charter School Board requested the assessment of SAC and WAC fees for Kaleidoscope's temporary classrooms scheduled to open this fall due to the school's cash flow issues created by the State of Minnesota's deferral of education funding payments to schools. Per City Council direction on August 13, City Attorney Andy MacArthur drafted the attached Agreement Between the City of Otsego and Kaleidoscope Charter School to assess SAC and WAC fees for Kaleidoscope's temporary classrooms. The terms of the agreement are for an assessment of $95,424 over five years at 3.4 percent interest. These fees will be applied to the SAC and WAC fees due with the school's permanent expansion takes place in 2016. SUPPORTING DOCUMENTS: X ATTACHED —NONE • Agreement Between the City of Otsego and Kaleidoscope Charter School Regarding Payment and Assessment of City SAC and WAC Fees MOTION: (Please word motion as you would like it to appear in the minutes.) Motion to approve the Agreement Between the City of Otsego and Kaleidoscope Charter School Regarding Payment and Assessment of City SAC and WAC Fees. BUDGET INFORMATION FUNDING: BUDGETED: ❑ YES N/A ❑ NO ACTION TAKEN ❑ APPROVED AS REQUESTED ❑ DENIED ❑ TABLED ❑ OTHER (List changes) COMMENTS: CITY OF OTSEGO COUNTY OF WRIGHT STATE OF MINNESOTA AGREEMENT BETWEEN THE CITY OF OTSEGO AND KCS BUILDING COMPANY REGARDING PAYMENT AND ASSESSMENT OF CITY SAC AND WAC FEES THIS AGREEMENT made this day of August, 2012 between the City of Otsego, a Minnesota Municipal corporation ("CITY") and KCS Building Company, a Minnesota corporation ("KCS"). WHEREAS, KCS owns certain property located within the CITY and legally described as follows: Lot 1, Block 1 DARA GLEN ADDITION according to the Plat on file and of record at the Office of the County Recorder, Wright County, Minnesota. WHEREAS, due to the need for the construction of temporary classrooms to accommodate additional students KCS is required to incur additional charges for delivery of to municipal sanitary sewer and water facilities ;and WHEREAS, the CITY SAC (Sewer Availability Charge) and WAC (Water Availability Charge) charges for the facility, due immediately upon hookup, are $95,424.00; and WHEREAS, KCS has requested that said charges be assessed against the above described property in equal annual installments over a period of seven (7) years; and WHEREAS, CITY agrees to the request as modified below, contingent upon KCS executing this Agreement, which shall be recorded against the property. NOW THEREFORE IT IS AGREED BETWEEN THE PARTIES AS FOLLOWS; 1. CITY agrees to assess the principal amount of $ 95,424.00 against the property for a period of five (5) years in equal annual installments at an interest rate of 3.4% per annum. 2. KCS, on behalf of itself and its successors in title, agree that the above described property benefits in at least the amount of the assessment stated above and that they waive any hearings, any irregularities in procedure, and any and all right of appeal under statute, Constitution, or case law, including the right of appeal under Minnesota Statute 429.081 or any rights under Minnesota Statute 444. 3. This Agreement shall run with the land, shall be recorded against the title to the property and shall be binding on all parties having any right, title or interest in the property their heirs, successors and assigns. 