HomeMy WebLinkAbout2026-06-15 I01H_03 Waukee Public Safety Renovation Project_Pmt Est 5AGENDA ITEM:
CITY OF WAUKEE, IOWA
CITY COUNCIL MEETING COMMUNICATION
MEETING DATE: June 15, 2026
AGENDA ITEM:Consideration of approval of Payment Estimate No. 5 (Combined) for
the Waukee Existing Public Safety Building Renovation Project in the
amount of $474,737.16.
FORMAT:Consent Agenda
SYNOPSIS INCLUDING PRO & CON: The renovation project for the building at 1300 SE
LA Grant Parkway continues. Work completed for this pay application includes glass and
glazing installation, earthwork and utilities, concrete work, framing, plumbing and mechanical
and the costs associated with Ryan Companies who is acting as the Construction Manager on the
project.
FISCAL IMPACT INCLUDING COST/BENEFIT ANALYSIS: Payment Estimate No. 5 is
in the amount of $474,737.16.
COMMISSION/BOARD/COMMITTEE COMMENT:
STAFF REVIEW AND COMMENT:
RECOMMENDATION: Approve Pay Estimate No. 5
ATTACHMENTS: I. Pay Estimate No. 5
PREPARED BY:Brad Deets, City Administrator
REVIEWED BY:
PUBLIC NOTICE INFORMATION –
NAME OF PUBLICATION:
DATE OF PUBLICATION:
I1H3
TO:City of Waukee PROJECT:Waukee Existing Fire/Police Renovation CMA APPLICATION NO: 5
230 Hickman Rd
Waukee, Iowa 50263
1300 SE LA Grant Parkway
Waukee, Iowa 50263
APPLICATION DATE: 6/15/2026
PERIOD FROM: 05/01/26
PERIOD TO: 05/30/26
FROM (CONTRACTOR): Ryan Companies PROJECT NO: 007507CMA
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
CONTRACT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous
months by Owner/Client:$ 2,702.70 ($11,933.90)
Total approved this Month:$ 1,300.00 ($147,018.00)
Totals:$ 4,002.70 ( $158,951.90)
Net change by change orders:($154,949.20)
ORIGINAL CONTRACT SUM $ 6,728,745.00
Net Change by Change Orders ($154,949.20)
CONTRACT SUM TO DATE $ 6,573,795.80
TOTAL COMPLETED & STORED TO DATE $ 716,737.63
RETAINAGE $ 14,148.82
TOTAL EARNED LESS RETAINAGE $ 702,588.81
LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 227,851.65
CURRENT PAYMENT DUE $ 474,737.16
ARCHITECT'S CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on-site observations and the data
comprimising this application, the Civil Engineer 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.
Amount Certified:$ 474,737.16
Architect:
By:
Date:
Civil Engineer:
By:
Date:
CONTRACTOR: RYAN COMPANIES US INC
By: Date:
State of: County of:
Subscribed and sworn to before me this ________day of _______________, 20_____.
Notary Public:__________________________________________________
My Commission expires:______________
APPLICATION AND CERTIFICATE FOR PAYMENT Page 1 of 2
City of Waukee
Brad Deets, City Administrator
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Item Number
Value Work Completed Materials Total Completed & Stored Materials Retainage
Prime
Contract Value Change Value Scheduled
Value
From Previous
Application ($)This Period ($)
Materials
Presently
Stored
Total to Date
($)
Total to Date
(%)
Balance to
Finish Total
1 BP01 - PDM - Glass &
Glazing
2 BP02 - DDVI - General
Construction
3 BP03 - Jordison
Construction - Concrete
4 BP04 - Forrest &
Associates - Masonry
5 BP05 - CarterBuilt -
Framing, Drywall & ACT
6 BP06 - WD Door -
Overhead Doors
7 BP07 - Richmond
Renovation - Painting
8 BP08 - Des Moines
Marble & Mantel Co - Tile
& Flooring
9 BP09 - Midwest
Automatic Fire Sprinkler
Co - Fire Protection
10 BP10 - Air-Con
Mechanical Corp -
Plumbing
11 BP11 - AMC
Mechanical Inc -
Mechanical
12 BP12 - DeVries
Electric Inc - Electrical
13 BP13 - Kelly Cortum
Inc - Earthwork & Utilities
14 Ryan Companies -
CMa Professional
Services
Grand Totals $6,728,745.00 ($154,949.20)$6,573,795.80 $229,472.28 $487,265.35 $0.00 $716,737.63 10.90%$5,857,058.17 $14,148.82
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 1 of 1Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
TO CONTRACTOR:PROJECT:APPLICATION NO:2
Ryan Companies
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
Waukee Existing Fire/Police Renovation CMA
1300 SE LA Grant Parkway
Waukee, Iowa 50263
INVOICE NO:
PERIOD:05/01/26 - 05/30/26
PROJECT NO:007507CMA
FROM SUBCONTRACTOR: CONTRACT NO:BP-01
PDM Precast Inc
220 SE 6th St Ste 100
Des Moines, Iowa 50309
CONTRACT DATE:
CERTIFICATE DATE:06/05/2026
SUBMITTED DATE:
SUBCONTRACT FOR: Glass & Glazing
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Subcontract. Continuation
Sheet is attached.
