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2025-05-19 I01H_01 Waukee Public Safety Building_Pmt Est 17
AGENDA ITEM: CITY OF WAUKEE, IOWA CITY COUNCIL MEETING COMMUNICATION MEETING DATE: May 19, 2025 AGENDA ITEM:Consideration of approval of Payment Estimate No. 17 (Combined) for the Waukee Public Safety Building Project in the amount of $2,080,048.47. FORMAT:Consent Agenda SYNOPSIS INCLUDING PRO & CON: Work on the new Public Safety building continues to wrap up. It is anticipated that the building will be completed and able to be occupied in mid- June. Pay Estimate 17 for the Waukee Public Safety Building project covers general construction costs, framing and drywall, mechanical and plumbing, electrical, audio-visual, earthwork and concrete, landscaping as well as several other smaller items associated with the project. FISCAL IMPACT INCLUDING COST/BENEFIT ANALYSIS: Payment Estimate No. 17 is in the amount of $2,080,048.47. COMMISSION/BOARD/COMMITTEE COMMENT: STAFF REVIEW AND COMMENT: RECOMMENDATION: Approve Pay Estimate No. 17 ATTACHMENTS: I. Pay Estimate No. 17 PREPARED BY:Brad Deets, City Administrator REVIEWED BY: PUBLIC NOTICE INFORMATION – NAME OF PUBLICATION: DATE OF PUBLICATION: I1H1 Document G736™ – 2009 Project Application and Project Certificate for Payment, Construction Manager as Adviser Edition AIA Document G736 – 2009 (formerly G722™CMa – 1992). Copyright © 1981, 1992 and 2009. All rights reserved. “The American Institute of Architects,” “American Institute of Architects,” “AIA,” the AIA Logo, and “AIA Contract Documents” are trademarks of The American Institute of Architects. This document was produced at 11:59:30 ET on 05/09/2025 under Order No.4104251064 which expires on 06/12/2025, is not for resale, is licensed for one-time use only, and may only be used in accordance with the AIA Contract Documents® Terms of Service. To report copyright violations, e-mail docinfo@aiacontracts.com.User Notes: (3B9ADA4F) 1 APPLICATION NO: 17 Distribution to:TO OWNER:City of Waukee 230 W. Hickman Road Waukee, IA 50263 PROJECT: Waukee Public Safety Building 815 NW 20th Street Waukee, IA 50263 PERIOD TO: April 30, 2025 ATTENTION: Brad Deets VIA CONSTRUCTION MANAGER:Ryan Companies US, Inc.PROJECT NOS: 6173-000 / 21841001 OWNER: CONSTRUCTION MANAGER: ARCHITECT: OTHER : PROJECT APPLICATION FOR PAYMENT PROJECT CERTIFICATE FOR PAYMENT Application is made for Payment, as shown below, in connection with the Project. AIA Document G737™–2009, Summary of Contractors' Applications for Payment, is attached. 1. TOTAL CONTRACT SUMS (Item A Totals)28,868,514.50 2. TOTAL NET CHANGES BY CHANGE ORDERS (Item B Totals)308,615.85 3. TOTAL CONTRACT SUM TO DATE (Item C Totals)29,177,130.35 In accordance with the Contract Documents, based on evaluation of the Work and the data comprising this Application, the Construction Manager certifies to the Owner that to the best of its knowledge, information and belief the Work has progressed as indicated; the quality of the Work is in accordance with the Contract Documents; and the Construction Manager recommends to the Owner and Architect that the Contractors be paid the AMOUNTS set forth in the attached Summary of Contractors' Applications for Payment. 