4. In the event that KCS, or its successors, fails to timely pay the assessments as they become due on the property the CITY, at its sole discretion, may demand immediate payment of the entire principal and interest due at the time and upon such demand KCS shall make such payment in full within thirty (30) days of the demand. 5. In the event that CITY must take action to enforce the terms and conditions of this Agreement related to prompt payment, KCS, or its successors, shall reimburse CITY for all costs incurred by CITY in enforcement, including reasonable attorney's fees. CITY OF OTSEGO Jessica Stockamp, Mayor 2 Tami Loff, City Clerk KCS BUILDING COMPANY By: Its STATE OF MINNESOTA) ) ss. COUNTY OF WRIGHT ) The foregoing instrument was acknowledged before me this day of August, 2012, by Jessica Stockamp, Mayor and Tami Loff, City Clerk of the City of Otsego, a Minnesota municipal corporation, on behalf of the City and pursuant to the authority of the City Council. NOTARY PUBLIC STATE OF MINNESOTA) ss. COUNTY OF ) The foregoing was acknowledged before me this day of August, 2012 by the of KCS Building Company, a Minnesota corporation, with authority and on behalf of the corporation. 3 NOTARY PUBLIC DRAFTED BY: MACARTHUR LAW OFFICE, LLC 3601 Thurston Avenue North Suite 103 Anoka, MN 55303 (763) 231-5850 4'..P Ot CITY O O MINNESOTA V DEPARTMENT INFORMATION Request for City Council Action ORIGINATING DEPARTMENT: REQUESTOR: MEETING DATE: Public Works City Engineer Wagner August 27, 2012 PRESENTER(s): REVIEWED BY: ITEM #: City Engineer Wagner City Administrator Johnson 4.1 AGENDA ITEM DETAILS RECOMMENDATION: City Staff Recommends awarding 2012 Bituminous Trail, Parking Lot and Driveway Maintenance project to the low quote. Quotes will be accepted until noon on August 27, 2012 and staff will review and bring quotes along with recommendation for council action. AREYOU SEEKING APPROVAL OF A CONTRACT? No A PUBLIC HEARING REQUIRED? o FN BACKGROUND/JUSTIFICATION: Council approved 2012 maintenance (fog seal) for trails, parking lots, and driveways in an amount up to $50,000. The attached plans show the 6.3 miles of trails and nearly 130,000 square feet of other city owned pavement that is purposed to be fog sealed. The fog seal will extend the useable life of the payment by sealing out the damaging rays of the sun and prevent water intrusion of the surface and through small hairline cracks. A minor amount of the project will be paid through water or sewer funds. SUPPORTING DOCUMENTS: X ATTACHED ❑ NONE • Engineers Estimate • Plan Sheets • Quotes (to be handed out at meeting) • Recommendation Based on Quotes Received (to be handed out) MOTION: (Please word motion as you would like it to appear in the minutes.) Motion to approve award 2012 Bituminous Trail, Parking Lot and Driveway Maintenance project to in the amount of $J_. BUDGET INFORMATION FUNDING: BUDGETED: X YES ❑ NO 202 Trail Management Fund In 2012 CIP in the amount of $50,000. ACTION TAKEN ❑ APPROVED AS REQUESTED ❑ DENIED ❑ TABLED ❑ OTHER (List changes) COMMENTS: ENGINEER'S ESTIMATE CITY OF OTSEGO 2012 Bituminous Trail, Parking Lot, and Driveway Maintenance Project Improvement Project No. 12-03 ALTERNATE A Quote Schedule "A" - 2012 Bituminous Trail Maintenance Proiect - ALTERNATE