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AFPLICATIOK AND CERTIFICATE FOR PAYMENT TO:ARROU INSCIATIOX. PROJECT:A n^oo»\Ql 0: 2 PAGEbCity of Orono c/o Eraui Anderson Construction Co. 525 5. 8th St.Mpis.. MM 55404 ATTEST!OK:Mr. John Davies 0 r u:: o C 1 ; v Ha.- a:: c ? u j i : c w u r .< s 3 u : ; ii i n s Cryscd. Jav. .v.N .55J2CCONTRACT ?0.R. A;::c :::su.a;:or.APPJICAT!''-•JM3ERw •» ••ap ?j:cat :c .y date.^£P:0D ?.30.Y:0:JO!C TRACT DATE • ::.a.7 ' : 5 / J H / 2 3 / V 2 ▼ / : 6 / 0 3 *1 / 2 5 '9 2 <br />ARROW IMSUIATION. ISC. APPLICATION FOR PAYMENT <br />tCMAMOS ORDER SUMMARY : <br />A u p . : c a 4: u n ; s a a c u for p 2 7 r e i. as s n o w i: d o . o rf . : n c o n n«. c :. o n ii: t n <br />info nation containeu in i.u* fol-owin*^ naijos o1 this oocucent. <br />THH PRESENT STATUS 0? THIS CONTRACT IS AS POLi.CMS; <br />Ohanga ordara approved in <br />pravioua aontha <br />TOTALS : <br />ADDITIONS : DEDUCTIO.NS I <br />• I <br />$0,400.00 t $0.00 : <br />Approvad thia aonth <br />- - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />Mua l Data Approvau <br />- - . . . . . . . . . . . . . . . . . . . . <br />I <br />I I <br />ym. i 9 W93 <br />I <br />TOTALS: <br />NET CHARGE iY CHANGE ORDERS <br />. . . . . .I <br />$6,400.00 i SO.00 ! <br />; <br />$0,400.00 i <br />Arrow laoulation. Inc. oartlflas tnat to the bast thalr knowlocge. <br />laforaatlon tad ballaf tha work covered by this application fur <br />payaaat baa beta ooaplatad ia accordance with the contract coc" <br />ttltRtt. tbtt all aaounto have bean paid ror work for which previous <br />Otrtlflaataa payaant ware iaauao and payaent received froa tiie <br />awaar. Md tbaVcurrant payaent ahown herein is now due <br />ARROW <br />ORIGINAL CONTRACT SUM. . . . . . . . . . . . . . . . . <br />$8 S40.30 <br />.Net change by change oruers. . . . . . . . . . . . . <br />56 . '.00 3C <br />CONTRACT SUM TO DATS. . . . . . . . . . . . . . . . . <br />$15,240.00 <br />TOTAL COMPLETED AND STORED TO DATS. . . . . . . .$15,240.00 <br />(total coluan G. foilow-ng psgetl <br />RETAINACE.... CS. . . . . . . . . . . . . . . <br />(or total cuiuxn I following pagoa 1 <br />50.00 <br />TOTAL EAX.NED LESS HETAI.'iACE. . . . . . . . . . . . . <br />$:s.240.00 <br />CUHHENT PAYAE.ST DUE . . . . . . . <br />S.J.VaOMW <br />$:.324.00 ^ <br />OOrtiriaataa payaent wan <br />awaar. tba^currant payai <br />AiROWy^»LAimN. IRC. <br />. . . . . . <br />David L. iacb Praaidant <br />ARCilTICTf certificate FOR PAYMENT <br />7'/A -?;5. <br />OATH <br />State of: <br />Sworn to before ae this <br />Notary Public; <br />My coaeiasion expires: <br />County of <br />day o .* <br />IB tcoardanot mt.h the contract docuaents. tiaseo on on*siie <br />abaarvatiana and tha data coaoriting the above application, the <br />Architect certifies to the owne* thsi me wun^ nas progressec lo <br />tha paint indicated, that to tha best of his }<now.efige. infori- <br />atian and belief, tne cuallty of the wore is :n eccuruancv w-v.*: <br />the oaniract docuaente. and that Arrow inauiaiion. inc. is entities <br />ta payaent of tne AMOLWT CERTIFIED <br />amount certified. . . . . . . . . . . . . . .s <br />(attacn explain.itior if aaount dlffera froa aoove) <br />ARCHITECT: <br />c?Y; DATE: _ _ <br />T.hls certif-*;ate is not .negoiiabie. The AMOUNT CERTIFIED <br />it payeoie un.y ;o i:;e cor. ;racior ranee ntrtin. Issuance, <br />payment, ano accentar.ce of payaent are wtt.-.uut arejadice <br />to riynis of :nr owne.- or contractor c:;cer *n.s contract <br />•i/OI ARROW IMIULATION. INC (fora slailar to AIA DOCUMENT G702)