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TO OWNER: QiycdOrono |•ROJtcr:Oruiio Ciiy Hall/Pulka and AITT lCAMt IN NO Disuibuiion 10:lEU irown Road South l*uhUc Works llulldbig PERIOD TO n OWNERGryiuilUy.MN 5SS2S PROJKri NO;4059 n ARClirrEfTTEROII CONTRACTOR: Slebilng« Coiuiructlon VIA AKairiEcr IkYaiman Knw>s Pflsier2V*2 North Second Siieei (2)hriKAC:i DATE 1 1 CONTRACTORMinneapolis. MN 55401OONTRACTFOR:CONTRACTOR'S APPLICATION FOR PAYMENT <br />AppHcRtloci U made for Pa)rmeiii« aaahoim below. In ccNincciion %diti die Conn act ConilnuAilon Sheet, <br />AlA Documem C70S. b attached. <br />*•••• »•«•••«••• •• ••••••••••»•••••••• •• ••••• <br />I ORIGINAL OONHUCT SUM <br />> No tlUBgebrCMA|« Oid<i%. <br />% CONTRACrSUMTObATt (Unc I A 2)..... <br />« TOTAL OOMPLTTtD A STORED TO DATE <br />254,000 00 <br />91,193 00 <br />315.193 00 <br />345.193 00 <br />RETAINACL <br />A <br />(ColMma D A t oa CTOS) <br />of Complcicd Wo(k <br />of Siotcd AUierUI <br />(ColunFonCTOS) <br />Tool Rcttldigc (Um %a a SA ot <br />Tottl III ColumB I of CTOS)__... <br />TOTAL EAKNU) I.LSS RCTAINACL. <br />(U«t It^ Une I Total) <br />LESS PttVlOUS CERTinCAIts H>ll PA\TtllKl <br />(Uiie A Irom prior Cenllkaic) <br />345.19300 <br />■tt44.3iltL4tO <br />t <br />CURRENT PAYMENT DUE •• •«« •••••••••••••• ••••••• « <br />AAIANCX TO nNUK PLUS RETAINACE <br />(Umc S Icm Ua« A) <br />aWiCIliMbttglHUAtV <br />?iiaff ftriera approtw d in <br />peaido ua mowiKa by <br />AT>l>rTlONS <br />Approved duaMocHh <br />__________ Totab <br />^^et chanoe bo Qinet Orders <br />r>IDUCTIONS <br />The undesigned C'.on i ran or ceriilirR dui to the hew of the IVmirartoft knkmledge. IrihKmaiion and belief the Wuik ciAered by this Application for Payment has been <br />C(»mpleted in accordance with the f uintia< t |V k uinenis, that all am<siiriis have been <br />paid by the (onitactur for Woik for tahuh previous CeriifKaies f**r Payment %»eie <br />Issued and |Yaymenis received from the Owtiet. and iliai tutreni payment ttiuHn <br />herein it nt*w due <br />CONITtACnOR; <br />hate: <br />State of; <br />Gutmiy of; <br />Subscribed and svMsrn lo before <br />me INs day of <br />Notary Public: <br />My Commisaiori eiipires <br />ARCHITECT S CERTIHCA'I E FOR PAYMENT <br />In accordance with the C'a>niraci Iksctimenis, based on on siie observations and the <br />data comprising the above application, the Archiitf i < er iifirs i#> the Owner that to the <br />best uf the A m liiiec i t kiMfwIedgr. irifoiiiieilun and belief the Work has progressed as <br />Indicated, the qualify cd the Work b in accordance with the Contract [kicumenta. and <br />the Casniraciof Is entitled to payment td the AMOlIN f (TKIIMID <br />AMOUNT rxjmnui.•#••«••••«•••••••••♦••«•••«•••••••••«•••• <br />{Attmtk •/ mm^unt catfi/bd d*jftn ft0m fib mmai nl a^od /•». Ma I*W <br />Mf/^gupo an lAu Ap^war«fn» and mm fkr (^mmltmumitmm Skmtt tkmt mt fAangnI la <br />imfmm la lA# mmmtmt tmuftmd ) <br />ARClinifT <br />l>aie <br />ItusCeriifcaie b imm negcniable The AXIOUN’r C .IKI lklll> is payable only 10 the <br />CAtniractof named herein IsniAtice. pjynirm and n < epiaim e »d payment m€ witfsosH <br />ptejudue u» any tights td itie (Hover ur (aAnitasior undci this Contract <br />saw *AffLICATIOW AMD CaRnnCATt MU PAVl4tKT*IWt |DmOSI*At^*IM|*THt AMfRICAN INTtmTI t»l a S< rtTlCTl. I?S3 MVl YliRSl AVlNl’t NW <br />DC IMMfM • WASNINCU UMgROwa pSo—yfSag fWAAM U J cc^fAlgai A«a tte m iRgaJ G70i m2