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APPLICATION AND CERTIFICATE FOR PAYMENT AIA document C702 (instructions on reverse side) TACEONtor 2 PACESTO (OWNER): Kraus-Anderson Construction525 South Eighth Street Minneapolis, MN 55A04 PROIECT: city Hall & Public Works Garage APPLICATION NO: 1Orono, MN PERIOD TO: 1-1-93FROM (CONTRACTOR): Ackley-Dornbach, Inc.716 N. 109th Street Wauwatosa, WI 53226 CONTRACT FOR: Detention Equipment VIA (ARCHITECT): Uoarraan, Kroos, Pflster ARCHITECT'S& Associates PRO)ECT NO:Distribution to: •□ OWNER□ ARCHITECT□ CONTRACTOR□□CONTRACT DATE: August 31, 1992CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. Continuation Shcci, AIA Document C703, is attached.CHANCE ORDER SUM.MARYChange Orders approved in previous months by OwnerTOTAL ADDITIONS DEDUCTIONSApproved this Month .* • Number Date Approved • 1 ........................ 1 TOTALS Net change by Change Orders 1. ORIGINAL CONTRACT SUM.......................................$___31,000.00.2. Net change by Change Orders ...................................$ 0.003. CONTRACT SUM TO DATE (Line 1 3:2).......................$____31,OOQ.._Q04. TOTAL COMPLETED & STORED TO DATE...................$____200,90.(Column C on G703)5. RETAINAGE:a. JjQ_ % of Completed Work $______52Q.._r^—(Column D + E on G703) b. _% of Stored Material $ , .................... 520.00 4.680.00 The undersigned Contractor certifies that to the best of tire Contractor's knowledge, information and belief the Work coveted by this Application for Payment has been completed In accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued arid payments received from the Owner, and that cu'rent paymtnt shown herein Is now due. (Column F on C703) Total Retainage (Line Sa + 5b or Total in Column I of G703).................................. $___ 6. TOTAL EARNED LESS RETAINAGE...............................$____ (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate)..............$ — 8. CURRENT PAYMENT DUE............................................$ — 9. BAUNCETO FINISH, PLUS RETAINAGE.....................$ 26.32Q.0Q (Line 3 less line 6) ______ Q.QQ 4.681M10 CONTRACTOR:Ackley-Dornbach, Inc. State of: Wisconsin County of: Milwaukee Subscribed and sworn to before me this , t 22/td' day of December ,1992 12-22-92 Subscribed and sworn to be fore me this ^ t Notary Public:^ /icAf My Commisr'on expires: /• lo permanent ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the above application, the Arcliitect certifies to the Owner that to the best of the Architect's knowledge, information and belief tlie Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED........................................................S (At.^ch explanation if amount certified diffets from the amount applied for.f ARCHITECT: By.Date: This Certificate Is not negotiable. The AMOUNT CERTIFIED Is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any fights of the Owner or Contractor under this Contract. AIA DOCIIMINT C70J • A}ir< rfPT'U^-'f ...................« , % APPTO (OWNER): City of Ore 1335 Brown Crystal Ba; FROM (CONTRACAllied Mechai 340 Michigan CONTRACT FOR.CONTRAtchance OROtCl^anRC Orders previous inof^llApproved ibis Nci change The undcrsijjr inlormalion a coir^plctcd ir> paid by ihc C issued and p hercir\ is nov ByV ARCHl In JCCordan data compri ihc ^ imlicaicd. I the CunUa MAUOCUM flit amum C