4. TOTAL COMPLETED & STORED TO DATE (Item F Totals)26,050,951.82 5. RETAINAGE (Item H Totals)1,205,610.67 6. LESS PREVIOUS TOTAL PAYMENTS (Item I Totals) 22,765,292.68 TOTAL OF AMOUNTS CERTIFIED ...........................................................2,080,048.47 7. CURRENT PAYMENT DUE (Item J Totals)2,080,048.47 CONSTRUCTION MANAGER: By: Date: The undersigned Construction Manager certifies that to the best of its knowledge, information and belief this Project Application for Payment is an accurate compilation of the Contractors' Applications for Payment, attached hereto. CONSTRUCTION MANAGER: By: Date: State of: In accordance with the Contract Documents, based on evaluation of the Work, the data comprising this Application, and the Construction Manager's recommendation, the Architect certifies to the Owner that to the best of its knowledge, information and belief the Work has progressed as indicated; the quality of the Work is in accordance with the Contract Documents; and the Contractors are entitled to payments of the AMOUNTS set forth in the attached Summary of Contractors' Applications for Payment. County of: ARCHITECT: Subscribed and sworn to before me this day of By: Date: Notary Public: My Commission expires: Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 5/9/2025 5/9/2025 Document G737™ – 2009 Summary of Contractors' Applications for Payment, Construction Manager as Adviser Edition AIA Document G737 – 2009(formerly G723™CMa – 1992). Copyright © 1992 and 2009. All rights reserved. “The American Institute of Architects,” “American Institute of Architects,” “AIA,” the AIA Logo, and “AIA Contract Documents” are trademarks of The American Institute of Architects. This document was produced at 11:59:22 ET on 05/09/2025 under Order No.4104251064 which expires on 06/12/2025, is not for resale, is licensed for one-time use only, and may only be used in accordance with the AIA Contract Documents® Terms of Service. To report copyright violations, e-mail docinfo@aiacontracts.com.User Notes: (3B9ADAAE) 1 APPLICATION NO.:17 APPLICATION DATE:May 09, 2025 AIA Document G732, Application and Certificate for Payment, has been completed by each Contractor. The content of those G732 forms is summarized below.PERIOD FROM:April 01, 2025 PERIOD TO:April 30, 2025 In tabulations below, amounts are in US dollars.PROJECT NOS.:Ryan Co.: 6173-000 /OPN: 21841001 0 A B C D E F G H I J K L DESCRIPTION OF WORK CONTRACTOR'S NAME ORIGINAL CONTRACT SUM NET CHANGES IN THE WORK CONTRACT SUM TO DATE WORK IN PLACE TO DATE STORED MATERIALS (Not in D or I) TOTAL COMPLETED AND STORED TO DATE(D + E)RETAIN-AGE %RETAINAGE AMOUNT PREVIOUS PAYMENTS CURRENT PAYMENT(F – H – I) BALANCE TO FINISH(C – F)% COMPL.(F ÷ C) General Const DDVI 2,905,000.00 33,835.15 2,938,835.15 2,453,159.89 0.00 2,453,159.89 5.00%122,657.99 1,976,099.83 354,402.07 485,675.26 83.47% Building Concrete Jordison Const 1,271,000.00 0.00 1,271,000.00 1,246,918.80 0.00 1,246,918.80 5.00%62,345.94 1,184,572.86 0.00 24,081.20 98.11% Precast Material Enterprise Precast 1,833,316.00 -2,822.13 1,830,493.87 1,833,316.00 0.00 1,833,316.00 5.00%91,665.80 1,741,650.20 0.00 -2,822.13 100.15% Steel Material TSF Structures 1,932,100.00 6,640.00 1,938,740.00 1,938,740.00 0.00 1,938,740.00 0.00%0.00 1,938,740.00 0.00 0.00 100.00% Erection Northwest Steel 1,064,188.00 13,560.00 1,077,748.00 1,077,748.01 0.00 1,077,748.01 5.00%53,887.40 1,023,860.61 0.00 -0.01 100.00% Metal Panels Forman Ford 575,239.00 0.00 575,239.00 571,621.33 0.00 571,621.33 5.00%28,581.07 533,588.60 9,451.66 3,617.67 99.37% Roofing Academy Roofing 998,000.00 3,030.75 1,001,030.75 999,080.75 0.00 999,080.75 5.00%49,954.04 949,126.71 0.00 1,950.00 99.81% Glass & Glazing Ford Metro 1,069,100.00 2,075.38 1,071,175.38 1,062,884.54 0.00 1,062,884.54 5.00%53,144.23 999,347.31 10,393.00 8,290.84 99.23% Overhead Doors Skold Door 310,000.00 1,346.00 311,346.00 301,146.00 0.00 301,146.00 5.00%15,057.30 286,088.70 0.00 10,200.00 96.72% Frame & Drywall Hilsabeck Schacht 2,562,500.00 27,903.33 2,590,403.33 2,093,639.83 0.00 2,093,639.83 