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APPLICATION AND CERTIFICATE FOR PAYMENT AIA document C702 (instructions on reverse side) PACIONCOf fACISTO (OWNER): city Of Orono1335 Brovm Road S.Crystal Bay, Mn. 55323FROM (CONTR.5CTOR):Steenberg Watrud Construction, Inc. <br />10255 Inver Grove Trail <br />CONTRACT FOR: Inver Grove Heights, Mn. 55076 <br />PROjECT. City Hall/Pol Ice andPublic Works Bldg.VIA (ARCHITECT):APPLICATION NO: 8PERIOD TO: 8/16/93ARCHITECTS PROIECT NO: 112A.0/| <br />CONTRACT DATE: <br />Obtribufion to;□ OWNER□ ARCHITECT□ CONTRACTOR□□ <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document C703, is attached. <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />ADDITIONS DEDUCTIONS <br />Approved this Month <br />Number <br />•A J6 1 8 19^ <br />I vffcU* f • '* * <br />^ ‘.r <br />TOTALS <br />Net change by Change Orders <br />1 ORIGINAL CONTRACT SUM..........................................S <br />2. Net change by Change Orders ... l-,.2>-3< A...............^ <br />3 CONTRACT SUM TO DATE (Line 1 i 2).........................S <br />4 TOTAL COMPLETED & STORED TO DATE.....................S <br />(Column C on C703) <br />5 ROAINACE: <br />a.___% of Completed Work S _ <br />3A2,500. <br />( 6,A83.19) <br />336,016.81 <br />336,016.81 <br />^poo.rrv <br />b. <br />(Column D + E on C703) <br />__% of Stored Material <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, <br />information and belief the Work covered by this Application for Payment has been <br />completed in accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor for Work for which previous Certificates fur Payment were <br />issued arsd payments'received frorn the Owner, and that current payment shown <br />It now due,' /^ 1;herein is now due, <br />CONTRA <br />^/r/ /f ,5 <br />Date: <br />(Column F on C703) <br />Total Retainage (Line 5a -t- 5b or <br />Total in Column I of C703)......................................S <br />6. TOTAL EARNED LESS RETAINAGE ................................S <br />(Line 4 less Line 5 Total) <br />7. LESS PREVlWf «R»irieATE«*fOR Received <br />PAYMENT (Line 6 from prior Certificate) to. date5 <br />8. CURRENT PAYMENT DUE............................................... S <br />9. BALANCE TO FINISH, PIUS RnAINAGE.......................$ <br />(Line 3 less Line 6) <br />---------------------r-t---------------------T —-------------------- <br />State of: * <br />Subscribed and ^orr\ tcsbi <br />Notary Public: T Vx <br />My Commission enpires: <br />0 0.90 <br />j06,5A3.52 <br />■^,A73.29 <br />befor £1 <br />i <br />hi: WATRUD _ <br />AntfeiMic-MiNNEsorA A, <br />DAKOTA COUNTY <br />WCaineiiHionEia*MM>.tO. 1«M <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with ihe Contract Documents, based on on site observations and the <br />data comprising the above application, the Architect ccrtihes to the Owner that to the <br />best o( Ihe Architect s knowledge, information and belief the Work has progressed as <br />•rnlkated, the quality of the Work is in accordance with the Contract Documents, and <br />the Contractor is entitlv^d to payment of the AMOUNT CtRTlFltD <br />AMOUNT CIRTIFIED............................................................. S------------------------- <br />(Attach enpljndtton t1 amount ccrUfit-d dtfferi from the dmount applied loi.l <br />ARCHITECT: <br />By:Dale: <br />This Certificate is not negotiable The AMOUNT CERTIfi. s payable only to the <br />Contractor named herein Issuance, payment and acceptance of payment are without <br />pre|udice to any rights of the Owner or Contractor under this Conlract. <br />AI4 fSOTUMiNf C7fi* AfeiirATiON Aso rMiTiriCAii mu • may i#.i ioiTiOn • ma* • c rsai