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APPLICATK_ AND CERTIFICATION FOR PAYMENT Al OCUMENT G702 TO OWNER: PROJECT: WELL NO. 4 KPPLICATION NO: 6 -FINAL Distribution to: CITY OF ORONO x OWNER 2750 KELLEY PARKWAY ARCHITECT ORONO, MN 55356 PERIOD TO: 05/31/17 CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Mark J Traut Wells, Inc. Bolton & Menk, Inc. 141 28th Ave South Steve Nelson PROJECT NOS: C13.111233 Waite Park, MN 56387 CONTRACT FOR: NORTH WELL PROJECT CONTRACT DATE: June 29, 2016 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 been Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Proposal and Contract Documents, together with insurance, surety and warranty provisions required therein; 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. L ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line l f 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETA[NAGE: a. 5 %of Completed Work (Column D + E on G703) b. % of Stored Material (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) 6. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR Included in above PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 556,468.00 $ 0.00 CONTRACTOR: 556,468.00 535,908.72 MARK J TRAUT WELLS, INC. By:1�-1. _` Date: Slat of Minnesota County of: Steams Subscribed and sworn to before me this day of Notary Public: My Commission expires: $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT $ 535,908.72_ In accordance with the Contract Documents, based on on-site observations and the data comprising the 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, $ 479,905.23 the quality of the Work is in accordance with the Contract Documents, and the Contractor $ 56,063.49 is entitled to payment of the AMOUNT CERTIFIED. $ 20,559.28 AMOUNT CERTIFIED ......... .. $ 56,003.49 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner Total approved this Month TOTALS $0.00 J$0.00 NET CHANGES by Change Order $0.00 (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and onthe Continuation Sheet that are changed to conform with the amount certified.) ARCHITECT: By: Date: 10-23-2017 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. PAORONO AIA DOCUMENT 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 G702 6/6/2017 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee.