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APPLICATION AND CERTIFICATE FOR PAYMENT m document cjozTO (OWNER): City of Orono1335 Brown Road South Crystal Bay, MN 55323 PROIECT: Orono City llall/Pollce and Public Works Bldgs.(Inslrucliops on fcvcf«e side) n^c£ ON| Of mcts APPLICATION NO: Six <br />FROM (CONTRACTOR): Steenb'irg-Watrud Constr. VIA (ARCHITECT): <br />10255 Inver Grove Trail <br />Inver Grove Ilts., MN 55076 <br />CONTRAa FOR: <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />V. <br />Cc: <br />CHANCE ORDER SUMMA^ <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />Date Approved <br />Mtt\TKr.) Conipoov totals <br />Net change by Change Orders <br />ADDITIONS DEDUCTIONS <br />Conltaclor-s knowledge. <br />utu.5^ H ‘O'”, Work for which previous Ceriilicales (or Payment were <br />he«in fs iow d!ir payment shown <br />CONTRACTOR^ttee/fberg-l t^d^nstructlon, Inc, <br />/i <br />Hale: __ H"‘30"92 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />Ir»M '^'L^ **15 Contract Documents, based rm on site observations and the <br />k !.1 Architect certifies to the Owner that to the <br />: J ° ' J*.V5 ‘^**^**5* ‘ 'n'ormation and belief the Work has progressed as <br />^iMted, the quality of ihe Work u in accordance with the Contract Documents, and <br />the Contractor is entitled to payment of the AMOUNT CLRTIMED. <br />M oocomint cm • APpnranoN ano riinirK ah <br />OisfribuHon to: □ OWNERPERIOD TO: U-30-,/2 □ ARCHITECT <br />, „ □ CONTRACTOR <br />ARCHITECrS □ <br />PROJECT NO: 1124.OA ’ □ <br />CONTRACT DATE: <br />1. ORICINAI CONTRACT SUM........................................... <br />2. change by Change Orders..................................^ (13,870 75 ) <br />3. CONTRACT SUM TO DATE (Line 1 i 2)................... S 328,629.25 <br />4. TOTAL COMPLETED & STORED TO DATE............. 1328,629.25 <br />(Column C on C703) .......... <br />5. RETAINAGE: <br />a. __LQ % of Completed Work $ 32.862.93 <br />(Column D + E on C701) <br />-----% of Stored Material $ ~0-_______ <br />(Column F on G703) <br />lolal Retainage (Line 5a + 5b or <br />Total in Column I of C703)..................................... 32,862.93 <br />6. TOTAL EARNED LESS RETAINAGE........................j 295,766.32 <br />(Line 4 less Line 5 Total) ' ~ <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 (torn prior Certificate)..............S 282 ,073.00 <br />8. CURRENT PAYMENT DUE....................................... ‘ j 13,693.32------- <br />Q RAt AlUI'C Tr% ClKilcaa n. • iai . ............... ...................................... ^ ^ ^ ^ ^9. BALANCE TO FINISH, PiUS RETAINAGE !!!!!!!..!!!!$ 37^862! 93 <br />(Liryt^ jess Line Q) <br />Subscribed Snd^Wer6 to |*c <br />Notary Public: <br />My Commission expires: <br />»clore/fn/thi: <br />[nnmufWMw <br />J. WATRUD <br />C~|yONNiSfcrA i <br />AMOUNT CERTIFIED <br />POBUC----- <br />y - DAKOTA COUNTY <br />^ My Commission Gxpims Fob. to. 1004 <br />S <br />By:’ ] ------------------------------------—-— ---------— Date: _____________ <br />Ihis Certificate is not negotiable. The AMOUNT CERTIFIED is Payable only lo th» <br />Contractor named herein. Issuance, payment and acceptance oi parent are wllhoul <br />prejudice lo any rights of tlie (Twner or Contractor under this Co^niracl. <br />J