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DEPARTMENT OF PUBLIC WORKS <br />DIVISION OF ENGINEERING <br />PROJECT CONSTRUCTION CHECKLIST <br />Project No.122-008 NTP 5/3/2022 <br />Project Name 2022 Contractor Paving Round 1 Sub. Comp. <br />Contractor Rieth-Riley Construction Co., Inc.Final Comp.9/2/2022 <br />Inspector JJE Today's Date 5/3/2023 <br />PAY APPLICATIONS & CHANGE ORDERS CHART <br />Pay App Contract <br />EVA <br />5/3/2022 $0.00 $0.00 <br />7/30/2022 $1,129,124.86 <br />8/30/2022 $1,172,582.38 <br />9/2/2022 $1,275,548.42 <br />PAYMENT APPLICATION SUMMARY <br />End Date Total Deductions Sub Total Prev. Pmts Amount Prev Pmt Error <br />1 7/30/2022 $1,188,552.49 $59,427.62 $1,129,124.86 $0.00 $1,129,124.86 - <br />2 8/30/2022 $1,234,297.24 $61,714.86 $1,172,582.38 $1,129,124.86 $43,457.51 <br />3 9/2/2022 $1,275,548.42 $0.00 $1,275,548.42 $1,172,582.37 $102,966.05 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />S ----$1,172,582.37 $1,275,548.42 <br />CHANGE ORDER SUMMARY <br />Date Prv. Contract Change Amt. New Contract Change % Total % Added Days <br />1 $1,350,781.84 $75,233.42 $127,548.42 -5.57% -5.57%32 <br />2 <br />S --$75,233.42 --5.57%9/2/2022 <br />POST-CONSTRUCTION DOCUMENT CHECKLIST <br />Items Notes Date Rec'D <br />1 Final Pay Application 4/19/23 <br />2 Project Completion Affidavit 4/19/23 <br />3 Final Waiver of Lien 4/19/23 <br />4 Final Change Order 4/19/23 <br />5 Complete Certified Payrolls <br />6 As-Built Documents N/A <br />7 Testing Reports <br />8 Warranty Information 4/19/23 <br />Signature: Date:4/19/2023