A | B | C | D | E | F | G | H | I | |
---|---|---|---|---|---|---|---|---|---|
1 | CERTIFICATION FOR PAYMENT FOR ESTIMATED WORK | ||||||||
2 | BLOCK 1 | Contractor: | Dunn Construction Inc. | ||||||
3 | Address: | 10340 NE Weidler | Phone: | (503) 408-7601 | |||||
4 | City, State, Zip: | Portlnad, OR 97220 | Fax: | (503) 408-7602 | |||||
5 | Proj Manager | Frank Dunn | |||||||
6 | |||||||||
7 | BLOCK 2 | Project: | SW Arboretum Hills LID | Progress Payment # | 6 Final | ||||
8 | Contractor: | Dunn Construction Inc. | Pay Period Ending Date: | 04/30/02 | |||||
9 | Contract #: | 33088 | Notice to Proceed Date: | 9/15/2000 | |||||
10 | Original Contract Amount: | $152,577 | No. of Days in Contract: | 71 | |||||
11 | Change Orders Authorized: | $1,992 | No. of Days Added by Change Order: | 0 | |||||
12 | Total Authorized: | $165,193 | Completion Date: | 10/31/2001 | |||||
13 | Invoice Date: | 10/31/01 | Days Remaining: | * | |||||
14 | |||||||||
17 | BLOCK 3 | R | Estimated Work Completed To Date (Page 2 Column N Total) | 165,192.76 | |||||
18 | S | Material-on-Hand (Page 3, Column I Total) | 0.00 | ||||||
19 | T | Total Completed & Material On Hand (R + S) | 165,192.76 | ||||||
20 | U | Retainage to date | 0.00 | ||||||
21 | V | 15% Retainage for Materials-on-hand (15% of S) | 0.00 | ||||||
22 | W | Total Retainage (U+V) | 0.00 | ||||||
23 | X | Authorized Payments to Date (T-W) | 165,192.76 | ||||||
24 | Y | Total Progress Payments Made to Date | 156,933.12 | ||||||
26 | AA | Total of Payments to Date (Y+Z) | 156,933.12 | ||||||
27 | AB | PAYMENT DUE (X-AA) | $8,259.64 |
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Pay this amount | ||||
28 | |||||||||
29 | |||||||||
30 | Approved for Processing: | Project Manager / Date | |||||||
31 | |||||||||
32 | |||||||||
33 | BLOCK 4 | For Accounting use only if there are multiple projects in a contract (completed by PM) | |||||||
34 | Accounting: please make the following job number charges. | ||||||||
35 | Job # | Current Charges | |||||||
36 | Proj # _______ | $0.00 | |||||||
37 | Proj # _______ | $0.00 | |||||||
38 | Proj # _______ | $0.00 | |||||||
39 | Proj # _______ | $0.00 | |||||||
40 | |||||||||
41 | Total Proj Charges | $0.00 | |||||||
42 |
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | BLOCK 1 | APPLICATION AND CERTIFICATION FOR PAYMENT | ||||||||||||||
2 | To: | City of Portland Bureau of Water Works | Contractor: | Dunn Construction Inc. | ||||||||||||
3 | 1120 SW 5th Ave, Rm 600 | Address: | 10340 NE Weidler | |||||||||||||
4 | Portland, OR 97204 | City, State, Zip: | Portlnad, OR 97220 | |||||||||||||
5 | Frank Dunn | Phone: | (503) 408-7601 | |||||||||||||
6 | Fax: | (503) 408-7602 | ||||||||||||||
7 | BLOCK 2 | Project: | SW Arboretum Hills LID | Progress Payment # | 6 Final | |||||||||||
8 | Contractor: | Dunn Construction Inc. | For Work Completed Through: | 04/30/02 | ||||||||||||
9 | Contract #: | 33088 | Completion Date: | 10/31/2001 | ||||||||||||
10 | Notice to Proceed Issued: | 9/15/2000 | Days Remaining | * | ||||||||||||
11 | BLOCK 3 | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O |
12 | Bid Amount | Previous Work | Current Work | Total Completed to Date | ||||||||||||
13 | Item No. | Description of Work | QTY | Unit | Unit Price | Original Authorization | Revised Authorization | Completed Quantity | Amount | Quantity | Amount | Qty | Amount | % Complete of Original | Balance to Finish | |