5.00%104,682.00 1,697,695.72 291,262.11 496,763.50 80.82% Fire Protection Elite Fire Sprinkler 364,700.00 0.00 364,700.00 364,700.00 0.00 364,700.00 5.00%18,235.00 332,215.00 14,250.00 0.00 100.00% Mech & Plumbing Kruck Plumbing 5,947,000.00 47,307.23 5,994,307.23 5,615,077.72 0.00 5,615,077.72 5.00%280,753.89 4,976,799.88 357,523.95 379,229.51 93.67% Elec & Comm Van Maanen 4,711,425.00 174,894.64 4,886,319.64 3,983,448.91 0.00 3,983,448.91 5.00%199,172.45 3,283,794.24 500,482.22 902,870.73 81.52% Audio-Visual TriCity Electric 602,832.00 -3,112.00 599,720.00 88,553.82 399,784.52 488,338.34 5.00%24,416.92 349,921.43 113,999.99 111,381.66 81.43% Earthwork Wenthold 803,330.50 720.00 804,050.50 733,144.70 0.00 733,144.70 5.00%36,657.25 613,162.95 83,324.51 70,905.80 91.18% SWPPP Absolute 155,000.00 0.00 155,000.00 36,875.00 0.00 36,875.00 5.00%1,843.75 24,106.25 10,925.00 118,125.00 23.79% Site Concrete Jordison Const 1,110,000.00 15,097.50 1,125,097.50 1,091,034.00 0.00 1,091,034.00 5.00%54,551.76 854,522.39 181,959.85 34,063.50 96.97% Landscape & Irrig Alpha Landscapes 653,784.00 -11,860.00 641,924.00 160,078.00 0.00 160,078.00 5.00%8,003.90 0.00 152,074.10 481,846.00 24.94% 0.00 0.00 0.00 0.00 0.00 0.00 0.00%0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00%0.00 0.00 0.00 0.00 0.00% TOTALS $28,868,514.50 $308,615.85 $29,177,130.35 $25,651,167.30 $399,784.52 $26,050,951.82 4.63%$1,205,610.68 $22,765,292.68 $2,080,048.47 $3,126,178.53 89.29% Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Waukee Public Safety Building: Pay Application No. 17 Pay Apps Due to Ryan Co: 04/23/2025 Pay Apps Due to OPN: 5/07/2025 Council Packet Info to Waukee: 5/14/2025 by midnight Council Approval: 5/19/2025 Payment Due to Prime Contractors no later than: 5/31/2025 Prime Contractors Current (less retainage) Bid Package #1: General Construction (DDVI)354,402.07 Bid Package #2: Building Concrete (Jordison Construction) Bid Package #3: Precast Material (Enterprise Precast) Bid Package #4: Steel Material & Misc. Metals (TSF Structures) Bid Package #5: Precast & Steel Erection (Northwest Steel) Bid Package #6: Metal Panels (Forman Ford)9,451.66 Bid Package #7: Roofing (Academy Roofing) Bid Package #8: Glass & Glazing (Ford Metro)10,393.00 Bid Package #9: Overhead Doors (Skold Door) Bid Package #10: Framing, Drywall & Ceilings (Hilsabeck Schacht) 291,262.11 Bid Package #11: Fire Protection (Elite Fire Sprinkler)14,250.00 Bid Package #12: Mechanical & Plumbing (Kruck Plumbing & Heating) 357,523.95 Bid Package #13: Electrical & Communications (Van Maanen Electric) 500,482.22 Bid Package #14: Audio-Visual (Tri-City Electric)113,999.99 Bid Package #15: Earthwork & Utilities (Wenthold Excavating) 83,324.51 Bid Package #16: SWPPP (Absolute Group)10,925.00 Bid Package #17: Site Concrete (Jordison Construction)181,959.85 Bid Package #18: Landscaping & Irrigation (Alpha Landscapes) 152,074.10 Pay Application Subtotal 2,080,048.46 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF TWO PAGES TO OWNER:APPLICATION NO:1 Distribution to: City of Waukee Waukee Public Safety Bldg INVOICE NO:3167 OWNER 230 W Hickman Rd Intersection of T Ave & Douglas Pkwy ARCHITECT Waukee, IA 50263 Waukee, IA 50263 PERIOD TO: 4/30/2025 CONTRACTOR FROM CONTRACTOR: Alpha Landscapes LLC 31273 510th Ave PROJECT NO: Slater, Iowa 50244 CONTRACT FOR: Landscaping CONTRACT DATE: 12/18/2023 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 beenContinuation 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. 