1.Original Contract Sum $155,170.00
2.Net change by change orders $(7,931.20)
3.Contract Sum to date (Line 1 ± 2) $147,238.80
4.Total completed and stored to date
(Column G on detail sheet)
$95,580.00
5.Retainage:
a. 3.00% of completed work $2,867.40
b. 0.00% of stored material $0.00
Total retainage
(Line 5a + 5b or total in column I of detail sheet)
$2,867.40
6.Total earned less retainage
(Line 4 less Line 5 Total)
$92,712.60
7.Less previous certificates for payment
(Line 6 from prior certificate)
$52,400.37
8.Current payment due: $40,312.23
9.Balance to finish, including retainage
(Line 3 less Line 6)
$54,526.20
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous months by Owner/Client:$2,702.70 $(11,933.90)
Total approved this month:$1,300.00 $0.00
Totals:$4,002.70 $(11,933.90)
Net change by change orders:$(7,931.20)
The undersigned certifies that to the best of the Subcontractor's knowledge, information and belief,
the Work covered by this Application for Payment has been completed in accordance with
the Subcontract Documents, that all amounts have been paid by the Subcontractor for Work which
previous Certificates for payment were issued and payments received from the Owner/Client, and
that current payments shown herein is now due.
SUBCONTRACTOR: PDM Precast Inc
By:ProcoreSubcontractorSignHere Date:ProcoreSubcontractorSignedDate
State of:
County of:
Subscribed and sworn to before
me this day of
Notary Public:
My commission expires:
APPLICATION AND CERTIFICATE FOR PAYMENT DOCUMENT SUMMARY SHEET Page 1 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Document SUMMARY SHEET, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:2
Contractor's signed Certification is attached.APPLICATION DATE:05/23/2026
Use Column I on Contracts where variable retainage for line items apply.PERIOD:05/01/26 - 05/30/26
Contract Lines
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
1
08-088100-S.S
Glass & Glazing.S - Labor
& Materials Subcontract
Shop Drawings $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00%$0.00 $150.00
2
08-088100-S.S
Glass & Glazing.S - Labor
& Materials Subcontract
Glass Purchased Materials $92,800.00 $49,760.00 $33,408.00 $0.00 $83,168.00 89.62%$9,632.00 $2,495.04
3
08-088100-S.S
Glass & Glazing.S - Labor
& Materials Subcontract
Fab & Install $57,370.00 $4,245.00 $11,474.00 $0.00 $15,719.00 27.40%$41,651.00 $471.57
TOTALS:$155,170.00 $59,005.00 $44,882.00 $0.00 $103,887.00 66.95%$51,283.00 $3,116.61
Change Orders
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
4 CCO #001 PDM CO#1
4.1 08-088100-S.S
ITC #1 - Storefront & Curtainwall Mods $(11,933.90)$(6,444.00)$(4,296.00)$0.00 $(10,740.00)90.00%$(1,193.90)$(322.20)
4.2 08-088100-S.S
04.03.2026 As Bid Document Update $0.00 $0.00 $0.00 $0.00 $0.00 0.00%$0.00 $0.00
4.3 08-088100-S.S
BP#1 AIA232 11.1.1 Insurance Language Update $0.00 $0.00 $0.00 $0.00 $0.00 0.00%$0.00 $0.00
4.4 08-088100-S.S
ITC #1 - Hardware Mods $2,702.70 $1,460.00 $973.00 $0.00 $2,433.00 90.02%$269.70 $72.99
5 CCO #002 PDM CO#02 - CW-1 Acid Etched Glass (DC)
5.1 08-088100-S.S
PDM_CW-1 Acid Etched Glass $1,300.00 $0.00 $0.00 $0.00 $0.00 0.00%$1,300.00 $0.00
TOTALS:$(7,931.20)$(4,984.00)$(3,323.00)$0.00 $(8,307.00)104.74%$375.80 $(249.21)
Grand Totals
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
GRAND TOTALS:$147,238.80 $54,021.00 $41,559.00 $0.00 $95,580.00 64.91%$51,658.80 $2,867.40
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 2 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
TO CONTRACTOR:PROJECT:APPLICATION NO:1
Ryan Companies
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
Waukee Existing Fire/Police Renovation CMA
1300 SE LA Grant Parkway
Waukee, Iowa 50263
INVOICE NO:25190
PERIOD:05/01/26 - 05/30/26
PROJECT NO:007507CMA
FROM SUBCONTRACTOR: CONTRACT NO:BP-03
Jordison Construction Inc
12014 Ridgemont Dr
Urbandale , Iowa 50323
CONTRACT DATE:04/20/2026
CERTIFICATE DATE:06/05/2026
SUBMITTED DATE:
SUBCONTRACT FOR: Concrete
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Subcontract. Continuation
Sheet is attached.
1.Original Contract Sum $575,000.00
2.Net change by change orders $0.00
3.Contract Sum to date (Line 1 ± 2) $575,000.00
4.Total completed and stored to date
(Column G on detail sheet)
$70,172.00
5.Retainage:
a. 3.00% of completed work $2,105.16
b. 0.00% of stored material $0.00
Total retainage
(Line 5a + 5b or total in column I of detail sheet)
$2,105.16
6.Total earned less retainage
(Line 4 less Line 5 Total)
$68,066.84
7.Less previous certificates for payment
(Line 6 from prior certificate)
$0.00
8.Current payment due: $68,066.84
9.Balance to finish, including retainage
(Line 3 less Line 6)
$506,933.16
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous months by Owner/Client:$0.00 $0.00
Total approved this month:$0.00 $0.00
Totals:$0.00 $0.00
Net change by change orders:$0.00
The undersigned certifies that to the best of the Subcontractor's knowledge, information and belief,
the Work covered by this Application for Payment has been completed in accordance with
the Subcontract Documents, that all amounts have been paid by the Subcontractor for Work which
previous Certificates for payment were issued and payments received from the Owner/Client, and
that current payments shown herein is now due.
