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TO OWNER: UcyolOionuISSS Brown Rood South CiyMAl Bay. K(N 5S52)mOMCON^niACTOR:CX)iVTRACr FOR.Gaphan Elecuk rkojtcTVL\ AKtjiriKrr Oroiiu Ciiy Ifjlt/rolka ajid I'uhlic Wurka IluildbigKi<xis Pfisirr Ntuili Seioiiil Sued Mii)ne4{M>lis. MN 55401 Al liJC A l ION I’FHIOH TO rkOjFCr NO :CKACr UA I F DitnibMiUwt lo;r~i owNi«40^9 r~l ABCUmCTf~| CONTRACrOHCONTRACTOR'S APPUCATION FOR PAYMENTAppUcmtkm It mmle for Paymcni, at thowii below. In connection with ihe Goniraci Omiimution Sheet. AlA Documcni G70S. It atuched1 ORICINAI. WNTRACr SlfMrt Nci chtfifc by Change OidettS CONTRACT SUM TO DA IT (Une I It 7)..4 TOTAL ODMPLrTED L SrrORU>TO 1>ATERETAINAGE:i.of Completed Woik(Column D «( E on G705)of Sioied Maifriat(Colum F on G70S) <br />Total Reialntfc (Line %a B SB or <br />Total In Column I of G70S) <br />TOTAL EARNED LESS RITAlNACt.................. <br />(Line 4 Icat Unc I Total) <br />LESS PREVIOUS CERTinCATES FOR PA\MEITr <br />(Unc 6 from prior CcrdOeaic) <br />CURREKT PAYMEK) DUE..... <br />■AlANCt TO nNISII. PLin RFTAINAr.t <br />(Un* S Im Unc 6) <br />279.400 006,958 50286358 50286.358 50 <br />286358.50 <br />276,981 00 <br />pSlAR^^lt 6lkhER SUMKUKY .AI>DrTlONS DFDUCriONS <br />OuMft OrCcre approved in <br />pftvtoiii months by owtier <br />Approved this kdomh <br />Toialt <br />The undefftigned Conn actor certifies that to *he best of the CAKiiractor'i kno%dedge. information and l>ellef the Work ctAeird l>y ihit A{>plicati4»ii for Payment hat been ioinpleied in accordance with the Omiraci IkMumenit. that ail amounu have been paid liy the Cionuacior for Work for which previousf>Mifitaiet for Payment were issued and |kaymrni» received (rom the Owner, and that current payment iftowtnherein is now due CT3NTR.ACTOR:Date.State of:CU»uniy of:Subscribed and twiurn to bcL* c ma this day ofNotary Public; <br />My Commission expires <br />ARCHITECT'S CERTIUCATE FOR PAYMENT <br />In accordance %dth die Gmuaci Lknimientt. based on on siic observadont and the <br />data comprising the abrjve application, the A«rhiieci erriifles to the Owner that to the <br />best of the Archheci't knosdedge. informaihm and belief the Work hat progresied at <br />indicated, the quaiiry of the Work it in accordance with die Contract Ducumenta* and <br />the Contractor It entitled to payment of the AMOUNT CFKTIFIk D <br />AMOUTsTT CFRTinFD <br />(Arrack €K^*u%mtt9n %f aiaacml ravfi/iad dtfftit rka aww a wl fm. Iwcfca/ <br />mtlfiguta m tka and «• Ike fanlinMa*can (kal are ck ang ad la <br />can/ena ra rkc amaimr €mtif*«d ) <br />ARf HMECT <br />lUte: <br />1 hit Cerufcaie it ru>t negotiable. The AMOUNT C.FK III- IFD It payable only lo she! <br />('.onirac u»i named herein tssuance, payment and arcepiancc of payment are tdfilotM <br />prejudice to any rights of die Owner or Camuacior itnder tliit Cajnuaci <br />awaaaaMM aiw •APftKATum anu attniKATt fut PAYkrtKiMMi ii>niuN*AU*iMif^iite am £iulan iKfirrcnr of aic itmcri in) Kaw Yumt avinuekw <br />VlIHRtCTQH. me lOQDi^ttdf * Warning UsnaaMd fawwfFWif «wiawi li.S. MMi cal^so it« aUlcsac i • irgcJ ^4 -••••0701 Ifft <br />L