1. ORIGINAL CONTRACT SUM $653,784.002. Net change by Change Orders $(11,860.00)CONTRACTOR:3. CONTRACT SUM TO DATE (Line 1 ± 2) $641,924.00 4. TOTAL COMPLETED & STORED TO $160,078.00 DATE (Column G on G703)By: Date:4/21/20255. RETAINAGE:a.5 % of Completed Work $8,003.90 State of: Iowa County of: Story(Column D + E on G703)b.0 % of Stored Material $(Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) $8,003.90 ARCHITECT'S CERTIFICATE FOR PAYMENT6. TOTAL EARNED LESS RETAINAGE $152,074.10 In accordance with the Contract Documents, based on on-site observations and the data(Line 4 Less Line 5 Total)comprising the application, the Architect certifies to the Owner that to the best of the7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) $0.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor8. CURRENT PAYMENT DUE $152,074.10 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE $489,849.90(Line 3 less Line 6)AMOUNT CERTIFIED . . . . . . . . . . . $152,074.10 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified.) in previous months by Owner $0.00 ($11,860.00)ARCHITECT: Total approved this Month $0.00 $0.00 By: Date: TOTALS $0.00 ($11,860.00)This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without NET CHANGES by Change Order ($11,860.00)prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 · APPLICATION AND CERTIFICATION FOR PAYMENT · 1992 EDITION · AIA · ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee. My Commission expires: 2/28/26Notary Public: Taylor FitzsimmonsSubscribed and sworn to me this 21st day of April, 2025. PROJECT: VIA ARCHITECT: Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 CONTINUATION SHEET AIA DOCUMENT G703 PAGE TWO OF TWO PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO:1Contractor's signed certification is attached.APPLICATION DATE:4/21/2025 In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:4/30/2025 Use Column I on Contracts where variable retainage for line items may apply.PROJECT NO: A B D E F G H IITEMDESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %BALANCE RETAINAGENO.VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G ÷ C)TO FINISH (IF VARIABLEAPPLICATIONSTOREDAND STORED (C - G)RATE)(D + E)(NOT IN TO DATED OR E)(D+E+F)5% 1 Planting $307,470.00 $0.00 $127,230.00 $0.00 $127,230.00 41%$180,240.00 $6,361.50 2 Biocell Excavation $11,880.00 $0.00 $0.00 $0.00 $0.00 0%$11,880.00 $0.00 3 Geotextile Fabric $1,260.00 $0.00 $0.00 $0.00 $0.00 0%$1,260.00 $0.00 4 Choker Layer 3"$2,250.00 $0.00 $0.00 $0.00 $0.00 0%$2,250.00 $0.00 5 Biocell Soil 42" $19,475.00 $0.00 $5,289.00 $0.00 $5,289.00 27%$14,186.00 $264.45 6 Weed Barrier $4,500.00 $0.00 $0.00 $0.00 $0.00 0%$4,500.00 $0.00 7 Trap Rock $2,160.00 $0.00 $0.00 $0.00 $0.00 0%$2,160.00 $0.00 8 Steel Edging $24,200.00 $0.00 $0.00 $0.00 $0.00 0%$24,200.00 $0.00 9 Hardwood Mulch $25,920.00 $0.00 $5,400.00 $0.00 $5,400.00 21%$20,520.00 $270.00 10 Rubber Mulch $20,370.00 $0.00 $11,672.00 $0.00 $11,672.00 57%$8,698.00 $583.60 11 Sod $47,310.00 $0.00 $0.00 $0.00 $0.00 0%$47,310.00 $0.00 12 Low-grow Turf Seed $9,300.00 $0.00 $0.00 $0.00 $0.00 0%$9,300.00 $0.00 13 Native Tall Grass Prairie Seed $29,150.00 $0.00 $0.00 $0.00 $0.00 0%$29,150.00 $0.00 PAGE TOTALS $505,245.00 $0.00 $149,591.00 $0.00 $149,591.00 30%$355,654.00 $7,479.55 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity AIA DOCUMENT G703 · CONTINUATION SHEET FOR G702 · 1992 EDITION · AIA · ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5232 G703-1992 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 CONTINUATION SHEET AIA DOCUMENT G703 PAGE TWO OF TWO PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO:1Contractor's signed certification is attached.APPLICATION DATE:4/21/2025 In tabulations below, amounts are stated to the nearest dollar.PERIOD TO:4/30/2025 Use