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a.isuvjtuo.u on fcvci^c ------------- — 7[7r 5 DisltlbuUon lo;APPUCMION NO; •=> ^ oWNtR□ ARCHlTtCT□ CONTRACTORa .O. n OWNtRp[RlOD TO:ARCHlTtCT’S ^3C. rROltCTNO:CONTRACT DATE; --------- -- ----------------Ootum^ni CTO’. ^^ ..........................’.‘V.’.’*.’* J,c ............................... JDAU (Unc ................................8, STORED TO DATE...................;70i).eawo,.on G70T) ___Matctlal ^ ------------------------ ” <br />n » ol .............................................j <br />ss ................................... <br />wincMtsroil ;// <br />>. i i,om p.io. c...ir.c..e)........- ’ <br />NT DUE................................. ^ ftf' ?M' <br />[tsH. f'lUS ..........................**“____________ <br />County of; <br />r\ f 14-^^*-''— t; day <br />.19^ a <br />‘illiT Associates <br />;an Krooii PExstet __ <br />Dale# •■ "“* I I ii>ft <br />ih. Mioum cww <br />--------------- —— QCl't8®2 <br />X APPLICATION AND CERTIFICATE FOR PAYMENT AIA document G7v>^ Unsnuclions on reverse side) PACtONiof l»AC£S*TO (OWNER): KRAUS ANDERSON CONSTRUCTION CO. I’ROItCT: qro NO MUNICIPAL FACILITY525 South 8th St. • ORONO.MNMPLS, MN 55A0A Attn: John DaviesFROM (CONTRACTOR): GOEBEL FIXTURE CO. VIA (ARCHITECT):528 Dale &;;reet SW Hutchinson, MN 55350 CONTRACT FOR: 818 Architectural Woodwork APPLICATION NO; IPtRIOD TO:ARCHITECT’S PROIECT NO:CONTRACT DATE:Distribution to;□ OWNER□ ARCHITECT□ CONTRACTOR□□CONTRACTOR'S APPLICATION FOR PAYMENTCHANCE ORDER SUMMARYChange Orders approved in previous months by OwnerTOTAL ADDITIONSApproved this Month pproved0 mz DEDUCTIONS Application is made (or Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document C703, is attached.1. ORIGINAL CONTRACT SUM......................................1 -------—2. Net change by Change Orders ...................................S3. CONTRACT SUM TO DATE (Line 1*2).......................$ ------------4. TOTAL COMPLETED & STORED TO DATE...................$ 3^»665,QQ--------------(Column G on G70J)5. RETAINAGE:a, 10 % ol Completed Work '> 3,4^6 ,flQ-----------(Column D + E on C701)b. _"Xi o( Stored Mater al S--------------------------— <br />li,;.... .'URJcrWHl TOTALS <br />(Column F cn G70T) total Rctainage (Line 5a + 5b or <br />Total in Column I ol G70J)...................................S 3,466.00 <br />C CNel«?hai\{fftU(vtghV(Wy3rdcrs <br />The undersigned Contiactor cenUlcs that to the best o( the Contractor ’s knowledge, <br />information and belief the Work covered by this Application for Payment has been <br />completed in accordance with the Conn act Documents, that all amounts have been <br />paid by the Contractor for Work for which previous Certificates for Payment wore <br />Issued and payments '■eccived (rom the Owner, and that current pt<yment shown <br />herein is now due. <br />(•. TOTAL EARNED LESS RETAINAGE...............................S _llt ^99.00 <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERUWCAIIS FOR <br />PAYMENT (LirifHnrSp' Certi(tcale)..............S-------------2. <br />B. CURRENT PAWHI nT ....................................S 31,199,.Q0 <br />IffTitSpi <br />IT PUkV . <br />CONTRACTOFU/COEBEL FIXTURE CO , <br />/ <br />') <br />By:^/l/xq-yc, <br />■VI i'kII 0u4ibcl, CEO <br />- fe Ciuntyol; MEEKER <br />..r»^iStit»sc^H*(|t^dUi%»tno belor^^ 8th day olDecember J9 92 <br />Date- December 8. 1992 ^(C^'C^t»mjyHiion expires; <br />' --------------------- ^...........................---------------------------------------------------------------------- I ...............— <br />Jf^MjljNT CERIIFIED.................................................8 <br />ARCFliTECTS CERTIFICATE FOR PAYMENT Mn.ich cxp/anafron .wnounf cc.rr/rc'i d /zers <br />In accordance with the Contract Documenis, based on on-site observations aird tire ARCHITECT; <br />data comprising the above application, the Architect ccrlilics to the Owner that lo the <br />best of the Architect ’s knowled'jC, information and belief the Work has progressed as gy;----------- ut i„ ,« th» <br />Indicated the quality of the V ork is in accordairce with the Contract Documenis. and Certilicale is not negotiable. I he AMOUNT CFRTIFIED is payable only W Iw <br />the Contractor is entitled to oaymenl ol the AMOUNT aRIll HD. Contractor named herein. Issuance . payment and acceptance olpaymenlarewithQUl <br />Date: <br />prejudice to any rights ol the Owrer or Contractor under this Contract <br />AIA DOCUMINI G7« • AmiCAIION AND URUfiCAU lOR fA>MINI • MAV i ill imiKm • *'»• <br />THI AMimcAN iNsmmi or xtriiu' <• ............