St. Louis County Public Works Department
4787 Midway Road
Duluth, MN 55811
Project CP 0000-430506 - CP 0000-430506 - Prime South Chip Seal 2020
Pay Request No. 1
Contractor:   KGM Contractors, Inc
  9211 Hwy 53
  Angora, MN 55703
Contract No. 449099
Vendor No. 00039735
For Period: 6/24/2020 - 6/30/2020
Warrant # __________ Date ___________
Contract Amounts
Original Contract $146,695.96
Contract Changes $0.00
Revised Contract $146,695.96
Funds Encumbered
Original $146,695.96
Additional N/A
Total $146,695.96
Work Certified To Date
Base Bid Items $0.00
Backsheet $0.00
Change Order $0.00
Supplemental Agreement $0.00
Work Order $0.00
Material On Hand $0.00
Total $0.00
 
 
  Work Certified
This Request
Work Certified
To Date
Less Amount
Retained
Less Previous
Payments
Amount Paid
This Request
Total Amount
Paid To Date
Amount Paid This Pay Request $0.00  
CP 0000-430506 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Percent Retained: 5.0000% Percent Complete: 0%
 
This is to certify that the items of work shown in this certificate of Pay Request have been actually furnished for
the work comprising the above mentioned projects in accordance with the plans and specifications heretofore approved.
Approved By  
N/A
Proj. Eng./Consultant
 
Date
Approved By Krasaway, Stephen
6ed7e7e38ebaf45bb17bf7535c4856a0
3e2f661900be1c96adaf81cb475600a9
Project Engineer
07/01/2020
Date
Approved By  
N/A
Contractor
 
Date



St. Louis County Public Works Department
4787 Midway Road
Duluth, MN 55811
Project No. CP 0000-430506
Pay Request No. 1
CP 0000-430506 Payment Summary
No. From Date To Date Work Certified
Per Request
Amount Retained
Per Request
Amount Paid
Per Request
1 06/24/2020 06/30/2020 $0.00 $0.00 $0.00

Totals: $0.00 $0.00 $0.00
 
CP 0000-430506 Funding Category Report
Funding
Category
No.
Work
Certified
To Date
Less
Amount
Retained
Less
Previous
Payments
Amount Paid
This
Request
Total
Amount Paid
To Date
001 0.00 0.00 0.00 0.00 0.00

Totals: $0.00 $0.00 $0.00 $0.00 $0.00
 
CP 0000-430506 Funding Source Report
Accounting
No.
Funding
Source
Amount Paid
This
Request
Revised
Contract
Amount
Funds
Encumbered
To Date
Paid To
Contractor
To Date
220582 - Hermantown Local by Municipality 0.00 146,695.96 146,695.96 0.00

