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t <br />APPLICATION AND CERTIFICATE FOR PAYMENT ma oor.uMsir r.7o<••om on rL’vef^e 'Kk*’•ACl '*f J’ACIVTO (OWNER); City of Orono1333 Brown Road South Crystal Bay, MH 55323 PROIECT City Hall 5. Public Works Gara^^-* “ Orono, MN <br />FROM (CONTRACTOR): CepharC Electric Co., Inc AIA (ARCHIUCT); Boorman, Kroos, Pfister <br />3600 l.aBore Road ^ Associates <br />St, Paul, MN 55110 222 North Second Street <br />CONTRACT FOR: Electrical Minneapolis, MN 55 *01 <br />'A'T'IICATION NO: Ten Otstribution lo:RKTAINACED OWNtRnRIOD TO: 02/28/93 □ ARCHITECT□ CONTRACTOR <br />ARCHITECTS □ <br />PROIECT NO: □ <br />CONTRACT DATE: <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />CHANGE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />AODITIOfJS DEDUCTIONS <br />Approved Ihis Month <br />Number Date Approved <br />TOTAl S <br />Net chaitgu hy Change Orders <br />The un(icrsi|(ned Coriractor certifies that lo tfie best of the Coniractor s tnuuied^e. <br />intormalioo and belief the Work covered by ibis Applicotion lor Payment ba^ lieen <br />completed in accordance with the Contract Documents, ihat all amounis have bei*n <br />paid hy the Coniractor for Work tor which previous ('ertdicales lor Payment were <br />issued and payments received Irom ihe Owner, and tliat current payment bhown <br />herein is now due. <br />CONTRACT^! Gephart Electric Co*, Inc. <br />By:/C n lie:03/15/9) <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance wilh the Coniraci Dmuments, based on on-site observaiions aiul the <br />data comprising the above application, the Arc hitecuerntics to the Owner ifiai m ibe <br />boslol the Archiled's knowlcd^e. intnrmation and heliel the Work has prt)^fe^^ed .w <br />indicaleii. the qiiality of the Work is m ai c ordaiu e wiib the Contraci Dot umenu. and <br />the Contractor is entitled lo payment ol ibe AMOU.NI (TKIIFILO <br />Applicaiion is made for Pa>r'ncnt. as shown below, in connection with the Contract. <br />Continuation Sheet, At A Duciimcnl G70.T, is attached. <br />279,400.001 ORIGINAL CONTRACT SUM............... .......................S <br />2. Net change by Change Orders.....................................S <br />3. CONTRACT SUM TO DATE (Line 1 i 2)..................... S__________ <br />4. TOTAL COMPLETED & STORED TO DATE....................$ 276,981,00 <br />(Column C on C70)) <br />276,981.00 <br />S. RETAINACE: <br />a.__!1 % o( Completed Wtjrk <br />(|^olumn D + E on G70J) <br />b.% of Stored ^talenal <br />S <br />$ <br />0.00 <br />0.00 <br />0.00 <br />276.981.00 <br />(Column F *>n <'j7(Hi <br />Total Ketaina^e (I me Sa «- 5I> or <br />Total in Column I ol G7I))).....................................S <br />(. TOTAL EARNED LESS REiAINACE.................................S <br />(1 in*.; 4 I me 5 Total) <br />7 lESS PREVIOUS CERTIFICATES FOR ^ <br />PAYMENT li ine (> irom prior Cerliliiaie)...............S 2A9.282.90____ <br />II CURRENT PAYMENT DUE ............................................ S 27,698.10 <br />•> BALANCE TO FINISH, PIUS RETAINACE......................5 <br />_____(I me \ less I me Id __ <br />State III; Minnesota Cnunivoi: Ramsey <br />Sub^tnlied and sworn ir) bvipfe me lliis 15til day of Marcli .1993 <br />Notary Public: ^ <br />My ('ommiSMon expdes: <br />iviofe me inis <br />'ft'ij ft-in* *' <br />AMOUNT CERIIFIID............................. <br />i.\(t.u/i ev/)/.in,irnm if .miiniiK certi/iet/ (/irtc/i^/MWI (iivJ(liuuVil.pp/S/iV(/!/(/'’.). <br />AKClUIlCl. <br />•‘“'Hi'**VIRGINIA A. PASIl'KiJJS ‘ <br />xivStif ..... antrttt _1 <br />'\"‘w My COfTinuvMDFi 2 i.Inujtuwint^ppiivifJUQt, <br />By: .Date: <br />lbl^ CeitilKJie >% nut ne^oliabte. Ibe AMOUNT (rEKTIFKD ii payable only In .the <br />( 0011.11 lor ojmed boii-m Uvianie. payment and atcepiaoctf olpayinent arewiiluiut <br />piojuilue lo any M^;hl^ «ii Ibe Owner or Contr.utof umlcr Ibiy Contract.