Laserfiche WebLink
f <br />AmJCATION AND CfflTIFlCATE FOR FAYMENT fSUUTITUTE AIA DOCUMENT 0702)^AGC ONC 0# I S <br />TOtOWNtlllt CHy •! LMi Uka <br />1N4Nft <br />U<ittJkt.MNlS38« <br />TAOJfCTt iMf Ula flr« tuitoii <br />340 W«owOn«t <br />Lon« LtM. Mil ssase <br />AmiCATK>M NO: • <br />MMOO TO: 30 S«9 02 <br />mOM ICONTIUCTOIII: Nocf«o«i Corpo^tMA <br />3ti0 AMiapalt Una NaRti. trnca I0i <br />Nyifiautfi. MN 81447 <br />VIA lARCNITfCD: MV 0«auf <br />222 Nonn 2nd Scraat <br />MmnaapoM. MN 88401 <br />AACHITtCrS <br />MOJf CT NO:tstsoi <br />COMfflACT NM: Oaaant CanaNaaEaii • MataHal CONTNACT OAH: <br />CONTRACTOR S AFFUCATION FOR FAYMENT <br />CHANGE ORDER SUMMARY <br />CKanpa OiOart aoprovad in <br />fftwaiit ifionina 8y Ownar <br />total <br />A0ora«a« m« Manvi <br />Numbar Oata Approvad <br />totals <br />AOOITIONS <br />82.220 00 <br />000 <br />ocoucnoNS <br />000 <br />Nat ehanpa by Cnanpa Ofdara 82.220 00 <br />Application tt mada for Paymtm« ta afKmn btiow. in eonnaction <br />with tha Contract. Continuation Shtat. Subitituta AJA Oocumant <br />0703 ta attachad. <br />Ttia undanipnad Convactor cartifiaa that to tha bati of tha Contr»ctor*t <br />knowiadgi. miorniation and baHaf iha Work covarad by thtt ApoKation <br />far Payment has baan compiatad m accordanca with iha Contract <br />Oocumania. that ai amoonu hava baan paid by tna Contractor lor Work for <br />wnicn prawioua Cartificaiaa for Paymant wara laauad and paymanu racanrad <br />from Iha Oamar. and that currant oaymant aho««n haram it nanr dua <br />Octobar 1. 2002 <br />1. OPiClNAL CONTIUCT SUM.......................................• <br />2. Nat Chanpt by Chartga Ordars .................................. a <br />3 CONTRACT SUM TO OaTI fLina 1 ♦/•2l ............ t <br />4 total C0MPLIT60 & SrOAEO TO OATf............ • <br />(Cotumn G on Q703i <br />8. fUTAINAQC: <br />a^% of Compiatad Work <br />iCoKimn 0^8 on G703I <br />b of Storad Matanai <br />(Column f on G703( <br />Total Aati*naga ILm# Sa *9b or <br />Total m Column I of 07031........................ • <br />8. total €AAN€0 LESS PETAINAOS .......................... a <br />(Lina 4 lata Lir>a S Totaii <br />7 less PPfViOUS CfPTiiiCAfIS POP <br />PAYMINT (Lina 6 from prior Cfitificaiai....... I <br />8 CUPP8NT PAYMENT CU5 . ..................................... I <br />8 SALANCS TO FINISH. PLUS PETAlNAGE................. I <br />(Ltna 3 lati Lina 6l <br />Stilt of: Mirinatoti County of. Harutapm <br />Subtcribad and swrom to bafora ma thia 1st day of Oc*obar. <br />1.981.000 00 <br />82 220 00 <br />2.083.220 00 <br />1.217.29: 59 <br />63.96- 93 <br />1 156.427 00 <br />881.269 SO <br />275 157 50 <br />906.793C0 <br />2002 <br />^ aaaaaaaAAAAAAAAAAAAI 1 <br />! . v :liC-MINNESOTA ; <br />; rtf Jan. 31.200S; • <br />..••••» *v# »wwwv>nAAnAAAAnAPN ^ <br />Notary Public <br />My Committion tapirta. January 31. 2005 <br />AACNinCT'S Of PTlilCATl FOR PAYMfNT <br />In accordanca with iha Conuact Oocumama, baaad on on tiia obtarvationa <br />•nd tfia data compnaing tha abovt application, iha Archuact carpnat to tM <br />Ownar plat to Iha bat I of Pw Archuact*! knoiMadsf. information and babaf tha <br />Work hat prograatad at indicttad. tha quakty of iha Work ia in accordanca <br />with Iha Contract Oocumantt. and tha ContiKtor it antitiad to ptymani <br />af Iha AMOUNT CEPTlFlfO <br />AA10UNT CEPTlFlfO.......................................• ^ <br />CAnach a«pianacton if amount carUiad difftra from tha amount aookad for.i <br />APCNinCT: <br />[Data_____ <br />Tha AMOUNT CEPTf>cata ITnot nagobab>a <br />Contlactor namad narain. itiuanca. ptyma^t and aeeaptanct <br />Ithoul prajuO^ to any ngnu Of ma Or«n«r or Contractor <br />unoar trus Contract.