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. .i-'i. Llv.V-Clll ’Ok'S /4WD FOK AIA DOCUf4EI iT G702 (Insouciions on fcvcfsc side) p*gi- onc or 2 i»ac .es <br />ID OWNER: City Qf orono, MN PROJECT: tiavarre Water Tower APPLICATION NO.: I <br />PERIOD TO: 7/20/05 <br />PROJECT NOS : Orono, MN <br />I ROM CONTRACTOR: Classic Protective Coatings via ARCHITECT. Bonestroo CONTRACT DATE: 6/15/05 <br />Disiribuiion to <br />□ OWNER <br />□ ARCHITECT <br />□ CONTRACTOR□□ <br />CONTRACT FOR: Rehabilitation of the Navarre Water Tower <br />i.OWTK/.»L:it)lrTS APPLICATION FOK PAYMEMT <br />Applicuion is m.idc for payment, as shown below, in connection with the Contract. <br />Coniinuuiion Shcci, AIA Document G703. is attached. <br />1. C/!VK'ilH/'.L COUVRACl* 811111..................................1 ?.n7»2.11^Qll <br />2. ua dioiKjo l>y ohongo Oivloro ........................I___?,,»*inQ.jniD- <br />The undersigned Contractor certifies that to the best of the Contractor’s knowlcdpc. infor­ <br />mation and belief the Wbrk covered by this Application for Payment has been crmplrrcd <br />In accordance with the Contract Documents, that all amounts have been paid by the <br />Contractor for Work for which previous Certificates for I^tymcnt were Issued and pay­ <br />ments received from the Owner, and that current payment shown hcicin is now due. <br />CONTRACrOR: Classic Protective CoatingSt Inc. <br />3. OOUrn/vOY 8UWI VO OAYla (Line I ± 2)............1.209^-201-00.By:> -t ■n.,., <br />4. iL/i?>t Ct>W»H.l£TED & STORED TO DATE.........« U4,B26.Qq <br />(Column O on C705) <br />5 . ra-; <br />a ^ % of Compictcil >xiork <br />(Columns O + E on G703) <br />l»_____% of Stored Mnierial <br />7,241.30 <br />State of: wi <br />County of DUNN <br />Subscribed and sworn lo before <br />me this 21 day of July <br />0.00 <br />(Column r on G703) <br />1bial Rcialnniie (Line Sa 5b or 7 5Ai an <br />Ibial m Column I of G703)................................*___' * <br />Notary Public: ^ <br />My Commission e;tplres '2)(Jo7 <br />fi. '. Jf -L l£/:nWi:C' LESS UCTAIMA(3G .................« 137,584.70 <br />(Line A less Line 5 Ibtal) <br />7 h iU:i W1L-VIOU3 CtsITriHICATES TOH PAYMENT <br />(Line 6 from prior Certificate)................................I--------- <br />ARCK3TLEGii'’B F05-J iPr:v <br />0.00 <br />8. CUlrtJl-W IWMEWT DOE » n7.SflA.7Q <br />•> (AALANct: tV l-INfSI 1, mCUJOINQ RETAINAGE <br />(Line 3 Ic.'is Line 6) * 77. lAA. TO <br />In accordance with the Contract Documents, based on on-sne observations and the data <br />compn.sing this application, the Architect ccnifics to the Owner that to the best of the <br />Architect’s knowledge, information and belief the Work has progressed as indicated, the <br />quality of the Work is in accoidance with the Contract Documents, and the Contractor <br />is entitled to payment of the .fMOUr4T CFR I IFIHD <br />ASaOUMT C2;7T(;i£D <br />CHAI4GE ORDER SUMMARY ADDITIONS DEDUCTIONS <br />loial changes approved in <br />previous months by Owner 0.00 0.00 <br />Total approved this Month 7, <;nn .nn gcTOTALS 7.^nn.nn cccNEI CH/.NGC;'. by Change Order 7 J «;nn r^n <br />(Attach explanation if amount certified differs from the amount applied for. Initial <br />all figures on ibis Applicafion and on the Contnwatton Sheet thet ere changed to <br />conform to the amount certified.) <br />ARCHITECT: <br />By:_______________________________ Date:___________________ <br />This Ceriificaic is not negotiable. The AMOUNT CERTIFIED is payable only to the Con­ <br />tractor named herein Issuance, payment and acceptance of pay.mcnt arc without <br />prejudice to any rights of the Owner or Contractor under this Contract <br />mokmmt aoa • application and CtimFICATE for ftWMENT • 1992 edition • AIA® • O1992 • the AMERICAN INSTITUTE or ARCMITKCTS. PSS NEW YORK <br />j j AVENUL. NW. WK:iHlNGTON. DC 2txX)6-S2y2 • tMAOMNO: IMbmod photoGOpylio vtettoo U8, oQpyrlt^ii tod aid vHE 'u» vioksor to Icscf picccsuUon. <br />». ..*« -I* I •• .• .U». <br />, __- ^ <br />1