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r-'•<r—♦- %• '• <br />PAYMENT APPLICATION <br />TO; CHyolOrono <br />2790KaaeyPartnny <br />Orano. MN 66336 <br />Alin; Aooounia Payabi* <br />FROM: DawCorpofMon <br />212SCanturyAvanue <br />North St F^ul. MN 85109 <br />FOR; <br />CONTRACTOR'S SUMMARY OF WORK <br />Appicaton la mada for paymant aa ahonwi balow. <br />ConVnuaUon Paga la atlachad. <br />1. CONTRACT AMOUNT <br />2. SUM OF AL4. CHANGE ORDERS <br />3. CURRENT CONTRACT AMOUNT <br />4. TOTAL COMPLETED AND STORED <br />(Coiumi G on Continuation Page) <br />S RETAINAOE: <br />8. 0.00% ofCompleled Work <br />(Coiumna O ^ b on ContliHiation Page) —— <br />b. 0.00% o( Matartal Slotad <br />(Column F on ConflnuaDon Page) <br />Total Retalnage (Line Sa ♦ 9b or <br />Column I on Continuation Page) <br />6. TOTAL COMPLETED AND STORED LESS RETAINAOE <br />(Una 4 mlnua Line 9 Total) <br />7. LESS PREVIOUS PAYMENT APPUCATIONS <br />(Ut» 6 from prior Applcatlon) <br />8. PAYMENT DUE <br />9 BALANCE TO COMPLETION <br />(Une 3 mlnua Una 6) 30.00 <br />(Una 1 2) <br />PROJECT 03005 <br />name AND <br />LOCATION: <br />3770'S700 Shoreline Drive <br />Oronr>. MN 89330 <br />ARCHITECT: BKV Group, Inc. <br />222N.2ndSL <br />MlnnaapoHa, MN SS401 <br />Page 1 <br />APPLICATION i <br />PERIOD THRU; <br />PROJECT ia: <br />DATE OF CONTRACT: <br />9 DisMiutlon to: <br />0»23«004 (2 OWNER <br />B architect <br />07/C1/2003 E contractor □□ <br />31.136.000,00 <br />323.317.00 <br />31.161.317.00 <br />31.161.317.00 <br />30.00 <br />30.00 <br />30.00 <br />31.161.31700 <br />31.120.136 00 <br />341,161.00 <br />SUMMARY OF CHANGE ORDERS'_____ADDITIONS DEDUCTIONS 1Total changes approved In i <br />pravlaus months 323,317.00 $0.00 <br />Totftf ipproYBd this month $6.00 $0.00 <br />TOTALS 323.317.00 t6.db <br />NET CHANGES 323.317.00 <br />PAYMENT APPLICATION <br />CONTRACTOR: <br />By;Date: <br />Robert S. Dew, Ptaaldenl <br />State of: Minnesota <br />County of: Ramsey <br />Subscribed and sworn to before <br />me this 9th day of July 2004 <br />Notary Public; Tammy Nelson <br />My Commission Expires: January 31.2005 <br />07/09/2004 <br />TAMMY J NELSON <br />NOTARY PUBLIC • MMNESOTA <br />My Cianbawljpaii Jan. 31.2005 <br />\ <br />ARCHITECrS CERTiFICAT <br />CERTFIEO AMOUNT.------ <br />••••••♦•••••••••••••••••• <br />negottabMT Payment ^ <br />udice to any righia of Owner or Contractor under <br />OSS. INC. DOCUMENT