Column I on Contracts where variable retainage for line items may apply.PROJECT NO: A B D E F G H IITEMDESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL %BALANCE RETAINAGENO.VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G ÷ C)TO FINISH (IF VARIABLEAPPLICATIONSTOREDAND STORED (C - G)RATE)(D + E)(NOT IN TO DATED OR E)(D+E+F)5% 1 Rain Garden Seed $1,520.00 $0.00 $0.00 $0.00 $0.00 0%$1,520.00 $0.00 2 Hydromulch $45,444.00 $0.00 $0.00 $0.00 $0.00 0%$45,444.00 $0.00 3 Recp. Blanket Type 2.D $21,600.00 $0.00 $4,461.00 $0.00 $4,461.00 21%$17,139.00 $223.05 4 Irrigation $56,975.00 $0.00 $4,026.00 $0.00 $4,026.00 7%$52,949.00 $201.30 5 Change Order 1 - Insurance Change $0.00 $0.00 $0.00 $0.00 $0.00 0%$0.00 $0.00 6 Temp. Irrigation for 30 Days $23,000.00 $0.00 $2,000.00 $0.00 $2,000.00 9%$21,000.00 $100.00 7 Change Order 2 ($11,860.00)$0.00 $0.00 $0.00 $0.00 0%($11,860.00)$0.00 8 9 10 11 12 13 PAGE TOTALS $136,679.00 $0.00 $10,487.00 $0.00 $10,487.00 8%$126,192.00 $524.35 GRAND TOTALS $641,924.00 $0.00 $160,078.00 $0.00 $160,078.00 25%$481,846.00 $8,003.90 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity AIA DOCUMENT G703 · CONTINUATION SHEET FOR G702 · 1992 EDITION · AIA · ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006-5232 G703-1992 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 24,106.25 10,925.00 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 9,000.00 2,500.00 $11,500.00 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 4.15.25 Iowa Polk15th April, 2025 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Invoice #: 331742APPLICATION AND CERTIFICATE FOR PAYMENT 1Page Contractor Architect Owner Distribution to : 87A176370 City of Waukee Public Safety Contract Date: Project Nos: Contract For: Via Architect: Tri City Electric Co of Iowa CorpFrom Contractor: Ryan Companies Project:To Owner: 4 Period To: Application No. : 111 E Grand Ave, Suite 200 6225 N Brady St Davenport, IA 52806 Des Moines, IA 50309 Application Date :4/21/2025 Due Date :5/21/2025 -$3,112.00 $24,416.92 day ofSubscribed and sworn to before me this County of:State of: 4. Total Completed and Stored To Date . . . . . . . . . . . . . . . Notary Public: $19,989.23 5.00%of Stored Materialb. Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet is attached. a. 5. Retainage : $4,427.69 ARCHITECT'S CERTIFICATE FOR PAYMENT My Commission expires: $113,999.99 5.00% By:____________________________________Date:______________$488,338.34 $599,720.00 Tri City Electric Co of Iowa CorpCONTRACTOR:$602,832.00 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 received from the Owner, and that current payment shown herein is now due. $349,921.43 $463,921.42 In accordance with the Contract Documents, based on on-site observations and the data comprising the above 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. 1. Original Contract Sum . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Current Payment Due . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Less Previous Certificates For Payments . . . . . . . . . . . . 6. Total Earned Less Retainage . . . . . . . . . . . . . . . . . . . . . . Total Retainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of Completed Work 3. Contract Sum To Date . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Net Change By Change Order . . . . . . . . . . . . . . . . . . . . CONTRACTOR'S APPLICATION FOR PAYMENT CHANGE ORDER SUMMARY Additions Deductions Total changes approved $0.00 $0.00 Total Approved this Month TOTALS $5,588.00$2,476.00 Net Changes By Change Order -$3,112.00 9. Balance To Finish, Plus Retainage . . . . . . . . . . . . . . . . .$135,798.58 AMOUNT CERTIFIED (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) ARCHITECT: 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. in previous months by Owner By:____________________________________Date:______________ $113,999.99 $2,476.00 $5,588.00 5/6/25 May 20256th Scott October 16, 2026 Iowa Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 CONTINUATION SHEET Page 2 of 2 (Not in D or E)(D+E+F) To Date(D+E) Application In Place Stored and Stored No.Value From Previous This Period Presently Completed (G / C)To Finish(C-G) Item Total Description of Work Scheduled Materials %Balance RetainageWork Completed A B C D E F G H I Contract : 87A176370 City of Waukee Public Safety 331742Invoice # : Architect's Project No.: To: 4/21/2025Application Date : 4Application No. :Application and Certification 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.Due Date :5/21/2025 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.001City of Waukee Public Safety 300.00 6,000.00 100.00% 6,000.00 0.00 0.00 6,000.00 0.002Submittals 1,435.35 0.00 100.00% 28,707.06 28,707.06 0.00 28,707.33 0.273AV Rough-in Material 925.00 10,000.00 100.00% 18,500.00 0.00 8,500.00 18,500.00 0.004AV Cabling 21,181.57 0.00 90.13% 423,631.28 371,077.46 52,553.82 470,000.00 46,368.725AV Material 575.00 0.00 16.88% 11,500.00 0.00 11,500.00 68,124.67 56,624.676AV Installation 0.00 0.00 0.00% 0.00 0.00 0.00 9,000.00 9,000.007AV Testing 0.00 0.00 0.00% 0.00 0.00 0.00 2,500.00 2,500.008Training 0.00 0.00 0.00% 0.00 0.00 0.00 260.00 260.00901Change Order #1 - Add Audinate USB Option 0.00 0.00 0.00% 0.00 0.00 0.00-5,588.00 -5,588.00902Change Order #2 - Material Credit for Rooms 211, 102, & 332 0.00 0.00 0.00% 0.00 0.00 0.00 2,216.00 2,216.00903Change Order #3 - Ceiling Mount Brackets for Mics 16,000.00 72,553.82 399,784.52 488,338.34 81.43% 111,381.66 24,416.92Grand Totals 599,720.00 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Docusign Envelope ID: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Certificate Of Completion Envelope Id: B7534BCA-4342-4D1A-8B4D-43B08F3CA403 Status: Completed Subject: Complete with Docusign: WPS Pay App 17-_Project Manual.pdf Source Envelope: Document Pages: 45 Signatures: 2 Envelope Originator: Certificate Pages: 5 Initials: 0 Beth Bertlshofer AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 533 South Third Street, Suite 100 Minneapolis, MN 55415 Beth.Bertlshofer@RyanCompanies.com IP Address: 4.43.134.74 Record Tracking Status: Original 5/9/2025 11:21:12 AM Holder: Beth Bertlshofer Beth.Bertlshofer@RyanCompanies.com Location: DocuSign Signer Events Signature Timestamp Ryan Pigneri Ryan.Pigneri@RyanCompanies.com Project manager Ryan Companies US, Inc. Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 174.215.242.179 Signed using mobile Sent: 5/9/2025 11:43:16 AM Viewed: 5/9/2025 12:14:11 PM Signed: 5/9/2025 12:14:17 PM Electronic Record and Signature Disclosure: Not Offered via Docusign Aaron Twedt atwedt@opnarchitects.com Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 140.82.188.2 Sent: 5/9/2025 12:14:20 PM Viewed: 5/9/2025 12:26:43 PM Signed: 5/9/2025 12:26:49 PM Electronic Record and Signature Disclosure: Accepted: 5/9/2025 12:26:43 PM ID: baff86c9-cf48-4f1d-8305-8a2851db40b0 In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 5/9/2025 11:43:16 AM Certified Delivered Security Checked 5/9/2025 12:26:43 PM Signing Complete Security Checked 5/9/2025 12:26:49 PM Envelope Summary Events Status Timestamps Completed Security Checked 5/9/2025 12:26:49 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, Ryan Companies US, Inc. 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