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PAYMENT APPLICATION <br />TO;ClyofOrono <br />27S0 Kelley Paikway <br />Or0fi0.MN 5533b <br />AKbr. Accounts Payable <br />FROM: DwCorpoiiOon <br />2125 Cofitury Avenue <br />North SL Paul, MN 55109 <br />PROJECT 03005 <br />NAME AND Fire Slation <br />LOCATION:3770-3700 Shorelna Drtve <br />Orono^MN 55336 <br />ARCHITECT: BKV GroupJna <br />222 N. 2nd St <br />Minnaepoli.MN 55401 <br />Post'll* Fax Note 7671 <br />fco4 <br />AAr ✓! <br />Phonof / <br />UHlt: ur* UUNIHAC1:07/01/2003 UU □ □ <br />FOR: <br />CONTRACTORS SUMMARY OF WORK <br />AppKcalkNi is made for payment as shovvn belw. <br />ConUnuatkNi Page to allached. <br />1. CONTRACT AMOUNT <br />Z SUM OF ALL CHANGE ORDERS <br />3. CURRENT CONTRACT AMOUNT <br />4. TOTAL COMPUETEO AND STORE <br />$1,138,000.00 <br />$0.00 <br />(Unat^A 2)$1,138,000.00 <br />$234,433J26 <br />(Column G on Conbnuafion Page) <br />5. RETAINAOE: <br />a. S.00% ofComptetadWoik <br />(Cohimnt 0 ♦ E on Continuation Page) <br />b. 5.00$^ of liatortol Sloiad <br /><Cohfmn F on Conlinualton Page) <br />Total Ralalnaga (Una 5a ♦ 5b or <br />Cotumn I on ContlnuaUon Pago) <br />$11,722.00 <br />$0.00 <br />$11,722.00 <br />6. TOTAL COMPLETED AND STORED LESS RETAiNAGE <br />(Lined mlniit Una SToUQ <br />7. LESS PREVIOUS PAYMBIT APPLICATIONS <br />(Una 6 bom prior AppicaOon) <br />8. PAYMENT DUE <br />9. BALANCE TO COMPLETION <br />(Una 3 miiNis Una 6) $915,288.72 <br />$222,711.20 <br />$24,312.26 <br />(kmtraclofto Signature irekm is his assuranoe to Owner, concerning the paymanl hereto apfrttod for. <br />that: (1) the Work has liaan perloimad as required in the Contract Doa lents. (2) al suma <br />previously paid to Cont edor under the Contract have been used to pa> Jontraclofto ooeta lor Ubof, <br />metertols end other oblgaticma under Um Contract for Work previously paid for, and P) Cordreclor Is <br />legally entiled to this payment <br />CONTRACTOR <br />By:07/3(V2003 <br />tobert S. Dew, Presidont <br />Stale oT. Mtoneaota <br />County of. Ramsey <br />Subscribed and s¥vorn to before <br />mathis 39th dayof July 2003 <br />mm <br />TAMMYJNBSON <br />WOTMnrRJBUC-MNMEtOU <br />Notary PUbIc; Tammy J. Natoon <br />My Commtoslon Explrea: January 31,2 <br />ARCHITECTS CERTIFICATI <br />m>c\v <br />ArchlecCt fllgMlure ImIow I> h s assurano* to Owner, concerning •>■! iwyinenl herein eppled Ibr. <br />Ihel: (l)AicMBctlieakMpeolei IhnWorIcropnMenledtrylhteApgIteutlon. (2)ench Werttheeheen <br />compleled to the eidenl Indleab d bi ttile Appicalkm, end the <)uen^y of woitonanshb) eiNl meleilils <br />ooidbrmewUitoeConhaclOoi umenU, (3)IhieApi^lionforPaymenIaccumtoliftoatostheatMunt <br />Vlfioik oomplalad and peyma 4 due therefor, and (4) Archlact knows of no taaion why paymanl <br />notbemada. .J.a ...ERTneO AMOUNT. <br />SUMMARY OF CHANGE ORDERS ADDITIONS OEOUCnONS <br />Totit chwgee apprewod In <br />pievtous monitie $0.00 $aoo <br />Total epproved thto monii 10.00 $aoo <br />TOTALS taoo $0J» <br />NET CHANGES $0.00 <br />(IftheoBfWBdBfnauntis <br />lr^tdllhe6gumM <br />ARCHITEi <br />PAYMEfJT APPtICATION <br />TV/h)m tfw peymanf dUa. you shoi4U riffac/r ari a^ptonattori. <br />ingBdhirmIchtheoertifi&damounL) <br />Data:^*itt <br />paymanl applied tor hatato la ateignabto or negoOiMai Paymanl ahaS <br />made aniy to Contractor, and la wdhout pn^ioa to any rights of Owner or Cotdraclor (aider <br />ContoKl Doaanentt or onwnetoa. <br />OSS. MC. DOCUNENT <br />S <br />s <br />5 <br />8 <br />S <br /><e«