SUBCONTRACTOR: Jordison Construction Inc
By:ProcoreSubcontractorSignHere Date:ProcoreSubcontractorSignedDate
State of:
County of:
Subscribed and sworn to before
me this day of
Notary Public:
My commission expires:
APPLICATION AND CERTIFICATE FOR PAYMENT DOCUMENT SUMMARY SHEET Page 1 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Document SUMMARY SHEET, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:1
Contractor's signed Certification is attached.APPLICATION DATE:05/21/2026
Use Column I on Contracts where variable retainage for line items apply.PERIOD:05/01/26 - 05/30/26
Contract Lines
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
1
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Footings - Labor $41,921.00 $0.00 $0.00 $0.00 $0.00 0.00%$41,921.00 $0.00
2
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Footings - Material $10,046.00 $0.00 $0.00 $0.00 $0.00 0.00%$10,046.00 $0.00
3
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Slabs - Labor $30,697.00 $0.00 $0.00 $0.00 $0.00 0.00%$30,697.00 $0.00
4
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Slabs - Material $14,044.00 $0.00 $0.00 $0.00 $0.00 0.00%$14,044.00 $0.00
5
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Demolition - Labor $119,944.00 $0.00 $70,172.00 $0.00 $70,172.00 58.50%$49,772.00 $2,105.16
6
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Sidewalks - Labor $28,608.00 $0.00 $0.00 $0.00 $0.00 0.00%$28,608.00 $0.00
7
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Sidewalks - Material $22,330.00 $0.00 $0.00 $0.00 $0.00 0.00%$22,330.00 $0.00
8
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Parking Lot - Labor $111,544.00 $0.00 $0.00 $0.00 $0.00 0.00%$111,544.00 $0.00
9
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Parking Lot - Material $189,496.00 $0.00 $0.00 $0.00 $0.00 0.00%$189,496.00 $0.00
10
03-033000-S.S
Concrete.S - Labor &
Materials Subcontract
Staking - Labor $6,370.00 $0.00 $0.00 $0.00 $0.00 0.00%$6,370.00 $0.00
TOTALS:$575,000.00 $0.00 $70,172.00 $0.00 $70,172.00 12.20%$504,828.00 $2,105.16
Grand Totals
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
GRAND TOTALS:$575,000.00 $0.00 $70,172.00 $0.00 $70,172.00 12.20%$504,828.00 $2,105.16
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 2 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
TO CONTRACTOR:PROJECT:APPLICATION NO:1
Ryan Companies
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
Waukee Existing Fire/Police Renovation CMA
1300 SE LA Grant Parkway
Waukee, Iowa 50263
INVOICE NO:15595
PERIOD:05/01/26 - 05/30/26
PROJECT NO:007507CMA
FROM SUBCONTRACTOR: CONTRACT NO:BP-04
Forrest & Associates Inc
817 SW 9th St
Des Moines, Iowa 50309
CONTRACT DATE:04/20/2026
CERTIFICATE DATE:06/05/2026
SUBMITTED DATE:
SUBCONTRACT FOR: Masonry
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Subcontract. Continuation
Sheet is attached.
1.Original Contract Sum $233,350.00
2.Net change by change orders $0.00
3.Contract Sum to date (Line 1 ± 2) $233,350.00
4.Total completed and stored to date
(Column G on detail sheet)
$2,196.00
5.Retainage:
a. 3.00% of completed work $65.88
b. 0.00% of stored material $0.00
Total retainage
(Line 5a + 5b or total in column I of detail sheet)
$65.88
6.Total earned less retainage
(Line 4 less Line 5 Total)
$2,130.12
7.Less previous certificates for payment
(Line 6 from prior certificate)
$0.00
8.Current payment due: $2,130.12
9.Balance to finish, including retainage
(Line 3 less Line 6)
$231,219.88
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous months by Owner/Client:$0.00 $0.00
Total approved this month:$0.00 $0.00
Totals:$0.00 $0.00
Net change by change orders:$0.00
The undersigned certifies that to the best of the Subcontractor's knowledge, information and belief,
the Work covered by this Application for Payment has been completed in accordance with
the Subcontract Documents, that all amounts have been paid by the Subcontractor for Work which
previous Certificates for payment were issued and payments received from the Owner/Client, and
that current payments shown herein is now due.