14 | ( Previous J ) | ( Previous K ) | (J * E ) | (H +J) | (I + K) | (M / F ) or (M/G) | (F - M) or (G - M) | |||||||||
15 | 1 | Mobilization | 1.0 | LS | 7,600.00 | 7,600.00 | 7,600.00 | 100% | 7,600.00 | 0% | 0.00 | 100% | 7,600.00 | 100% | 0.00 | |
16 | 2 | Trench Excavation | 596.0 | CY | 5.00 | 2,980.00 | 2,980.00 | 596.0 | 2,980.00 | 0.0 | 0.00 | 596.0 | 2,980.00 | 100% | 0.00 | |
17 | 3 | Rock Excavation | 10.0 | CY | 10.00 | 100.00 | 0.00 | 0.0 | 0.00 | 0.0 | 0.00 | 0.0 | 0.00 | 100% | 0.00 | |
18 | 4 | Trench Backfill (Import) | 220.0 | CY | 10.00 | 2,200.00 | 2,200.00 | 220.0 | 2,200.00 | 0.0 | 0.00 | 220.0 | 2,200.00 | 100% | 0.00 | |
19 | 5 | Trench Backfill (Native) | 15.0 | CY | 10.00 | 150.00 | 132.00 | 13.2 | 132.00 | 0.0 | 0.00 | 13.2 | 132.00 | 100% | 0.00 | |
20 | 6 | 6" Class 52 Restrained DI Pipe w/ Pipe Zone Bedding and Backfill | 1782.0 | LF | 31.00 | 55,242.00 | 55,242.00 | 1782.0 | 55,242.00 | 0.0 | 0.00 | 1,782.0 | 55,242.00 | 100% | 0.00 | |
21 | 7 | AC Pavement (Base Lift) 1-1/2" | 245.0 | SY | 23.00 | 5,635.00 | 5,543.00 | 241.0 | 5,543.00 | 0.0 | 0.00 | 241.0 | 5,543.00 | 100% | 0.00 | |
22 | 8 | AC Pavement Overlay (Top Lift) 2" | 2500.0 | SY | 10.00 | 25,000.00 | 22,100.00 | 2210.0 | 22,100.00 | 0.0 | 0.00 | 2,210.0 | 22,100.00 | 100% | 0.00 | |
23 | 9 | Crushed Rock Pavement Base | 41.0 | CY | 10.00 | 410.00 | 410.00 | 41.0 | 410.00 | 0.0 | 0.00 | 41.0 | 410.00 | 100% | 0.00 | |
24 | 10 | Crush Rock Resurfacing | 156.0 | SY | 15.00 | 2,340.00 | 2,619.00 | 174.6 | 2,619.00 | 0.0 | 0.00 | 174.6 | 2,619.00 | 100% | 0.00 | |
25 | 11 | 6" Gate Valve | 4.0 | EA | 400.00 | 1,600.00 | 1,600.00 | 4.0 | 1,600.00 | 0.0 | 0.00 | 4.0 | 1,600.00 | 100% | 0.00 | |
26 | 12 | Hydrant Assemblies | 4.0 | EA | 1,900.00 | 7,600.00 | 7,600.00 | 4.0 | 7,600.00 | 0.0 | 0.00 | 4.0 | 7,600.00 | 100% | 0.00 | |
27 | 13 | 3/4" Air Release Assembly | 1.0 | EA | 500.00 | 500.00 | 500.00 | 1.0 | 500.00 | 0.0 | 0.00 | 1.0 | 500.00 | 100% | 0.00 | |
28 | 14 | 3/4" Service Lateral | 150.0 | LF | 12.00 | 1,800.00 | 1,740.00 | 145.0 | 1,740.00 | 0.0 | 0.00 | 145.0 | 1,740.00 | 100% | 0.00 | |
29 | 15 | 3/4" Backside Water Service | 540.0 | LF | 53.00 | 28,620.00 | 42,135.00 | 795.0 | 42,135.00 | 0.0 | 0.00 | 795.0 | 42,135.00 | 100% | 0.00 | |
30 | 16 | Connections for Other Backside Work | 14.0 | EA | 200.00 | 2,800.00 | 2,800.00 | 14.0 | 2,800.00 | 0.0 | 0.00 | 14.0 | 2,800.00 | 100% | 0.00 | |
31 | 17 | Erosion Control | 1.0 | LS | 2,500.00 | 2,500.00 | 2,500.00 | 1.00 | 2,500.00 | 0.00 | 0.00 | 1.0 | 2,500.00 | 100% | 0.00 | |
32 | 18 | Construction Sign | 1.0 | EA | 500.00 | 500.00 | 500.00 | 1.0 | 500.00 | 0.0 | 0.00 | 1.0 | 500.00 | 100% | 0.00 | |
33 | 19 | Landscape Restoration | 1.0 | LS | 5,000.00 | 5,000.00 | 5,000.00 | 1.0 | 5,000.00 | 0.0 | 0.00 | 1.0 | 5,000.00 | 100% | 0.00 | |
34 | ||||||||||||||||
35 | Subtotal 1 | 152,577.00 | 163,201.00 | 163,201.00 | 0.00 | 163,201.00 | 0.00 | |||||||||
36 | ||||||||||||||||
37 | 20 | Change Order 1 | 1.0 | LS | 873.49 | 0.00 | 873.49 | 1.0 | 873.49 | 0 | 0.00 | 1.0 | 873.49 | 100% | 0.00 | |
38 | 21 | Change Order 2 | 1.0 | LS | 1,118.27 | 0.00 | 1,118.27 | 1.0 | 1,118.27 | 0 | 0.00 | 1.0 | 1,118.27 | 100% | 0.00 | |
39 | 22 | Change Order 3 | 1.0 | LS | 0.00 | 0.00 | 0.00 | 1.0 | 0.00 | 0 | 0.00 | 1.0 | 0.00 | 100% | 0.00 | |
40 | ||||||||||||||||
41 | Subtotal 2 | 0.00 | 1,991.76 | 1,991.76 | 0.00 | 1,991.76 | 0.00 | |||||||||
42 | ||||||||||||||||
43 | TOTALS | 152,577.00 | $165,192.76 | $165,192.76 | $0.00 | $165,192.76 | $0.00 |