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APPLICATION AND CERTIFICATE FOR PAYMENT AIA document C702 (InslmcUons on reverie side)PACE ONE OF PACESfh-ici-Anderson Construction Hall & Public WorksG'r--------- --------- -----------*■TO (0WNE^25 South 8th StreetMinneapolis, MN 55404 farage - Orono, Minnesota APPLICATION NO:Two^wa^^on*^L*^o^ngdale, Inc.P.O. Box 26070, Mpla., MN 55426 VIA (ARCHITECT):Boatman, Kroos,Pfister & Associates Distribution to:□ OWNERPERIOD TO: ^2/31/92 □ARCHITECT□ CONTRACTORARCHITECT'S □PROIECT NO: ^0^9 □CONTRACT FOI^^^^ Wa11 rnvnring CONTRACT DATE: 05/11/92CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached.CHANGE ORDER SUMMARYChange Orders approved in previous months by OwnerTOTAL ADDITIONS DEDUCTIONSAPI^rgygd ^i|Number " '’Dal^'Apjirovedrjl,;. <br />1 » <br />Nel change by Change Orde. <br />1. ORIGINAL CONTRACT SUM.........................................$2. Nel change by Change Orders ......................................$tJ94.000.003. CONTRACT SUM TO DATE (Line 1 ±2)........................$------24,894 .._0^4. TOTAL COMPLETED & STORED TO DATE.....................$ —23,00.0^0^(Column C on C703)5. RETAINAGE:t»9___% of Completed Work $ ,2,300_. 00---------(Column D + E on C703) \jP___% of Stored Material $0.00(Column F on G703) <br />Total Retalnage (Line 5a + 5b or <br />Total in Column I of G703)2.300.00 <br />I he undcrsigneo L.onif3Cior ccfinics inai lo ine uusi oi ine v-umidtjui » miuwiuu ^v., <br />information and belief the Work covered by this Application for Payment has been <br />completed in accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor for Work for which previous Certificates for Payment were <br />issued and payments received from the Owner, and that current payment shown <br />herein is now due. <br />CONTRACTOR:Swanson & Youngdale, Inc. <br />6. TOTAL EARNED LESS RETAINAGE............................$ —20.7QQ.t.Qj3L <br />(line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate)...............$........1 5 « 30Q.* QQ <br />8. CURRENT PAYMENT DUE...............................................S--------5 ■ 4QQ.QQ <br />9. BALANCE TO FINISH, PLUS RETAINAGE.......................$ 4.194.00 <br />(Line 3 less Line 6) <br />By:Dale:12/15/92 <br />uxot: Hennepin __ <br />-------------- ^ S. E. EDI^S : <br />Notary Publicft4./J f notary PUBUC • MINNESOTA <br />County of: <br />Subscribed and sworn to before me ihisV <br />ARCHITECf'S CERTIFICATE FOR PAYMENT <br />My Commission expires: /(j /5 • 94, HENNEPIN COUNTY { <br />‘ H|| uiiyilliaion (XL ti IW f <br />In accordance with Ihe Contract Documents, based on on-site observations and the <br />dala comprising the above apjrlication, the Architect certifies to the Owner that to the <br />best of the Architect's knowledge, information and belief the Work has progressed as <br />indicated, the quality of the Work is in accord.mre with the Contract Documen s, and <br />the Contractor is entitled to payment of ttie AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED................................ <br />(Attach explanation if amount ceftified dUfeis from the amount applied for.) <br />ARCHITECT: <br />By:Dale: <br />This Certificate is not negotiable. TT»e AMOUNT CERIlflEO is payable only to the <br />Contractor named herein. Issuanc*- payment and acceptance of payment are without <br />prejudice to any rights of the O viier or Contractor under this Contract. <br />ATA OOCUMINl C7«» APPIICMION AND CtKIIIICAIl tOR IWMlNt • A»AY IS8I IDITION • ALA* • © 1981 <br />Tin AAttltCAN INSllIUTt Or AROIItM IS, 171S NIW YORK AVINUl, N.W. WASIIINCION. DC. JUMt C.702-1983 <br />FRCVi <br />••OflSlfl <br />Tfie <br />info <br />Com <br />paid <br />iissui <br />Tierc <br />cot <br />AR <br />In nc <br />data <br />bcsl <br />indtc <br />the i <br />AIA n <br />tiff /