SUBCONTRACTOR: Forrest & Associates Inc
By:ProcoreSubcontractorSignHere Date:ProcoreSubcontractorSignedDate
State of:
County of:
Subscribed and sworn to before
me this day of
Notary Public:
My commission expires:
APPLICATION AND CERTIFICATE FOR PAYMENT DOCUMENT SUMMARY SHEET Page 1 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Document SUMMARY SHEET, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:1
Contractor's signed Certification is attached.APPLICATION DATE:05/23/2026
Use Column I on Contracts where variable retainage for line items apply.PERIOD:05/01/26 - 05/30/26
Contract Lines
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
1
04-042200-S.S
Unit Masonry.S - Labor &
Materials Subcontract
Sign Masonry - Materials $2,938.00 $0.00 $0.00 $0.00 $0.00 0.00%$2,938.00 $0.00
2
04-042200-S.S
Unit Masonry.S - Labor &
Materials Subcontract
Sign Masonry - Labor $2,072.00 $0.00 $0.00 $0.00 $0.00 0.00%$2,072.00 $0.00
3
04-042200-S.S
Unit Masonry.S - Labor &
Materials Subcontract
New Interior CMU Walls - Materials $19,064.00 $0.00 $0.00 $0.00 $0.00 0.00%$19,064.00 $0.00
4
04-042200-S.S
Unit Masonry.S - Labor &
Materials Subcontract
New Interior CMU Walls - Labor $41,692.00 $0.00 $0.00 $0.00 $0.00 0.00%$41,692.00 $0.00
5
04-042200-S.S
Unit Masonry.S - Labor &
Materials Subcontract
Masonry Restoration - Materials $45,384.00 $0.00 $0.00 $0.00 $0.00 0.00%$45,384.00 $0.00
6
04-042200-S.S
Unit Masonry.S - Labor &
Materials Subcontract
Masonry Restoration - Labor $120,004.00 $0.00 $0.00 $0.00 $0.00 0.00%$120,004.00 $0.00
7
04-042200-S.S
Unit Masonry.S - Labor &
Materials Subcontract
Bonds $2,196.00 $0.00 $2,196.00 $0.00 $2,196.00 100.00%$0.00 $65.88
TOTALS:$233,350.00 $0.00 $2,196.00 $0.00 $2,196.00 0.94%$231,154.00 $65.88
Grand Totals
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
GRAND TOTALS:$233,350.00 $0.00 $2,196.00 $0.00 $2,196.00 0.94%$231,154.00 $65.88
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 2 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
TO CONTRACTOR:PROJECT:APPLICATION NO:1
Ryan Companies
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
Waukee Existing Fire/Police Renovation CMA
1300 SE LA Grant Parkway
Waukee, Iowa 50263
INVOICE NO:
PERIOD:05/01/26 - 05/30/26
PROJECT NO:007507CMA
FROM SUBCONTRACTOR: CONTRACT NO:BP-05
Dwelling Enterprises LLC
207 Dwelling Dr
New Sharon, Iowa 50207
CONTRACT DATE:04/20/2026
CERTIFICATE DATE:06/05/2026
SUBMITTED DATE:
SUBCONTRACT FOR: Framing, Drywall, & ACT
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Subcontract. Continuation
Sheet is attached.
1.Original Contract Sum $274,689.00
2.Net change by change orders $0.00
3.Contract Sum to date (Line 1 ± 2) $274,689.00
4.Total completed and stored to date
(Column G on detail sheet)
$13,942.00
5.Retainage:
a. 3.00% of completed work $418.26
b. 0.00% of stored material $0.00
Total retainage
(Line 5a + 5b or total in column I of detail sheet)
$418.26
6.Total earned less retainage
(Line 4 less Line 5 Total)
$13,523.74
7.Less previous certificates for payment
(Line 6 from prior certificate)
$0.00
8.Current payment due: $13,523.74
9.Balance to finish, including retainage
(Line 3 less Line 6)
$261,165.26
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous months by Owner/Client:$0.00 $0.00
Total approved this month:$0.00 $0.00
Totals:$0.00 $0.00
Net change by change orders:$0.00
The undersigned certifies that to the best of the Subcontractor's knowledge, information and belief,
the Work covered by this Application for Payment has been completed in accordance with
the Subcontract Documents, that all amounts have been paid by the Subcontractor for Work which
previous Certificates for payment were issued and payments received from the Owner/Client, and
that current payments shown herein is now due.
SUBCONTRACTOR: Dwelling Enterprises LLC
By:ProcoreSubcontractorSignHere Date:ProcoreSubcontractorSignedDate
State of:
County of:
Subscribed and sworn to before
me this day of
Notary Public:
My commission expires:
APPLICATION AND CERTIFICATE FOR PAYMENT DOCUMENT SUMMARY SHEET Page 1 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Document SUMMARY SHEET, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:1
Contractor's signed Certification is attached.APPLICATION DATE:05/23/2026
Use Column I on Contracts where variable retainage for line items apply.PERIOD:05/01/26 - 05/30/26
Contract Lines
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
1
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
General Conditions $47,175.61 $0.00 $7,075.00 $0.00 $7,075.00 15.00%$40,100.61 $212.25
2
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Bonding $6,867.00 $0.00 $6,867.00 $0.00 $6,867.00 100.00%$0.00 $206.01
3
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Framing Material $18,224.00 $0.00 $0.00 $0.00 $0.00 0.00%$18,224.00 $0.00
4
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Framing Labor $35,500.00 $0.00 $0.00 $0.00 $0.00 0.00%$35,500.00 $0.00
5
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Insulation Material $5,061.00 $0.00 $0.00 $0.00 $0.00 0.00%$5,061.00 $0.00
6
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Insulation Labor $2,000.00 $0.00 $0.00 $0.00 $0.00 0.00%$2,000.00 $0.00
7
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Drywall Material $16,500.00 $0.00 $0.00 $0.00 $0.00 0.00%$16,500.00 $0.00
8
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Drywall Labor $35,760.00 $0.00 $0.00 $0.00 $0.00 0.00%$35,760.00 $0.00
9
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Acoustical Ceiling Labor $27,740.00 $0.00 $0.00 $0.00 $0.00 0.00%$27,740.00 $0.00
10
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Acoustical Ceiling Material $48,260.00 $0.00 $0.00 $0.00 $0.00 0.00%$48,260.00 $0.00
11
09-092100-S.S
Gypsum Board.S - Labor
& Materials Subcontract
Contractor Fee $31,601.39 $0.00 $0.00 $0.00 $0.00 0.00%$31,601.39 $0.00
TOTALS:$274,689.00 $0.00 $13,942.00 $0.00 $13,942.00 5.08%$260,747.00 $418.26
Grand Totals
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
GRAND TOTALS:$274,689.00 $0.00 $13,942.00 $0.00 $13,942.00 5.08%$260,747.00 $418.26
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 2 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
APPLICATION AND CERTIFICATE FOR PAYMENT 2
TO OWNER: PROJECT: Distribution to:
City of Waukee Iowa Waukee Exg. Fire/Police Building Renovation PERIOD TO:
230 W Hickman Road 1300 SE La Grant Parkway PROJECT NOS:Owner
Waukee, IA, 50263 Waukee, Iowa 50263 X Const. Mgr
FROM CONTRACTOR:VIA ARCHITECT / CM CONTRACT DATE:Architect
Carter Built Ryan Companies, US Inc.Contractor
207 Dwelling Drive 111 E Grand Avenue, Suite 200
New Sharon, IA 50207 Des Moines, IA 50309
CONTRACT FOR:Bid Package 05: Framing, Drywall & ACT
$ CONTRACTOR:
$
3. CONTRACT SUM TO DATE (Line 1 +/- 2)-----$ By: Date:
4. TOTAL COMPLETED TO DATE-------------------$
(Column G on Continuation Sheet)State of:
5. RETAINAGE:County of:
a. 3.0% of Completed Work $ Subscribed and sworn to before
(Columns D+E on Continuation Sheet)me this
b. 3.0% of Stored Material $
(Column F on Continuation Sheet)Notary Public:
My Commission expires:
$
$
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
$
$
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) $
By: Date:
13,942.00
Total in Column 1 of Continuation Sheet--------
Total Retainage (Line 5a + 5b or
CERTIFICATE FOR PAYMENT
418.26
day of
418.26
274,689.00
CONTRACTOR'S APPLICATION FOR PAYMENT
1. ORIGINAL CONTRACT SUM-----------------------
274,689.00
2. Net change by Change Orders------------------
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 therein is now due.
