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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMFiNT G702 (Insmicilons on reverse s UIc) moeoNioF 2 packs <br />1X> OWNKU: CITY OP OKONO <br />City Hall <br />P.O. Box 66 <br />Orono, MN 55323 <br />FROM CONTRAaOR: AUTOMATIC SYSTEMS CO. <br />P. 0. Box 120359 <br />St. Paul, MN 55112CONTHACr l••OK: <br />I'KOJIicr: SCADA Project <br />Orono, MN <br />V,A ARCHITECT: ^o.^STROO, ROSENE. ANDERLI kTC"s®.'^"'^'^= <br />2335 West Trunk Highway 36 <br />Roseville, MN 55113 <br />Al'I'I.ICATION NO.: 3 (Final) l>ls»H»uHon in: <br />PERIOD TO: 9/4/03 □ OWNER <br />PROJECr NOS.: 139-01-113 □ 4HCIIITECT <br />□ CONTRACTOR□□ <br />CONTRACTOR’S APPLICATION FOR PAYMENT <br />Application Is made for payment, as shown hetow. In connection wiili the ContracL <br />Continuation Sheet, AIA Document 0703, Is attached. <br />1. ORIGINAL CONTRACT SUM...................................I 174.328.QQ__________ <br />2. Net change by Change Orders............................i 3^141,Sfi__________ <br />3. CONTRACT SUM TO DATE (Line I t 2)..............I _177>471,56 <br />\. TOTAL COMPLETED & STORED TO DATE..........t_,L77 ^471.56 <br />(Column Cl on G703) <br />5. RETAINAGE: <br />a. Q ”» of Completed Work <br />(Columns D ^ I; on 0703) <br />li. ______% of Stoicd Material <br />None <br />(Column F ott 0703) <br />*ibial l(ciaitta|»c (I.Ittc 5a t 5h or <br />Total iti Colutnn I of 0703).................................I None <br />6. TOTAL EARNED LESS RETAINAGE.......................t_177a47li56 <br />(Line 4 l**ss l.ltie 5 *roinl) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br />(Line 6 frotn pilor Certificate)................................I 166«652>80 <br />II. CURRENT PAYMENT DUE L0gHI8.76 <br />9 . BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) I None <br />CllANC;i: OUDEK SUMMAKY ’^ADDITIONS UEDUCilONS <br />Toi;il t hanges ;tppmvrd In <br />picvloiis iiionihs by Owner .6546.UU <br />1btal approved this Month 3402.44 <br />• ‘ lOTALS _____6546^00____1407.44 <br />Nl{*r CIIANtiliS by Change Order +3143.56_ <br />'l*hc utulcrsigncd Contractor ccriinrs that to the best of the Contractor's knowledge, Itifor- <br />mailon and belief the >Xbrk covered by litis Application for Payment has l>een completed <br />In accordance with the Contract Documents, that all amounts have been paid by ihe <br />Coniraciur for Work for which previous Certificates for Payment were Issued and pay* <br />mcnis received from the Owner, and tliat current payment shown herein is now due. <br />D:».e: 9/4/03 <br />amyni^on <br />GARVL. K <br />St;iic of; Minnesota <br />Conniyof: Ramsey <br />.Siiliscriltcd and sworn to before <br />mcihis 4th ,<layof September, 2003 <br />Noiury Fiibll^AURIE F. KRAUS <br />My C oiA ihKuoii expires; January 31, 2005 ~ <br />LAURIE F. Kl <br />Notary PiMe <br />Minoaaota <br />II.Mi <br />ARCHITECT’S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on site observations and the dr•*» <br />comprising this application, the Architect certifies to the Owner that to tlie best of the <br />ArrhItcTi's knowledge, information anti lielicf the VMnrk has progressed as Indicated, the <br />i|iialiiy nl the \M)ik Is In atvoidam r with the Coniiact Doniitienis, and the Conirant.r <br />is entitled to payment of the AMOUNT CPUTIPIP.D. <br />AMOUNT CERTinED ..............................................................« <br />(AtUuh if iimntiNi certi/uu! from tiw rwinunt nppHcfi fttr. initini <br />(iU JlyAtres on ibis AppUention and on the Continuation Sheet that are thanked to <br />ionform to tfie amttunt cv9 lifted ) <br />AThis CcrtinrSlFlsnot negotiable. The AMOUNT CERTIFIED Is |»yable t^nly the Con* <br />iracior named herein. Issuance, payment and acceptance of payment arc without <br />prejudice to any rights of ilie Owner or Contractor under this Contract. <br />AIA DOCUMENT G702 • AN'Ilf AIION ANtl ( I KIIHCAIH K)N IVLYMHKT • IW I tMTtON • AIA* • €)m2 • HIR AMFKICAN INSTiniri: OF AaCftllEcriS, IMS NEW Yl^MK <br />AViNDi’. NW. WAMiiNtiiON, IK'. jiNVViSJVi • WAIINatQ: UflictAMd pholocopytng vIolaMs US. copyright Imm end imM tuh|cct Itio vtotolof to Itgal pioMcullori.G7D2-1992 <br />f> •«ITm»|. Vr.' ....... A whirh Unn iht^ rniitinn nrinteH In red. An nrininal Astiires that ehamiAt wilt not he ohscured as may occtir whan doctimenla am repfodueail.