A (Pitch Black ©) ITEM NO. Mn/DOT SPEC. NO. I ITEM DESCRIPTION ESTIMATED QUANTITY UNIT UNIT PRICE EXTENSION 1 2021.501 MOBILIZATION 1 LS $500.00 $500.00 2 2355.502 BITUMINOUS MATERIAL FOR SEAL Pitch Black @) 47,575 GAL $1.00 $47,575.00 3 2563.601 TRAFFIC CONTROL 1 LS $500.00 $500.00 4 2582.502 4" SOLID WHITE PAINT NO GLASS BEADS 1,935 LF $0.50 $967.50 5 1 2582.501 PAVEMENT MESSAGE HANDICAPPED SYMBOL PAINT 6 EACH $50.00 $300.00 Total Quote Schedule A ALTERNATE B Quote Schedule "B" - 2012 Bituminous Trail Maintenance Proiect - ALTERNATE B (CSS -1h) $49,842.50 ITEM NO. Mn/DOT SPEC. NO. ITEM DESCRIPTION ESTIMATED QUANTITY UNIT UNIT PRICE EXTENSION 1 2021.501 MOBILIZATION 1 LS $500.00 $500.00 2 2355.502 BITUMINOUS MATERIAL FOR FOG SEAL CSS -1h 47,575 GAL $1.00 $47,575.00 3 2563.601 TRAFFIC CONTROL 1 LS $500.00 $500.00 4 2582.502 4" SOLID WHITE PAINT NO GLASS BEADS 1,935 LF $0.50 $967.50 5 2582.501 1 PAVEMENT MESSAGE HANDICAPPED SYMBOL PAINT 6 EACH $50.00 $300.00 Total Quote Schedule B $49,842.50 ot386 2012 quote form Engineer's Estimate Page 1 BID TABULATION CITY OF OTSEGO 2012 Bituminous Trail, Parking Lot, and Driveway Maintenance Project Improvement Project No. 12-03 Quotes opened 12.00 p.m., Monday, August 27, 2012. There were 1 quote received, as shown herein. Quote Schedule "A" - 2012 Bituminous Trail Maintenance project - ALTERNATE A (Pitch Black© or approved equal) Allied Blacktop Company Engineers Estimate ITEM NO. SPEC. ITEM DESCRIPTION ESTIMATED QUANTITY UNIT PRICE EXTENSION UNIT PRICE EXTENSION 1 2021.501 MOBILIZATION 1 LS $1,500.00 $1,500.00 $500.00 $500.00 2 2355502 BITUMINOUS MATERIAL FOR SEAL Pitch Black @ or approved equal) 4,757 GAL $7.59 $36,105.63 $10.00 $47,570.00 3 2563.601 TRAFFIC CONTROL 1 LS $1,500.00 $1,500.00-1------$500.00 $500.00 $500 00 4 2582.502 4" SOLID WHITE PAINT NO GLASS BEADS 1,935 LF $0.25 $483.75 $0.50 $967.50 5 2582.501 PAVEMENT MESSAGE HANDICAPPED SYMBOL PAINT 6 EACH $50.00 $300.00 1 $50.00 $300.00 Total Quote Schedule "A" $39,889.38 $49,837.50 Quote Schedule "B" - 2012 Bituminous Trail Maintenance Por'et - ALTERNTAE B CSS -1 h Allied Blacktop Company Engineer's Estimate ITEM NO. SPEC. ITEM DESCRIPTION ESTIMATED QUANTITY UNIT PRICE EXTENSION UNIT PRICE EXTENSION 1 2021.501 MOBILIZATION 1 LS $1,500.00 $1,500.00 $500.00 $500.00 2 2355.502 BITUMINOUS MATERIAL FOR FOG SEAL CSS -1h 4,757 GAL $5.50 $26,163.50 $7.50 $35,677.50 3 2563.601 TRAFFIC CONTROL 1 LS $1,500.00 $1,500.00 $500.00 $500.00 4 2582.502 4" SOLID WHITE PAINT NO GLASS BEADS 1,935 LF $0.25 $483.75 $0.50 $967.50 5 2582.501 PAVEMENT MESSAGE HANDICAPPED SYMBOL PAINT 6 EACH $50.00 $300.00 I .00 $300.00 Total Quote Schedule "B" ot3B6 2012quote tabQUOTE TABULATION BT- 1 OF 1 $29,947.25 $37,945.00 ' i .011l MIMIL IIl1fY { I vs -- 2 LS BMOA i21rS AOR SEAT Push Q y 4751 EACH 'i UMT UNrf FPXF 2582. "2OWS BEADS f 635 8 M2,601 W MESSAGE NANO tMIPM SYMBOL) FAINT 6 Cry K.► J_e j +0 k :f Total Quota 3Cheduie A ALTERNATE B OU019 OOV - 2012 6& nin" rnW Malntr wcs EMEd - ALTERNATE B CSS -1h ITEM MWDOT BSrIMtAYED NO. WIEC. NO. ITEM DESCMPTION OUANTITY I ...1 1., ..Vtr, I 4 5 Total Q ,,v,:ro -9("16 3's-0 1,5001 C"D to 5'Gtd. v a a5' s all " r r � Ob 00 GAL I vs -- LS EACH 'i UMT UNrf FPXF EXTENSIOr7 ,,v,:ro -9("16 3's-0 1,5001 C"D to 5'Gtd. v a a5' s all " _ �- �� ■ ■_� _L�� • � ■ I' ■III �� i