Application is made for payment, as shown below, in connection with the Contract.
Continuation Sheet is attached.
PAGESPAGE ONE OF
05/31/26
APPLICATION #: 1
04/20/26
NET CHANGES by Change Order
TOTALS
Total approved this Month
Total changes approved in previous
months by Owner
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 of Contractor under this Contract.
(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.)
ARCHITECT:
261,165.26
CHANGE ORDER SUMMARY
8. CURRENT PAYMENT DUE--------------------------13,523.74
ADDITIONS DEDUCTIONS
In accordance with Contract Documents, based on on-site observations and the data comprising
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.
6. TOTAL EARNED LESS RETAINAGE-----------
AMOUNT CERTIFIED ---------------------------------- $
(Line 6 from prior Certificate)-------------------
13,523.74
5/12/2026
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Page 2 of 2
1
PROJECT: 05/12/26
Waukee Exg. Fire/Police Building Renovation 31-May-26
1300 SE La Grant Parkway
Waukee, Iowa 50263
A B C D E F H I
Item Description of Work Scheduled Materials Total % Balance Retainage
No. Value From Previous This Period Presently Completed (G/C) To Finish
Application Stored And Stored (C - G)
(D + E) (Not In To Date
D or E) (D + E + F)
1 General Conditions 47,175.61 7,075.00 7,075.00 15% 40,100.61 212.25
2 Bonding 6,867.00 6,867.00 6,867.00 100% 206.01
3 Framing Material 18,224.00 18,224.00
4 Framing Labor 35,500.00 35,500.00
5 Insulation Material 5,061.00 5,061.00
6 Insulation Labor 2,000.00 2,000.00
7 Drywall Material 16,500.00 16,500.00
8 Drywall Labor 35,760.00 35,760.00
9 Acoustical Ceiling Labor 27,740.00 27,740.00
10 Acoustical Ceiling Material 48,260.00 48,260.00
11 Contractor Fee 31,601.39 31,601.39
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
SUBTOTALS PAGE 2 274,689.00 13,942.00 13,942.00 5% 260,747.00 418.26
CONTINUATION SHEET
APPLICATION DATE:
PERIOD TO:
ARCHITECT'S PROJECT NO:
G
Pages
ATTACHMENT TO PAY APPLICATION APPLICATION NUMBER:
Work CompletedManufactuer or
Supplier
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
TO CONTRACTOR:PROJECT:APPLICATION NO:1
Ryan Companies
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
Waukee Existing Fire/Police Renovation CMA
1300 SE LA Grant Parkway
Waukee, Iowa 50263
INVOICE NO:5412
PERIOD:05/01/26 - 05/30/26
PROJECT NO:007507CMA
FROM SUBCONTRACTOR: CONTRACT NO:BP-10
Air-Con Mechanical Corp
3121 SE 14th St
Des Moines, Iowa 50320
CONTRACT DATE:04/20/2026
CERTIFICATE DATE:06/05/2026
SUBMITTED DATE:05/21/2026
SUBCONTRACT FOR: Plumbing
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Subcontract. Continuation
Sheet is attached.
1.Original Contract Sum $282,445.00
2.Net change by change orders $0.00
3.Contract Sum to date (Line 1 ± 2) $282,445.00
4.Total completed and stored to date
(Column G on detail sheet)
$26,405.40
5.Retainage:
a. 3.00% of completed work $792.16
b. 0.00% of stored material $0.00
Total retainage
(Line 5a + 5b or total in column I of detail sheet)
$792.16
6.Total earned less retainage
(Line 4 less Line 5 Total)
$25,613.24
7.Less previous certificates for payment
(Line 6 from prior certificate)
$0.00
8.Current payment due: $25,613.24
9.Balance to finish, including retainage
(Line 3 less Line 6)
$256,831.76
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous months by Owner/Client:$0.00 $0.00
Total approved this month:$0.00 $0.00
Totals:$0.00 $0.00
Net change by change orders:$0.00
The undersigned certifies that to the best of the Subcontractor's knowledge, information and belief,
the Work covered by this Application for Payment has been completed in accordance with
the Subcontract Documents, that all amounts have been paid by the Subcontractor for Work which
previous Certificates for payment were issued and payments received from the Owner/Client, and
that current payments shown herein is now due.
