Laserfiche WebLink
PAYMENT APPLICATION Page 1 <br />TO: <br />FROM: <br />DlyofOrano <br />2750 KeMey Parkway <br />Orono. MN 55336 <br />Attn: Accounts Payable <br />Dew Corporatkm <br />2125 Century Avenue <br />North SI Paul. MN 55109 <br />PROJECT <br />NAME AND <br />LOCATION: <br />FOR: <br />03005 <br />Navarre Fire Station <br />3770-3790 Shoreline Drive <br />Orono. MN 55336 <br />ARCHITECT: BKV Group. Inc. <br />222 N. 2nd St. <br />Minr>eapolis. MN 55401 <br />APPLICATION « <br />PERIOD THRU: <br />PROJECT H <br />DATE OF CONTRACT: <br />4 DisIriMlion lo: <br />(xl OWNER <br />(xi ARCHITECT <br />0r/0t«003 M CONTRACTS□□ <br />CONTRACTOR'S SUMMARY OF WORK <br />ApfiiicaUon Is made lor paymenl as shown below. <br />ConKnusUon Page Is attached. <br />1. CONTRACT AMOUNT <br />2. SUM OF ALL CHANOE ORDERS <br />3. CURRENT CONTRACT AMOUNT <br />4. TOTAL COMPLETED AND STORED <br />$1,138,000.00 <br />$0.00 <br />(Une 1 ♦/. 2)$1,138,000.00 <br />(Column G on Conllnuallon Page) <br />S. RETAMAOE: <br />a. 5.00% ol Compleled Worh <br />(Columns O ♦ E on ConOnuailon Page) <br />b. 5.00% ol Material Stored <br />((Column F on ConUnualion Page) <br />Total Relalnage (Line 5a « Sb or <br />OAimn I on ConUnualion Page) <br />$570,151.28 <br />$27,859.00 <br />Conbactoi's signature below is his assurance lo Orwier. concerning ihe payment herein applied lor. <br />that: (1) Ihe Work has been perlOrmed as required In the Contract Documents. (2) aH sums <br />prevlousty paid lo Contractor under the Conbact have been used to pay Conbaclor's costs lor labor, <br />materials and other obbgations under the Conbact lor Work previousiy paid lor. and (3) Conbactor N <br />legally entitled to Ihts payment <br />CONTRACTOR; <br />By:0912912003 <br />$649.00 <br />$28,508 00 <br />6. TOTAL COMPLETED AND STORED LESS RETAINAGE <br />(Line 4 minus Line 5 Total) <br />7. LESS PREVIOUS PAYMENT APPLICATIONS <br />(Line 6 born prior Applicabon) <br />8. PAYMENT DUE <br />9. BALANCE TO COMPLETION <br />(Line 3 minus Line 6) <br />$541.643 28 <br />$366,505.28 <br />$179,138.00 <br />$596.356 72 <br />SUMMARY OF CHANGE ORDERS ADDITIONS oeouct Ions <br />Tout chaniN* approved to <br />pravioue months $0.00 $0.00 <br />Tow approved tois monto $0.00 $0.00 <br />TOTALS io.oo $0.00 <br />NET changes 'iooo <br />S. Dew. Preski^ <br />Slate of: Mwviesola <br />County ol: Ramsey <br />Subscribed and sworn lo before <br />melhis 29ih dayof September 2003 <br />TAMMY J NELSON <br />tJCTVtv public imCSOTA <br />f»r*f*JiA31.200 <br />NoUfy Public Tammy J. Nalton <br />My Commission Expires: January 31. <br />ARCHITECT'S CERTIFICATI <br />ymUnlArchiiecrs signalure below is his assurance to Owner, concerning the paymMlI herein appied for <br />that: (l)Ardslect has Inspeeled toe Work represented by WsAppUcation. (2) such Work has be« <br />oompteted to iie extent indicaled in this Applicalion, arnl the quaibty ol workmanship and matertais <br />conforms with the Contract Documents. (3) this Application for Payment accurately stales the amount <br />shouSnS^^^ due therefor, and (4) Architect knows of no reason why payment <br />CERTIFIED AMOUNT..'^..i.Tl[<X.|.J.^.fe.,.(>.C>.._ <br />(H lh» certified emourt is ditfewd from Ihe peyimni due, you should altacli an a. <br />Initiel ell Ihe gguies thgt^chengedlo match the certified amount.) <br />Aptenaboa <br />nagobattw. I^fiwantApplicalion nor payment appUad tor harain la asUgnabla or _________________ <br />bt mada only to Conbactor. and is «4tooul pre|udtot to any nghta of Onnar or Conbactor under <br />toe Conbact Documanta or otharwtaa <br />OSS. INC. DOCUMENT <br />■' <br />A