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fAClSlo: <br />10 ilie <br />lihout <br />MMl <br />/ <br />K iCATION and certificate for payment a/a iHH iiMLN! (,7uj (Insltiu tinns nn rt'vi'tsi* silli’) i)N| ni r>u;iAto i(AVNIK):Clry of Orono l*KO|ici; Citv Mill A I'uhlic WKs1 H5 Urowo Kcl. S. Orono.Hi nii.('rystiil MN 5‘iA2A AmiC AIION NO . 6riKioniO; 5/A1/93FKOM (CONTRACTOR):Niilciiiw, Inc.CONTRACT FOR:VIA (AKCimU r»; K-A MplsS s . H i h Si . Mpls, Minn.Bid Divisions /H4 & 20 - Drywnll & Kli'S AK( HiTicrs I'kOllCr NO:Di%lrilnition lo;□ OWNFRn AKCHITtCT□ CONTRACTOR□□CONTRACT DATf:CONTRACTOR'S APPLICATION FOR PAYMENT Applicalion is madi? lor l\iymt*f»C as shown below, in ronneclion wilh Ihc ConlracL Contiiiualion Sheel, AIA Oociiment G703, is aMiuhed.CHANGE ORDER SUMMARYChange Orders approved in previous months by OwnerTOTAI AOOiriONS DEDUCTIONSApproved this MonlhNumberDale ApprovediiAiovJlliM <br />l i ! • <br />1 «/CJ%.l4t99J <br />1 _ _ . ___ <br />C u .m.. *1 TOTAI S <br />Net chanf^e hy Change Orders <br />I. ORIGINAL CONTRACT SUM............................................S ---------1. Nfl change hy Change Onlers ........................................S —t ---------I. CONTRACT SUM TO DATE (I ine I i 2)............... ... $ 177 ,620.00 -------I TOTAL COMPLETED & STORED TO DATE..................S 177,62Q_.00 ____^(Column G on C'#70h »V RtTAINACI: LSO //«=*of Compleled Work $.1.(Column D ♦ £ on C'j70T) h. ___% o( Slored Molerial <br />The undersigned Contractor certifies that to the besi of the Contrac tor's knowlt*dge. <br />infonmtion and Indief the Work tovered hy this Appliialion for Payi.ienI luis lu‘en <br />complelert in accordance with the ( ontr.ul Documents, ihat all amounts luive been <br />paid by the Contra*::tor lor Work for which previous C'ertifirates for PaymenI were <br />issued and (uyments received from the Owne^ and tbai uirrent paymenl sitovvn <br />herein is now due. <br />(Column F on G7()i) <br />total Kelait^age (line Sa ♦ *ib or ^ <br />total in Column I of Ci70t) ... <br />(. TOTAL EARNED LESS RETAINAGE.................................... <br />(tine 4 less line 5 Total) ^ <br />7 lISS PREVIOUS CERTIFICATES EOR nn <br />PAYMENT (line (»(r«>m prior CL-rlilitale)..........$ -l-Gt, JUJJJO <br />n CURRENT PAYMENT DUE..........................S —ittrt <br />•I BALANCE TO fINISII, PIUS RETAINAGE <br />(I iiu‘ i less I ini' l») <br />/CS.OOO.^ <br />4 t\ r\£\O, <br />CONTKACIOR:Mill cahv , Inc. <br />______________D.ili-: <br />Mate of:Minnosoi i tfimiy «><: Mash I m>l:on <br />Suhs< nlH'(l'»"rnclYwi}rn In hetiire me this <br />Not.uy .’</ 1. . I <br />My ( nmmis'jliin espin»s. <br />'HWU)U uyg ’’ <br />ySSafejSSS"* <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance wilh the Contract Documents, based on on site observations and the <br />data comprising the alHive applii alitin. die Arc hiiei i < erldies to the Owner that lo the <br />lieslol the Arc hitei t\ knowledge, intoiniation and heliet the Work haspiogiesM**! as <br />Indicated, lhei|iialily of the Woik is m ai loidaiue with the ( onliai l IV»i umer.is. amt <br />llte Cnntr«utor is entitled to payment of the AMOUNI CIKIIIIID. <br />AMOUNT CERTIFIED............................................. ) — <br />I Ul.K h e^/)/a/u//ou tt .initntnt ceU/fieif tliffcfs (mm ihv .imoiinr a/>pftec/ lofj <br />Aia IIIIK t <br />. Date: <br />tills ( eihiuate is not iM |;oiiahle. Ihe AMOUNI (4 Rill III) is payable only lo the <br />C iintiai tor named herein hsiiaiu e. paymenl and aiceplaiue ul payment are wllhcuit <br />prt*|iid)ie to any rl^t1ls ut the OwiU'r or C'ontfactor under Htis Contract. <br />AIADOCUMINI G7tl* ACrilC AIION AND ( IKItflt All M )K l*\\ Ml Nl • M v. fi8 I UllllON * AI X * • « niO <br />nil AMIKICAN INStmm Ul Akclillll IS. I/I» NIW Xi»KK AViNhl NW VVASiIIM.IDN IM Jum ..r.702-nai <br />Cl• I <br />c