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'T' <br />K’Tt -tvJi <br />•V. . -i •< <br />•.^- ♦ : ;... <br />V- <br /><r . a V immmm <br />APc^LiC^iAJtON AWD CEHTIFICJATis FOR iP'AYiiV-dkiiOT AIA DOCUMEHT G702 Onscruaions on reverse sWO page one of 2 paces <br />TO OWNER: City of Oronot MN PROJECT; Navarre Water Tower <br />FROM CONTRACTOR; Classic Protective Coatlngs.VIJnWCHITECT; Bonestroo & Associates <br />APPLICATION HO.; 2 Discribution lO; <br />PERIOD TO; 08/17/2005 DOWNER <br />FROFECT NOS ; Orono, MN Q ARCHITECT <br />□ CONTRACTOR <br />CONTRACT DATE; 06/15/2005 □□ <br />CONTRACT FOR; Rehabilitation of the Navarre Water Tower <br />COOTRACiiiOR’S APPLICATION FOR PAYMENT <br />Applicaclon is made for payment, as shown below, In connection with the Contract. <br />Continuation Sheet, AIA Document 0703, is attached. <br />1. ORK5IWAL COfTl'RACT 801W.............................i 207,231.00 <br />2. Wot clinngo by Ohongo Ordora........................t 2,500.00 <br />The undersigned Coniractor ccriifics ihai lo the bcsi of the Contractor s knowledge, infor­ <br />mation and belief the Work covered by this Application for Payment ha.s been completed <br />in accordance with the Contract Documents, that all amounts have been paid by the <br />Contractor for Work for which previous Certificates for Payment were issued and pay­ <br />ments received from the Owner, and that current payment shown herein is now due <br />3. COWi*WACT|- SUM TO OMTs (Line I ±2)............| 209,731.00 <br />CONTRACTOR: Classic Protective Coatings, Inc. <br />f <br />_ _ _ _ _ Date;By; <br />A. iuasL coMPLint® a sixDReo to date ......i 209.731.00 <br />(Column G on G703) <br />5. nUYAIM^tGG: <br />a. ___i_% of Completed Work <br />(Columns 0 ^ B on G703) <br />b. ___£L.% of Stored Material <br />I 10,486.55 <br />I_______Q.QQ <br />State of; WI <br />County of: Dunn <br />Subscribed and sworn to before <br />me this 17 day of August 2005 <br />(Column F on G703) <br />Total Rciainagc (Line 5a ♦ 5b or <br />Total in Column I of G703) .10,486.00 <br />Notary Publlc^^^7(^C<^9 <br />My Commission expires ^ <br />6. IXTfAt l£AfWeO LE88 RETAIHAGG.....................i_I99,244.45 <br />(Line \ less Line 5 Total) <br />7 LuB8 r4K£VIC)U3 CEfTtlFIG^S FOH mVN^MT <br />(Line 6 from prior Certificate)................................i 117^7Q <br />ARCHITEGY’S FOR nblKMT <br />8. CUMUm iWMEMT DUI2 I 61,659.75 <br />9.bA!JU>ia£ *iDI*1M8H, NCIJWM^ <br />(Line 3 less Line 6) t 10,486#55 <br />In accordance with the Contract Documents, based on on-site observations and the data <br />comprising this application, the Architect certifies 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 1$ In accordance with the Contract Documents, and the Coniractor <br />is entitled to payment of the AMOUNT CERTIFIED. <br />AR900MT CSlTlTM!-!}............................................................I. <br />CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS <br />Ibtal changes approved In <br />previous months by Owner 2.500.00 0.00 <br />Tbtal approved this Month 0.00 0.00 <br />TOTALS 2.500.00 0.00 <br />NET CHANGES by Change Order 2.500.00 0.00 <br />(Attach expianatiofi if amount certified differs from tbe amount applied for. hutiot <br />att figures on this Application and on the Continuation Sheet tbet ere changed to <br />conform lo tbe amount certified) <br />ARCHITECT: <br />By;______________________________________ Date:__________________ <br />This Ccrllficaic is not negotiable. The AMOUNT CERTIFIED is payable only to the Con­ <br />tractor named herein. Issuance, payment and acceptance of pay.nent arc without <br />prejudice to any rights of the Owner or Contractor under this Contract <br />AiA nOCUMDIT 0^02 • APPUCATION AND CSItTIFICATB FOR IWYMENT • 1992 BDITION • AIA* • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS. |-»3S NFW YORK <br />AVENUE. NW, WWSHINCTON. DC 20006-5292 • IMARNMO: UnRcofioed (ihotoocpylno i^ololoo ua co|^R^it lom and iMi cubisol Uia violaior (0 Iccol pnacesu^. <br />■ • .1 .T • J Ill* V ««« AI a i «• V4I*U4,*«*«•»!» *3 \u%\ t. .• ii; it . It* j ui, . ♦ I.:,.«A ■ ? <br />■ ...