SUBCONTRACTOR: Air-Con Mechanical Corp
By:ProcoreSubcontractorSignHere Date:ProcoreSubcontractorSignedDate
State of:
County of:
Subscribed and sworn to before
me this day of
Notary Public:
My commission expires:
APPLICATION AND CERTIFICATE FOR PAYMENT DOCUMENT SUMMARY SHEET Page 1 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Document SUMMARY SHEET, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:1
Contractor's signed Certification is attached.APPLICATION DATE:05/23/2026
Use Column I on Contracts where variable retainage for line items apply.PERIOD:05/01/26 - 05/30/26
Contract Lines
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
1
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Bond $2,825.00 $0.00 $2,825.00 $0.00 $2,825.00 100.00%$0.00 $84.75
2
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Mobilization $3,000.00 $0.00 $3,000.00 $0.00 $3,000.00 100.00%$0.00 $90.00
3
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Plumbing Demo $26,605.00 $0.00 $8,779.65 $0.00 $8,779.65 33.00%$17,825.35 $263.39
4
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Pipe Insulation Materials $6,600.00 $0.00 $0.00 $0.00 $0.00 0.00%$6,600.00 $0.00
5
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Pipe Insulation Labor $5,200.00 $0.00 $0.00 $0.00 $0.00 0.00%$5,200.00 $0.00
6
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Water Piping Materials $35,623.00 $0.00 $0.00 $0.00 $0.00 0.00%$35,623.00 $0.00
7
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Water Piping Labor $37,348.00 $0.00 $0.00 $0.00 $0.00 0.00%$37,348.00 $0.00
8
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Sanitary Pipe Materials $20,719.00 $0.00 $5,179.75 $0.00 $5,179.75 25.00%$15,539.25 $155.39
9
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Sanitary Pipe Labor $44,140.00 $0.00 $6,621.00 $0.00 $6,621.00 15.00%$37,519.00 $198.63
10
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Plumbing Fixtures Material $81,950.00 $0.00 $0.00 $0.00 $0.00 0.00%$81,950.00 $0.00
11
22-220000-S.S
Plumbing.S - Labor &
Materials Subcontract
Plumbing Fixtures Labor $18,435.00 $0.00 $0.00 $0.00 $0.00 0.00%$18,435.00 $0.00
TOTALS:$282,445.00 $0.00 $26,405.40 $0.00 $26,405.40 9.35%$256,039.60 $792.16
Grand Totals
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
GRAND TOTALS:$282,445.00 $0.00 $26,405.40 $0.00 $26,405.40 9.35%$256,039.60 $792.16
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 2 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
TO CONTRACTOR:PROJECT:APPLICATION NO:1
Ryan Companies
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
Waukee Existing Fire/Police Renovation CMA
1300 SE LA Grant Parkway
Waukee, Iowa 50263
INVOICE NO:10129-1
PERIOD:05/01/26 - 05/30/26
PROJECT NO:007507CMA
FROM SUBCONTRACTOR: CONTRACT NO:BP-11
AMC Mechanical Inc
215 Summit St
Otley, Iowa 50214
CONTRACT DATE:04/20/2026
CERTIFICATE DATE:06/05/2026
SUBMITTED DATE:
SUBCONTRACT FOR: Mechanical
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Subcontract. Continuation
Sheet is attached.
1.Original Contract Sum $672,000.00
2.Net change by change orders $0.00
3.Contract Sum to date (Line 1 ± 2) $672,000.00
4.Total completed and stored to date
(Column G on detail sheet)
$65,550.00
5.Retainage:
a. 3.00% of completed work $1,966.50
b. 0.00% of stored material $0.00
Total retainage
(Line 5a + 5b or total in column I of detail sheet)
$1,966.50
6.Total earned less retainage
(Line 4 less Line 5 Total)
$63,583.50
7.Less previous certificates for payment
(Line 6 from prior certificate)
$0.00
8.Current payment due: $63,583.50
9.Balance to finish, including retainage
(Line 3 less Line 6)
$608,416.50
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous months by Owner/Client:$0.00 $0.00
Total approved this month:$0.00 $0.00
Totals:$0.00 $0.00
Net change by change orders:$0.00
The undersigned certifies that to the best of the Subcontractor's knowledge, information and belief,
the Work covered by this Application for Payment has been completed in accordance with
the Subcontract Documents, that all amounts have been paid by the Subcontractor for Work which
previous Certificates for payment were issued and payments received from the Owner/Client, and
that current payments shown herein is now due.
