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h ‘-3PAGE. 7 OF 7 appucatcn number !•CONTHRtTOnrSPnOJECTHO; 406>TOTAU XMFIEIH) «edtooategaa4M.1l >t0<%omancetoFNSH[«r3Wili retanacsl«4.E4».20 ^>3 <br />‘Jsl <br />■ V i- <br />. <br />ICATION AND CERTIFICATE FOR PAYMENT^HP mIOIVNIKI:WcJty of Orono ' J33S Drown Road South Crystal Day, MN 55323 MOM (CONTRACTOR):C o VSTjf»*«c7>^<A//\ DOCUMENT (]702 (lnUnictiom on tevc;>c %lt)c) paci om o<5 • •1‘KOItCr:Orono City 11a 11/Pol i ce aiul Public Works DuiUlings Am ICATION NO: 8 I'lKlOO 10; 6-3-93CONTRACT fOR:CONTRACTOR'S APPLICATION FOR PAYMENTVIA (ARCIIIltCll; ARCUmCrSBoatman Kroos Ptister ami Assm;. I'KOiiCT NO: 1124,OA 222 North Second StreetMinneapolis, Mil 55401 contract dat I;Disliibulion lo: n OWNtR□ ARCI lITf CTn CONTRACTOR□ nCHANCE OROfR SUMMARYCliange Ordcrk approved In previous monllis liy OwnerTOTAIApproved Ihis Monthyeft***^ Approved <br />m 7 'WJ <br />^,sLviv)n <br />I iUA ' ii <br />TOTAI S <br />AOniTIONS DfOUCTlONS <br />Nel change by ChanRc Orders <br />The undersigned Conlracior ccnillcs ihal io the besi o( ihe Conliacior s knowleilge, <br />tnfnrmallon and Ucllel Ihe Wilrk covered by ibis Applicaiion (or I'aymenl has been <br />complctcfl In accordance with llio Conlratl Documeiili, tliai sill amounis Iuvl * been <br />paid by (be Conlracior lor Work (or wbkb previous Ccrulitales b»r Paymenl were <br />issued and payments teceiverl Iroiii lire Owner, and Ibal luiient paymeni shown <br />herein is now due. <br />CONTRACTOR: <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In acciirdarKu with lire Conlrad nm iunenls, based oit on siie oirservalinns and die <br />dataiomprisinglhcaiioveapplu alion, lire AnbiletUeilibes lo die Owner lliat lo Ibe <br />best o( Ihe ArthilCtl’s kttowledge, iidormalion and beliel Ibe Work ius ptO(>f e>sed as <br />imliialed. Ihe t|ualily ol Ihe Work Ism aacirriame wtili die Cooiraci Om umenis. and <br />Ihe CutilraUof is etdilled lo paymeni ol die AMOIINI (I Kill III). <br />Applu aiion is made lor Paymeni. as shown below, in conocclion with ibe Conlraci. l unitmulioit SbccI, AlA Dociimeid C703, Is allacbeil.1. OKIC.INAL CONTRACT SUM.........................................2. Nel ebange by Change Orders.....................................^ -92,-348-I. CONTRACT SUM TO DATI (line I ±2)........................$346,.34^I TOTAL COMPlETin a< SIORLD TO DATE.....................$544^48 ------------------a V'X. " ol Complelerl Work $ _3 /i <br />iColuinn D I- C on G70)) <br />b.___% of Stored Material $----------------------------- <br />(Column f on 0701) <br />lolal Kelainagc (tine 5a I 5b or <br />lolal in Column I ol C.70)).....................................$ -3^|4>3y780 ■ <br />(. TOTAL lARNIO LESS RETAINACI.................................. <br />(line 4 less line 5 lolal) <br />7 I ESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (line fc from prior Cerlificalc)^ S3n9,91.3>?n _ <br />II CURRENT PAYMENT DUE......................^ <br />•j BALANCE TO FINISH, PIUS RETAINACF......................$ " <br />_____(line 3 less tine fc)__________________ <br />Suic ol: ' County <br />Subscril)c(l and In before me-jbis ^ <br />Notary Public ^ <br />My Commission expires: $l|fCefl«llsalMEipirM0ctM,1H7 <br />—— --------------------^ f < ■'-fttwttfWftttfgififWYsywwY'YiYvv <br />AMOUNT CIK1IFIID ........................................... <br />(.A/l.itli e»/>l.»n.i(ion if .uiiminl cvtlificif diffvfi fumi ific arnounl app/ici//or.) <br />Aluiitiici; Uourinan Kroos I’fiatcr anti Associates <br />lly;--------Dale: <br />Ibis (i iiiluaic IS not negotiable. The AMOUNT CrKllfltO Is payable only lo ihc <br />< onlrar Im named ben in hsiiam e, paynienl and arceplancc of paymeni arewillioul <br />pieimlKC lo any rights ol ibe Owner or Coniratlor under ibts Conlracl. <br />C.70M903 <br />WMIMinC, I1..llrrn^^a rh.<lrv-«iv.l"'n vl it |M I iv.-. .f » K •..■l.t.O t ■ i .1 |.i.- .•>