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> i <br />APPLICATION AND CERTIFICATE FOR PAYMENT ma oocuMwruiK .cvc.scsw.r’2~«10 (OWNtR); City of Orouo1335 Brown Road SouthCrystal Bay, MN 55323 PROIECTClty Hall and Public Works Garage AmiCATION NO: Five (5) Dlsiribulion lo: Orono, UN □ OWNER. rruioo TO: 31. 1992 □architect•1 I • □ CONTRACTORrROM (CONTRACTOR): W. L. Hall Co. VIA (ARCIII'ECT): AROIITECT'S “IA800 Martin Drive Boarman, Kroos, Pflster and Associates pROjTCT NO;H2^*0A [jEden Prairie, MN 553A4 222 N. Second Street, Mpls., MN 55A01CONTRACT FOR: pivlalon //31. Section 10635 "Folding Partitions"___________________CONI RACE DATE: August 31, 1992_______CONTRACTOR'S APPLICATION FOR PAYMtNTCHANGE ORDER SUMMARYChange Orders approved in previous montlis by OwnerTOTAL ADDIIIONS290.00 DEDUCTIONSApproved Ibis Monlb <br />Nun)bcr Dale Apptovcrl <br />TOIALS <br />Net clrange by Cliange Orders <br />Applirnlion is made (nr rnymotU. ftS sirown below, in conncrlion with lire Contract. Continiialton Slicet, AIA Uociinient C703, is attaclrcd.1. ORIGINAL CONTRACT SUM..............................j ! 12,656^002. Net change liy Cliange Orders......................................S J______^?0»003. CONTRACT SUM TO DATE (t ine 1 ± 2)............A. TOTAL COMPLETED ^ SIORID TO DATE.............j 12,946.0 0(Column G or^ G701) <br />5. RE!/ INACF. <br />a. —— % o( Coin|)lclc(l Work <br />(Col'imn 1) I t on C70.1) <br />I). % of Slorr?(l Malrrial <br />ICuliiinn F on C'JIU) <br />Tolol RclainaRe (line* Sn F 51) or <br />Total in Column I of C70T) <br />i 1,294,60 <br />i 0,00 <br />1,294,60 <br />TOTAL EARNED LESS RETAINACE............................$ ' llf^MlA9 <br />Tlie undersigned Coniraclor certifies llial l«) IIm! best of lire Cnnlfatlor's knowledge, <br />information and bcIioT llic Work covered by ibis Applir .tlion (or (*,-iymeiil lias bee r <br />complolcd in accordance with lire Conlract Uocimrenis, tital all ammmls liave Ireen <br />paid by the Coniraclor (or Work frrr wliicli previous Cetlilir ales (or P.iymeol were <br />issued and p.iynrenls received from tire Owner, and dial turteni paymcnl shown <br />Itcrcin is now due. <br />(Line 1 (ess Line S lolai) <br />7. LESS PR'^Vi JUS CERTITICATES FOR <br />PAYMENT (line 0 from prior Ccrlilkate) <br />n. CURRENT PAYMENT DUE............. <br />9. BALANCE lO TINISII, PIUS REIAINAGE <br />(Line .1 less Line 0) <br />. • ' <br />3,198.60 <br />^ • •• 8,452.80 <br />GE*..t" ' 1.294.60 <br />CONIRACTOR; W. L. Hall Co. <br />Ry:D.iio; Deccml)er 17. 1992 <br />Slate of: Minnesota <br />Subscritjcd .ind sworn lo bdorp me tin <br />Notary Pid.lic <br />[gJ^PJ^ASYLYK <br />»t <br />ARCHITECT'S CERTIFICATE FOR PAYMENT „ <br />In accordance will) (he Conlract Docunrenl^, bsi^ii'd on ofiAili* oliservaiions sinci the <br />data comprising the above application, tl)c Archilrc I rrrtilir^i to ilu* Ov npr \Um lo ibe <br />best of Ibc Architeers knowledge, information arid helirf llu* Work ba^ pn |;ressed a«i <br />Indicated, the quality of Ibe Work is in accordam r wiih (br ( onirar t Out uments, and <br />the Contractor is entitled lo payment of the AN\C>UNI ( I RIlflll). ' <br />Mh OOCUMINI C7«1 • Af*n ICAOON AND C IROIK AM I UK IMKMNI • K) W ‘OmON • AIA* • t | ifll <br />im AAUHUrSN INSI'fOn of AJU UmCtS I7IS NIW VUliK AON) . N W \‘ l« MiinM Or nntn. <br />My C n »^sion ex|)irr*s. April 9, <br />AMOUNT aRUriED <br />(AUac/i CYp/anafrun if nmnunt cerfrhed differs from (he ^nunmt app/ied for.) <br />ARCHIUCi:i»*‘ <br />...» . s <br />By:Date: <br />Ibis Cerlificale is not negotiable. The AMOUNT CFRTiriED is psiyable only to thd <br />Cfinlrac lor named herein. Issuanc e, paymeni arid acceptance of payment are without <br />prejudice lo any righls of the Owner or Contraclur under this Conlract. <br />. ■ *^ « •» .1* » m m ^