Totals: $0.00 $146,695.96 $146,695.96 $0.00



St. Louis County Public Works Department
4787 Midway Road
Duluth, MN 55811
Project No. CP 0000-430506
Pay Request No. 1
CP 0000-430506 Project Item Status
Line Item Description Units Unit Price Contract
Quantity
Quantity This
Request
Amount This
Request
Quantity
To Date
Amount
To Date
CP 0000-494171 (LOBERG AVE.) 
1 2021.501/00010 MOBILIZATION LUMP SUM $3,950.00 1 0 $0.00 0 $0.00
2 2102.518/00010 PAVEMENT MARKING REMOVAL SQ FT $2.40 1065.66 0 $0.00 0 $0.00
3 2355.506/00010 BITUMINOUS MATERIAL FOR FOG SEAL GALLON $1.60 3026 0 $0.00 0 $0.00
4 2356.504/00010 BITUMINOUS SEAL COAT SQ YD $0.80 25213 0 $0.00 0 $0.00
5 2356.506/00020 BITUMINOUS MATERIAL FOR SEAL COAT GALLON $2.30 8068 0 $0.00 0 $0.00
6 2506.602/69011 PROTECT CASTING COVER EACH $45.00 3 0 $0.00 0 $0.00
7 2563.601/00010 TRAFFIC CONTROL LUMP SUM $1,900.00 1 0 $0.00 0 $0.00
8 2573.502/00110 STORM DRAIN INLET PROTECTION EACH $120.00 27 0 $0.00 0 $0.00
9 2580.503/00010 INTERIM PAVEMENT MARKING LIN FT $0.12 21558 0 $0.00 0 $0.00
10 2582.503/30104 4" SOLID LINE MULTI COMP LIN FT $0.30 4773 0 $0.00 0 $0.00
11 2582.503/30106 6" SOLID LINE MULTI COMP LIN FT $0.35 6065 0 $0.00 0 $0.00
12 2582.503/30124 24" SOLID LINE MULTI COMP LIN FT $7.50 190 0 $0.00 0 $0.00
13 2582.503/30204 4" BROKEN LINE MULTI COMP LIN FT $0.30 600 0 $0.00 0 $0.00
14 2582.503/30404 4" DBLE SOLID LINE MULTI COMP LIN FT $0.55 1591 0 $0.00 0 $0.00
15 2582.503/69001 6" DOTTED LINE MULTI COMP LIN FT $1.35 1740 0 $0.00 0 $0.00
16 2582.503/69006 6" BROKEN LINE MULTI COMP LIN FT $0.55 2098 0 $0.00 0 $0.00
17 2582.518/02000 PAVT MSSG MULTI COMP SQ FT $9.00 823.75 0 $0.00 0 $0.00
18 2582.518/06000 CROSSWALK MULTI COMP SQ FT $7.00 1152 0 $0.00 0 $0.00
Totals For Section CP 0000-494171 (LOBERG AVE.):   $0.00   $0.00
CP 0000-494172 (MARKET ST.) 
19 2021.501/00010 MOBILIZATION LUMP SUM $4,200.00 1 0 $0.00 0 $0.00
20 2355.506/00010 BITUMINOUS MATERIAL FOR FOG SEAL GALLON $1.60 1404 0 $0.00 0 $0.00
21 2356.504/00010 BITUMINOUS SEAL COAT SQ YD $0.80 11704 0 $0.00 0 $0.00
22 2356.506/00020 BITUMINOUS MATERIAL FOR SEAL COAT GALLON $2.30 4138 0 $0.00 0 $0.00
23 2506.602/69011 PROTECT CASTING COVER EACH $80.00 5 0 $0.00 0 $0.00
24 2563.601/00010 TRAFFIC CONTROL LUMP SUM $1,900.00 1 0 $0.00 0 $0.00
25 2573.502/00110 STORM DRAIN INLET PROTECTION EACH $110.00 17 0 $0.00 0 $0.00
26 2580.503/00010 INTERIM PAVEMENT MARKING LIN FT $0.15 11814 0 $0.00 0 $0.00
27 2582.503/30104 4" SOLID LINE MULTI COMP LIN FT $0.30 1740 0 $0.00 0 $0.00
28 2582.503/30106 6" SOLID LINE MULTI COMP LIN FT $0.40 2602 0 $0.00 0 $0.00
29 2582.503/30124 24" SOLID LINE MULTI COMP LIN FT $7.50 153 0 $0.00 0 $0.00
30 2582.503/30204 4" BROKEN LINE MULTI COMP LIN FT $0.30 360 0 $0.00 0 $0.00
31 2582.503/30404 4" DBLE SOLID LINE MULTI COMP LIN FT $0.60 1667 0 $0.00 0 $0.00
32 2582.602/6903 PROTECT PAVEMENT MARKINGS EACH $115.00 49 0 $0.00 0 $0.00
33 2582.603/6901 PROTECT PAVEMENT MARKINGS LIN FT $5.00 106 0 $0.00 0 $0.00
Totals For Section CP 0000-494172 (MARKET ST.):   $0.00   $0.00
CP 0000-494173 (WESTBERG RD.) 
34 2021.501/00010 MOBILIZATION LUMP SUM $4,500.00 1 0 $0.00 0 $0.00
35 2355.506/00010 BITUMINOUS MATERIAL FOR FOG SEAL GALLON $1.60 716 0 $0.00 0 $0.00
36 2356.504/00010 BITUMINOUS SEAL COAT SQ YD $1.15 5963 0 $0.00 0 $0.00
37 2356.506/00020 BITUMINOUS MATERIAL FOR SEAL COAT GALLON $2.30 1908 0 $0.00 0 $0.00
38 2563.601/00010 TRAFFIC CONTROL LUMP SUM $1,900.00 1 0 $0.00 0 $0.00
39 2580.503/00010 INTERIM PAVEMENT MARKING LIN FT $0.12 7496 0 $0.00 0 $0.00
40 2582.503/30106 6" SOLID LINE MULTI COMP LIN FT $0.40 3693 0 $0.00 0 $0.00
41 2582.503/30404 4" DBLE SOLID LINE MULTI COMP LIN FT $0.60 1874 0 $0.00 0 $0.00
42 2582.603/6901 PROTECT PAVEMENT MARKINGS LIN FT $5.00 39.5 0 $0.00 0 $0.00
Totals For CP 0000-494173 (WESTBERG RD.):   $0.00   $0.00
Project Totals:   $0.00   $0.00