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. iAPPLICATION ANO CERTIFICATE FOR PAY.VIENT AIA document C702 dnstruciions on reverse side) rACi ONI of^n%cisTO (OWNER):City of Orono1335 Brown Road South <br />Crystal Bay, MN 55323 <br />FROM (CONTRACTOR): <br />PROIECT:Orono City llall/Police and <br />Public Works Buildings AmiCATlON NO: 3 . <br />PERIOD TO: 12/31/92 <br />CONTRAa FOR: <br />VIA (ARCHITECT): ARCHITECT'S <br />Doarman Kroos Pfister and Assoc. PROlECr NO: 1124.04 <br />222 North Second Street <br />Minneapolis, MN 554 01 CONTRACT DATE: <br />Distribution to:□ OWNER <br />□ ARCHITECT <br />□ CONTRACTOR□□ <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />CHANCt OKDtR SUMMARY <br />Change Orders approved In <br />i'reviuus months hy Owner <br />TOTAL <br />ADDITIONS <br />^proved Ihls Month <br />1*' <br />one <br />. , DaJe Approved <br />bci. • <br />11/2/92 <br />by Giange (prders <br />TOTALS <br />DEDUCTIONS <br />(-3,/t63.00) <br />Application is made lor Payment, as shown below. In connection with the Coniraci. <br />Continuation Sheet, AIA Document G703, is attached. <br />1. ORIGINAL CONTRACT SUM......................................$ <br />2. Net change by Change Orders...................................$ <br />3. CONTRACT SUM TO DATE (Line 1 ± 2).......................| <br />A. TOTAL COMPLETED & STOKED TO DATE...................S _ <br />(Column C on C703) <br />5. RETAINAGE: <br />a. % ol Completed Work \ 7 ^ 16A , jQ <br />(Column D i E on G703) <br />b. _% ol Stored Matcri.tl $________________ <br />(Column F on C703) <br />Total Rctainage (Line 5a + 5b or <br />Total In Column I ol G703) ... .........- . w . S 7,16A.50 <br />The undersigned Conlrai^ior ci|rtinus that to the best ol the (^Contractor's knowledge, <br />inlorntalion and beliel Ihc Work covered Ly litis Application (or Payment has been <br />completed in accordance with Ihc CuntracI Oocumems, ih^t all amounts have been <br />paid by Ihc Contractor (or Work (or which previous Cerlilicaics lor Payment were <br />issued and payments 'ccelved from the Owner, and I’lal current payment shown <br />herein Is nuw due. <br />6. TOTAL EARNED LESS RETAINAGE ... <br />(Line A less Line 5 Total) <br />7. LESS PREVIOUS CERTIHCAIES TOR <br />^A-A8075TT <br />49,509.90 1/PAYMENT (Lir»e 6 Irorn prior Ccriilicalc)..............$ <br />6. CURRENT PAYMENT DUE............................................$ ,9/U. bU <br />9. BALANCE TO fINISH, PIUS RETAINAGE.....................$ 10,801,50 <br />(Line 3 less Line (>) <br />CONTRACTOR: Iloffer's Inc, <br />ny. Gcorp.e Hints Date:12/18/92 <br />Stale <br />Subscribed and <br />Notary Public <br />My Commission expires <br />ARCHITECT'S CERTirTCATE FOR PAYMENT <br />Coiw\Y.Ql I <br />henmepw county j <br />AMOUNT CERTIFIED <br />u., r.nfflmiuion EiPkM Feb O. tW* > <br />!333vvvw S5 v ^^ <br />In accordance with the Contract Documents, based on on siitr observations and the <br />data comprising lire above application, lire Arihilect cerlilies to the Owner llial to Ihc <br />iivst oi tile Archnecl's knowledge, information ami belief lire Work lias progressed as <br />indicated, lire quality o( the Work is in accnrdanr e wills the CoiilracI Documents, and <br />die Cuniractur is entitled to payment ul llic AMOUNT CIKliriED. <br />(Aliach explanation if amount certified differs from the amount applied for.) <br />ARCHITECT: Boarman Kroos Pfister and Associates <br />By:_ Dal;: <br />Tills Ccriilicale Is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein. Issuance, payment and acceptance of payment arc without <br />prciudice to any rights of the Owner or Contractor u.ider tliis Contract. <br />AMIMKUMINt Cm*AmiCAIlON ANIlCtNIIIICAIt lOR mYMINI • MAY l<MI initlON • AIA* • « IWl <br />f»t« * " .