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rAcc ONC or rACU I24JUDnow(OOtmACTOR); J 4 F ConstructionP.O. Box A20 Eau Claire, WI 54702ooKTRAcrroRt Jim Dobrzvnski (7!5) 835-5119 <br />VIA (ARatmCT):APflJCATION NO.: Qnc PEJIIOO TO:Axcurncrs PROJECT NO.: 4059 <br />CPNIRACTDATT: 10-22“92 <br />Dbirtbytlow id :^ OWNERI 1 ARoirricr I I COKIRACrOR <br />CONTRACTOR'S APPUAHON FOR PAYMENT <br />Appliodon It made for Paumcni. at ihoam Ulo«. In tonn«o.ii. Hih the Contract Condnuadoa iffmt. <br />AIA Document C705. U amchedo <br />CHANCCORDtR summary ' ---------------------------—1 <br />Chaiifi Otden afprowd la <br />pwMomtnutM by owner <br />——— <br />Approetd tMe Month <br />ADOmONS DEDUCTIONS <br />SEP <br />Krdii... fanun <br />2 4 1993 <br />i-AfKJerson <br />Toiila 0 <br />Net change by Chanfe Orders <br />ORIGINAL OONTRACr SUM____________________ | 36,4^)9.00 <br />Net change by Qiange Ordem------------------------------ | <br />OOKIRACr SUM TO DATE (Unt I A J)--------------- | o?.50 <br />TOTAL COMPUTED A yrORED TO DATE_______ } 36.409.00 <br />RTTAINACE:; <br />»• ______ofCompleudWorh <br />(Column D lb E on 0709) <br />h. of Stored Maurlal <br />raccor*# knowledge. <br />^ ^ Work omred by ihU AppUcaiJon for Payment hu Uen <br />rtmpitiad bi necordafica ariih iht Gomract DocumcniA all amounu ha¥« been <br />paM by Oit Ooninclor for Work for which prarloua Genillcaui for Taymeni were <br />ptjfwowii rtcthpfd fooM the Owner, Md ihai aineni payment ahown <br />6 <br />7 <br />a <br />9 <br />(G>lum Fon C709) <br />Total RccaJnage (Line %a k SB or <br />Total In Column I of C709)____________________ g <br />total EARNED LESS RETAINACE .._____________ | <br />(Unc4)caUncSToul) <br />IXSS PREVIOUS CtJrnriCATtSrOR PAYMENT___ } <br />(Unc 6 from prior Cc/dfleau) <br />CURRENT PAYMENT DUE____________________ , <br />balance TO HNISII. PLUS RTTAINACE_________ | <br />___(IJnt S lc« Unc 6) <br />0.00 'bt.MO.'iO <br />0 00 <br />OIL. <br />OOKIRACrOR: <br />CouniroE Eau Claire <br />Dale: <br />siauoE Wisconsin <br />Subeaibed and Dvorn lobe fore, me thb 01 day of r* ^ • <br />NcratrPubUc ueptember <br />MrCommUlon capl.t. |HnOWM <br />Irt r <br />.19 <br />ARCHTTECrS CERTmCATE FOR PAYMENT <br />la ■rnntancc «ldl Om (htuna DootiMniA bwed on oimIm olncmiJon. »nd the <br />OUMpiWng lh« «bo«a appUcMion. iho Architect ccriiAec to the Owner that u> (he <br />IMalike Archhect't kiiowltd|t, Informaifoii and beUel the Work hu pn>greaaed aa <br />Wka^ the ^aliiy of ihe Work la in accordance with the Cuniract Documents and <br />M OMitrKlor Is tnlliied lo payment of the AMOUNT CERTIFlEiX <br />0 <br />/ <br />AMOUNT CUninED.----------} <br />(Attath ciplanadon of areOuntcerdAed dlffenfrora the amount applied for) <br />ARQilTECr: <br />cunncaTiauaAema/iiarMMuincw/AAv i»m <br />iiwMwieaifwiMuiMv. Rnnne um.aL <br />________^ Date: <br />Thit Ceruncat* it not ncfotlaUc. The AMOUNT CIR-nnrbu payable o My to the dontracior <br />lumH hetcin. IiMance, payment and acceptance of payment ai« widtool prejudice to <br />any ri|{hlj of the fOwner or Contractor under thia Conuact.