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--. tc <br />APFLICAiUN AUL^ JUoTii'iCA‘1 i£ i*Oft PAYlViENV coNsiMucuouMANAGDi-AuvistH numoN <br />AIA l)OCUMEN*r G702/CM;! (InMrucilonx (HI rcwiM* 5lilc)l>MiK ONK or IWillS <br />1U OWNliU:Pttojiirri-Long Lake Fire Station <br />Orono, Minnesota <br />City of Long Lake <br />1964 Park Avenue <br />Long Lake, HN <br />Ingraa Excavating Inc. <br />18900 Pioneer Trail <br />Eden Prairie, MN 55347 via CONSTHUCTION managIsH: <br />c:oNTKA(n* lOK; Package # I via AKcmiRcr: <br />APIM.ICAI ION NO.: 1 <br />PRKIOI) IX): <br />PROJUCI <br />l••|^OM CONI HACrOR:CONTRACr DAI F.: <br />DUiribulUm lo: <br />□ OWNER <br />□ CONJTIRIKHION <br />MANAGER <br />□ ARCIIITP.Cr <br />□ CONI RACTOR <br />S.E.H. <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />AppJiciiioii L^ in;uJc for payincnf. as shown IkIow, In connection with ihc ConinKi <br />Continuation Sheet, AIA Document Ci703, i.s aiiachecl. <br />I. ORIGINAL CONTRACT SUM..................................i 217,881.00__________ <br />1 Tic undersigned ('oniractor certifies that to tlie licsi of tlic Contractor's knowledge. Infor- <br />Illation and iielief tiie Wirk covered hy this Application for l\iynicni has lKX*n completed <br />In accordance with the Contract Documcni.s. that all amounts have l>ccn paid hy the <br />Contractor for \Xtork for which previous Certificates for Payment were Ivsued and pay- <br />2. ftel Change By Change Orders ..........................i 7i619>00 <br />3. CONTRACT SUM TO DATE (Line I i 2)..............I 225,500.00 <br />4. TOTAL COMPLETED A STORED TO DATE..........t 225,500.00 <br />ments rci;cU)tfMlJroni the C)wner, and that current payment shown herein Ls now due. <br />RACrOtlTCONfRACloli: Ingra^ ExcavaClng Inc. <br />4^i-ni <br />n„c: 1/30/2002 <br />Todd A. Ingro <br />Minnesota <br />Vice President <br />(Oilumn (• <m (•702) <br />S. RETAINAGE: jqb lOOZ complete <br />;<• __y__% of Completed VRifk I.-0- <br />Cuumy of: Hennepin n o. <br />January ^0^^ . 1 <br />Sub.scrilKd and sworn to iKforc <br />me thus day of <br />(Cfiliiiiin.s I) 4 K on 070.5) <br />h. ______% of .Stored Material <br />30th <br />Notary Public;L. jSx-t-vk, <br />R. •): <br />tr wi <br />••»-4 <br />(Coltiiiiii P on G70.5) <br />Tliial Kctalnagc (Line 5a 4 5h or <br />Thtal in Column I of G703).. <br />My Comiiiission expires: 1/31/2005 <br />-0- <br />6. TOTAL EARNED LESS RETAINAGE......................i 225,500.00 <br />(Line ‘I lc.v« Line 5 'Ibul) <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br />(Line (»from prior Ceriifle;t(c)................................I. <br />K. CURRENT PAYMENT DUE.............................. <br />CERTIFICATE FOR PAYMENT <br />.00 <br />* 77s,snn.nn <br />9. BALANCE TO FINISH. INCLUDING RETAINAGE <br />(Line 3 le.vi Line f*) I____oa <br />In accordance with the Contract lAKumcni.s, based on on site observations and tlK* data <br />comprising this application, the Oiastruction Manager and Architect certify u> iIk Owm:r <br />that to the iK'st of their knowledge, information and liclicf the Vt^irk has progre.sscd as <br />indicated, ihc (|uality of the Vtturk Ls In accordance wiili the Contract l>cK:umeiU.s, and <br />the Cuimactor is entitled to payment of the AMOUNT CEUTTPIED. <br />AMOUNT CERTIFIED.............................................................i <br />(AUacb expiafialiott if amount certified lUffers from the amount appUed for. initial <br />ailfittnres on this Appheathm and on tin: Omiinuation Stnet lital chanftcd to conform <br />to the amount certified.) <br />CIIANGI-: ORDER SUMMARY ADDITIONS DI-DUimONS <br />Total changes approved In <br />previous month.s hy Owner <br />'li>tai approved this Month 7,619.00 <br />lt)TALS 7,619.00 <br />NliT CMANCiliS by Change Order 7,619.00 <br />CON! <br />Ily:Dale <br />ARCIIITUa- <br />By:Dale: <br />Tlii.t Ccrtincaic Is tKM negtRlablc TItc AMOUN1' CERTIFIED is payalde only lo the Con- <br />iracior turned licrcin. IxMiancc. payiiKoi and arccptaiice «>f paynxmi arc wIiImhii <br />prcimlicc lo any rigim of llic Owner or Coniracior under lliis Omiract. <br />.1 <br />• AmjtAIIOtr ANO CtMIIIHMTK l«W IXVMmT • UN«SIM<<ninN MAIMIitiXArWI<ini nmiON <br />WIi KDITHIN • AIA- • fclWi • 1IIK AAiaUlIAN MCillUTR Of AirjineCtX I7.« N«W WUX AtTflHIl!. N W.. VltflilNOnjN.1II: iMia,S7*M • WMMsia: imumms piioionppns <Mmi G702/CMa-1992