SUBCONTRACTOR: AMC Mechanical Inc
By:ProcoreSubcontractorSignHere Date:ProcoreSubcontractorSignedDate
State of:
County of:
Subscribed and sworn to before
me this day of
Notary Public:
My commission expires:
APPLICATION AND CERTIFICATE FOR PAYMENT DOCUMENT SUMMARY SHEET Page 1 of 3
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Document SUMMARY SHEET, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:1
Contractor's signed Certification is attached.APPLICATION DATE:05/20/2026
Use Column I on Contracts where variable retainage for line items apply.PERIOD:05/01/26 - 05/30/26
Contract Lines
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
1
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Mobilization/Management $62,800.00 $0.00 $0.00 $0.00 $0.00 0.00%$62,800.00 $0.00
2
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Bond $6,983.00 $0.00 $0.00 $0.00 $0.00 0.00%$6,983.00 $0.00
3
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Mechanical Demo $19,500.00 $0.00 $17,550.00 $0.00 $17,550.00 90.00%$1,950.00 $526.50
4
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Refrigeration Piping $21,780.00 $0.00 $0.00 $0.00 $0.00 0.00%$21,780.00 $0.00
5
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
HVAC Installation $99,248.00 $0.00 $0.00 $0.00 $0.00 0.00%$99,248.00 $0.00
6
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Ductwork $64,440.00 $0.00 $0.00 $0.00 $0.00 0.00%$64,440.00 $0.00
7
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Equipment Install $45,756.00 $0.00 $0.00 $0.00 $0.00 0.00%$45,756.00 $0.00
8
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
HVAC Materials $19,800.00 $0.00 $0.00 $0.00 $0.00 0.00%$19,800.00 $0.00
9
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
MAU $20,391.00 $0.00 $0.00 $0.00 $0.00 0.00%$20,391.00 $0.00
10
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Radiant Heaters $17,419.00 $0.00 $0.00 $0.00 $0.00 0.00%$17,419.00 $0.00
11
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
HVLS Fans $12,544.00 $0.00 $0.00 $0.00 $0.00 0.00%$12,544.00 $0.00
12
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Rist Package Fans,FSDs,GRDs $27,195.00 $0.00 $0.00 $0.00 $0.00 0.00%$27,195.00 $0.00
13
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Setpoint VRV Furnaces,ERV,MS $165,375.00 $0.00 $48,000.00 $0.00 $48,000.00 29.02%$117,375.00 $1,440.00
14
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Controls Sub BMS $55,994.00 $0.00 $0.00 $0.00 $0.00 0.00%$55,994.00 $0.00
15
23-230000-S.S
HVAC Systems.S - Labor
& Materials Subcontract
Insulation Sub ICS $19,450.00 $0.00 $0.00 $0.00 $0.00 0.00%$19,450.00 $0.00
16 23-230000-S.S T&B Sub - SMB $13,325.00 $0.00 $0.00 $0.00 $0.00 0.00%$13,325.00 $0.00
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 2 of 3
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
HVAC Systems.S - Labor
& Materials Subcontract
TOTALS:$672,000.00 $0.00 $65,550.00 $0.00 $65,550.00 9.75%$606,450.00 $1,966.50
Grand Totals
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
GRAND TOTALS:$672,000.00 $0.00 $65,550.00 $0.00 $65,550.00 9.75%$606,450.00 $1,966.50
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 3 of 3
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
TO CONTRACTOR:PROJECT:APPLICATION NO:1
Ryan Companies
533 South Third Street, Suite 100
Minneapolis, Minnesota 55415
Waukee Existing Fire/Police Renovation CMA
1300 SE LA Grant Parkway
Waukee, Iowa 50263
INVOICE NO:
PERIOD:05/01/26 - 05/30/26
PROJECT NO:007507CMA
FROM SUBCONTRACTOR: CONTRACT NO:BP-13
Kelly Cortum Inc
340 Wright Rd Ste E
Norwalk, Iowa 50211
CONTRACT DATE:
CERTIFICATE DATE:06/05/2026
SUBMITTED DATE:
SUBCONTRACT FOR: Earthwork & Utilities
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Subcontract. Continuation
Sheet is attached.
1.Original Contract Sum $405,580.00
2.Net change by change orders $0.00
3.Contract Sum to date (Line 1 ± 2) $405,580.00
4.Total completed and stored to date
(Column G on detail sheet)
$197,782.00
5.Retainage:
a. 3.00% of completed work $5,933.46
b. 0.00% of stored material $0.00
Total retainage
(Line 5a + 5b or total in column I of detail sheet)
$5,933.46
6.Total earned less retainage
(Line 4 less Line 5 Total)
$191,848.54
7.Less previous certificates for payment
(Line 6 from prior certificate)
$0.00
8.Current payment due: $191,848.54
9.Balance to finish, including retainage
(Line 3 less Line 6)
$213,731.46
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total changes approved in previous months by Owner/Client:$0.00 $0.00
Total approved this month:$0.00 $0.00
Totals:$0.00 $0.00
Net change by change orders:$0.00
The undersigned certifies that to the best of the Subcontractor's knowledge, information and belief,
the Work covered by this Application for Payment has been completed in accordance with
the Subcontract Documents, that all amounts have been paid by the Subcontractor for Work which
previous Certificates for payment were issued and payments received from the Owner/Client, and
that current payments shown herein is now due.
SUBCONTRACTOR: Kelly Cortum Inc
By:ProcoreSubcontractorSignHere Date:ProcoreSubcontractorSignedDate
State of:
County of:
Subscribed and sworn to before
me this day of
Notary Public:
My commission expires:
APPLICATION AND CERTIFICATE FOR PAYMENT DOCUMENT SUMMARY SHEET Page 1 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Document SUMMARY SHEET, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:1
Contractor's signed Certification is attached.APPLICATION DATE:05/23/2026
Use Column I on Contracts where variable retainage for line items apply.PERIOD:05/01/26 - 05/30/26
Contract Lines
A B C D E F G H I
ITEM
NO.BUDGET CODE 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
1
31-312000-S.S
Earthwork.S - Labor &
Materials Subcontract
Site Demo $82,715.00 $0.00 $33,086.00 $0.00 $33,086.00 40.00%$49,629.00 $992.58
2
31-312000-S.S
Earthwork.S - Labor &
Materials Subcontract
Site Grading & Excavation $196,740.00 $0.00 $78,696.00 $0.00 $78,696.00 40.00%$118,044.00 $2,360.88
3
31-312000-S.S
Earthwork.S - Labor &
Materials Subcontract
Site Utilities $86,000.00 $0.00 $86,000.00 $0.00 $86,000.00 100.00%$0.00 $2,580.00
4
31-312000-S.S
Earthwork.S - Labor &
Materials Subcontract
Alternate #1 $40,125.00 $0.00 $0.00 $0.00 $0.00 0.00%$40,125.00 $0.00
TOTALS:$405,580.00 $0.00 $197,782.00 $0.00 $197,782.00 48.77%$207,798.00 $5,933.46
Grand Totals
A B C D E F G H 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)
RETAINAGEFROM PREVIOUS
APPLICATION
(D + E)
THIS PERIOD
GRAND TOTALS:$405,580.00 $0.00 $197,782.00 $0.00 $197,782.00 48.77%$207,798.00 $5,933.46
CONTINUATION SHEET DOCUMENT DETAIL SHEET Page 2 of 2
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF PAGES
To: City of Waukee APPLICATION NO: 4
230 W Hickman Road PROJECT: Waukee Existing Fire/Police Renovation
Waukee, Iowa 50263 APPLICATION DATE: 6/4/2026
PERIOD FROM: 5/1/2026
ATTN: Brad Deets, City Administrator PERIOD TO: 5/31/2026
FROM (CONTRACTOR):RYAN COMPANIES US, INC.
