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APPLICATION AND CERTIFICATE FOR PAYMENT aia oocuMrNT C702 iinMm. t.ons on r.-vrrse suk>i PACT ONI 0» W.ISTO (OWNER): City of Orono1335 Brown Road South Crystal Bay , Minnesota m))(('i: Orono Municipal Facility Orono, Minnesota55323 <br />FROM Corporation <br />CONTRACT <br />VIA (ARCHtTfCT): <br />Boarman, Kroos, Pfister & Assoc. <br />222 N. 2nd St. <br />umTnous Paving Minneapolis, Minn. 55401 <br />AmiCAiiON NO: ThreeriKIODTO: 9/10/93AK( MIHCrs <br />PROlfCT NO: <br />Dislrittuliun lo:I 1 OWNER I ] ARC iniFCT ( 1 CONTRACTOR 1 )□ <br />CONTRACT DATf; May 11, 1992 <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />AUDI I IONS DfDUCTlONS <br />Approved this Month <br />Number Date Approved <br />1. <br />2 <br />Keceii <br />12/31/92 <br />See details <br />fed <br />20,457.50 <br />7,092.50 <br />5tK d 1 totals 27^550700 <br />+27;550:00-- -hjef chan^^^biJ^Change Orders ___.... ---------------------—^ — <br />iolornrtalion and belit ‘1 Ihe Work coveted by Ibis Ajiphialion lot Payment has been <br />compleled in accordance with the Contrail Ooiumenls, that all amounts have been <br />paid by Ihe Conirailor (or Work lor whiih previous Certiluates for Payment were <br />issued and payments received Irom Ihe Owner, and llial current payment sfiown <br />herein is rsow due. <br />CONTRACTOR"O <br />n.ile J/ao/3 <br />Application is made lor Paymeni, as shown below, in connection with the Contract. <br />Continuation ShecC AIA Document G703, is attached. <br />t. ORIGINAL CONTRACT SUM ..........................................S --------------- <br />2 Net change by Change Orders ........................................S --------------- <br />3 CONTRACT SUM TO DATf time I t 2) ‘ 0O,D0U.UU <br />- 0 - <br />4 TOTAL COMPIfTlO & STORED TO DATE......................S ,Ms65Q.0Q <br />(Column G on Ci70l) <br />5 RETAINAGE: <br />a 0 % of Complel(»d Work $____ <br />(Column D t t on G7(H) <br />h.___% ol Stored Material % <br />(Column F on ('1701) <br />lotal Retainaf*e (line 5a ^ 5h or <br />Total in Column I ol (i7(M)............ <br />(> TOTAL EARNED LESS RETAINAGE ....................................S J8_,S5Q»QQ l _ <br />(line 4 less line 5 Total) <br />7 LESS PREVIOUS CtRIIFICATIS FOR <br />PAYMENT (line <> Irom poor Cerlificale) <br />H CURRENT PAYMENT DUE.................................................................^ <br />9 BALANCE TO FINISH. PLUS RETAINAGE........................$ ~ <br />(I me I less I me l>) <br />0.00 <br />HHiHB <br />State of ( (> <br />Siihscrih«*d and sworn to helore me this <br />Notary Piihlu ^ <br />My ('ommission expires .-/4 *9Sf <br />I HEORIX I <br />**r <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the ( cmtract Doc uments, t)ased on on site ol)servations and the <br />data comprising the above aptilic ation. the Arc hitec t c c*rtities to tiu* ()wnc*r t^ jt to the <br />best of the Afchilect's knowledge, information and heliel the Work has pmgressed as <br />Indicated, the equality ol the* Work is m ac c or dam t* with ihc* ( ontrac t Doc uments. ancf <br />the C ontractor is entitled lo payment ol the* AMOUN! ( IKIIMID <br />AMOUNT CERTIfilD S------------------------- <br />(Attd(h vxpIjndtK^n it jmnunt (crtiiivd (litters tmm the jmouni applied lot ) <br />ARC HIIK I <br />Hv - ____ Date _______________ <br />This Certificate is not negotiable Ihe AMOUNt CtRIIMH) is payable only to the <br />Contractor named herein Issuam e, paymefil and acc ef)lanc e ol paynu*nl are wilFwiut <br />preiudu i» to any rights ol Ihe ()\vm*r or ( ontrac lor undc ‘i this (.ontrac t <br />AIA IKK UM4NI • ATiniC AtiON ANt) ( IRTlfiC All fOR • MVi em \ M Ml ION • AIA* • 1«WU <br />IMI AMHtKAN INSTlIUH Of ARC Mill I IS O IS NIVV VOKK AM M •! NW WASliINC.ION IH <br />WARHIHG. Uniktf'ttd ptsotocopytng vtototet U S copytlghl irntn •nd »• l lo legal pn>aat ulion <br />G702 fWI