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Application and Certificate for Payment <br />(substitute for AIA Document G702) <br />Application No.: <br />Application Date: <br />Period To; <br />La Force Job No.: <br />04 <br />12/18/92 <br />12/25/92 <br />1A151 <br />Project Name: CITT HALL/PUBLIC WORKS FAC <br />TO: KRAUS ANDERSON <br />525 SOUTH EIGHTH STREET <br />MINNEAPOLIS, KN 55404 <br />FROM: LA FORCE HARDWARE 6 MFG. CO. <br />P.O. BOX 10068 <br />GREEN BAY, WI 54307-0068 <br />TRADE PAYMENT BREAKDC’JN IS ATTACHED. <br />^ $ 35,465.001. Original Contract Sum .. . . . . . . . . . . . . . . . .*. . . . ^ '7.010.00 <br />2. Net Change by Change Orders . . . . . . . . . . . . . . . . . . . . . . . . . u^\->5.Q0 <br />3. Contract Sum to Date (line 1 + 2) . . . . . . . . . . . . . . . . . . . . . 37*885 00 <br />4. Total Completed & Stored to Date (column G) . . . . . . . . . . . . . . . . ? j/,ooj.w <br />5. Retainage: , -x e tar sna. lO.OOZ of completed work (column D + r.) . . . . 5 3,/oo.ou <br />b. 10.002 of Material Stored (column F) . . . . . . f , 700 so <br />Total Retainage (line 5a + 5b; or total colu^ I) . . . . . . . . . . . | 3,/bbj^ <br />6. Total Earned Less Retainage (line 4-5 totals) . . . . . . . . . . . . 14*088 60 <br />7. Less Previous Certificates for Payment ......................................................... + ' <br />(line 6 from prior certificates) ^ 20.007.90 <br />8. Current Payment Due .................. g 8 ’37s!50 <br />9. Balance to Finish, Plus Retainage . . . . . . . . . . . . . . . . . . . . . ’ <br />(line 3 less line 6) <br />The undersiened Contractor certifies that to the best of the Contractor's knwledge, <br />information and belief the Work covered by this Application for payment has been <br />completed in accordance with the Contract Documents, that all amounts have been pai y <br />the"Jont?actor for Work for which previous Certificates for <br />payments received from the Owner, and that currer^j^yment sho^^ herein is now d . <br />CONTRACTOR. LA FORCE HARDWARE R MFC. CO. . 12/18/92 <br />State of: Wisconsin County of: Brown . QJ 19 UV <br />ARCHITECT'S CERTIFICATE FOR PAYMENT ^orrs *nd the data <br />In accordance with the Contract Documents, Base on Owner that to the best <br />comprising the above application, the Architect certifies to the Owner <br />of the Architect's knowledge, information and belief the Wor ** the <br />indicated, the quality of the Work is in accordance with the Contract Docum . . <br />Contractor is entitled to payment of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED $ <br />ARCHITECT:By:Date: <br />This Certificate is not negotiable. The A.M0UNT CERTIFIED P*J*^g* without