533 South Third Street, Suite 100 PROJECT NO: 7507-000
Minneapolis, MN 55415
CONTRACT FOR: Waukee Existing Fire/Police Renovation - CMa Services
CONTRACTOR'S APPLICATION FOR PAYMENT ORIGINAL CONTRACT SUM $1,028,544.00
CHANGE ORDER SUMMARY Net change by Change Orders -$147,018.00
Change Orders approved in ADDITIONS DEDUCTIONS
previous months by Owner CONTRACT SUM TO DATE $881,526.00
TOTAL
Approved This Month TOTAL COMPLETED & STORED TO DATE $245,110.23
Number Date Approved
001 5/14/2026 147,018.00 RETAINAGE 0.0% $0.00
TOTAL EARNED LESS RETAINAGE $245,110.23
LESS PREVIOUS CERTIFICATES FOR PAYMENT $175,451.28
CURRENT PAYMENT DUE $69,658.95
TOTALS 0.00 147,018.00 AMOUNT DUE FROM PREVIOUS APPLICATION #________
Net change by Change Orders -147,018.00
TOTAL AMOUNT DUE $69,658.95
State of: County of:
CONTRACTOR: RYAN COMPANIES US, INC. Subscribed and sworn to before me this ________day of _______________, 20_____.
Notary Public:
By: DATE: My Commission expires:
Docusign Envelope ID: BA7BDCC8-0B98-8626-809E-1F1473733745
6/4/2026
Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
CONTINUATION SHEET AIA DOCUMENT G703
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 4
Contractor’s signed Certification is attached.APPLICATION DATE: 6/4/2026
In tabulations below, amounts are stated to the nearest dollar.PERIOD FROM: 5/1/2026
Use Column I on Contracts where variable retainage for line items may apply. TO: 5/31/2026
A B C D E F G H I J K
Total Completed Balance
ITEM DESCRIPTION OF WORK SCHEDULED CHANGE REVISED PREVIOUS This Application and Stored %To Finish
No.VALUE ORDER VALUE APPLICATIONS Work in Place Stored Materials To Date (G/C)(C-G)
(not in D or E)(D+E+F)
1 Preconstruction Services
2 Preconstruction Management 100,000.00 100,000.00 100,000.00 100,000.00 100%0.00
10 Construction Services 371,548.00 59,363.00 430,911.00 56,137.50 49,375.40 105,512.90 24%325,398.10
20 General Conditions 330,739.00 (183,570.00)147,169.00 13,791.10 16,441.49 30,232.59 21%116,936.41
30 Cma Fee - 3.25% Management Time & GCs 226,257.00 (204,219.41)22,037.59 5,522.68 2,139.05 7,661.73 35%14,375.86
40 Cma Fee - 3.25% Cost of Work (Primes)181,408.41 181,408.41 0.00 1,703.01 1,703.01 1%179,705.40
Total 1,028,544.00 (147,018.00)881,526.00 175,451.28 69,658.95 0.00 245,110.23 28%636,415.77
WORK COMPLETED
Docusign Envelope ID: BA7BDCC8-0B98-8626-809E-1F1473733745Docusign Envelope ID: EF3EE9DE-57D9-8F19-829E-661F51CD7944
Certificate Of Completion
Envelope Id: EF3EE9DE-57D9-8F19-829E-661F51CD7944 Status: Sent
Subject: 7507000 Waukee Reno Prime Pay App #5
Source Envelope:
Document Pages: 27 Signatures: 0 Envelope Originator:
Certificate Pages: 4 Initials: 0 Allyson Meiners
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
533 South Third Street, Suite 100
Minneapolis, MN 55415
Allyson.Meiners@RyanCompanies.com
IP Address: 4.43.134.74
Record Tracking
Status: Original
6/10/2026 8:41:41 AM
Holder: Allyson Meiners
Allyson.Meiners@RyanCompanies.com
Location: DocuSign
Signer Events Signature Timestamp
Jill Boetger
jill.boetger@ryancompanies.com
Sr Project Manager
Ryan Companies US, Inc.
Security Level: Email, Account Authentication
(None)
Sent: 6/10/2026 8:42:50 AM
Viewed: 6/10/2026 9:39:39 AM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Danielle Hermann
dhermann@opnarchitects.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 3/8/2024 9:41:52 AM
ID: b5094507-12ff-4a23-a34a-4f95064c0e54
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 6/10/2026 8:42:50 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
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Electronic Record and Signature Disclosure created on: 3/8/2022 10:52:08 AM
Parties agreed to: Danielle Hermann
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