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‘APPLICATION AND CERTIFICATE FOR PAYMENT ma document G702 (ii.situnions on rcvi-isc sku*) iv«.ioni()(flO (OWNfR);City ot Orono P.O. Box 66 <br />Cr^'stGl Bay, MN 55323 <br />IROM (CONlRA.ilOK): ^ Meter Seryice, Inc. <br />I ’ROirci;Otono MntnclpaJ. Facilities Orono, MN Al’I'l lCAIION NO: 2 «>lR!f)|) K): <br />il303 Excelsior Blvd. <br />Hopkins, MN 55343 <br />VIA (AR(,IIIIICI):Boanran & Assoc. <br />222 No. 2nd St. <br />Mpls, MN 55401 <br />CONI RAC r FOR:F^r»r*- 144*Sn VoMcIp I.irtn <br />ARCHIILCrS <br />PROIECrNO: H24.07 <br />6-12-92 <br />CONTRACT DATE; p.p, 16207 <br />Uisuibuliun to;□ OWNERn ARCniltCI <br />IICONIKACIOR□□ <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made (or Paymrnt, as sliown below, in cconnection with the Contract <br />Con'dnuatinn Shed, AIA Document 0701, is attacliec). <br />CHANGl ORDER SUMMARY <br />Change Orders approved in <br />previous monllis by Own«*r <br />TOTAL <br />ADDITIONS <br />Approved this Month <br />Number Dale Approved <br />TOIALS <br />DtDUCnONS <br />L Net chan ge by CbaoKC Orders <br />1. ORIGINAL CONTRACT SUM.........................................% _3U^1.JQ0. <br />2. Net change by Change 0» Icrs ... ... $ . <br />3. CONTRACT SUM TO DAIE (line 1 ±2)........................$ —mill.'?!. <br />4. TOTAL COMPLETED & STORED TO DATE....................S _.) <br />(Column G on G701) <br />5. RETA'NACE: <br />a.___% of Completed Work $__________________ <br />(Column D f E on G70J) <br />b.___% of Stored Material <br />(Column F on G703) <br />Total Relainage (Line 5a + 5b or <br />Total in Column I o( C70J).....................................$-------r_0_r. <br />5*' <br />Ihc undersigned Contractor certifies that to the best of the Contrar tor's knowledj;e, <br />information and belief the Work covered by this Applu alnm for I'ayment ha^ been <br />completed in accordance with the Contract Dorurnents, that all amounts b.ive f)er*n <br />paid by the Contractor ior Work for which |>revious C rutificates for Payment were <br />issued and payments receiver! from the Owner, and that current payment shown <br />lierein is now due. <br />6. TOTAL EARNED lESS RHAINAGE.................................$ _r 321il:'51r: ^ <br />(Line 4 less Line 5 Total) w *C2 <br />7. LESS PREVIOUS CERTIFICATES TOR <br />PAYMENT (Line (> Irom prior Cer(ilicate)...............$ <br />8. CURRENT PAYMENT DUE..............................................S —^ <br />9. OALANCE TO FINISM, PIUS RFIAINACE......................^ - Q <br />(Line 3 less Line 6) ________ __________________ <br />CONIRACIOR State t)(; <br />Date /-y-^3 <br />ARCHITECl'S CERTIFICATE FOR PAYMENT <br />In arcorrlante witfi the Contract Doujments, hasrd on n»'. observations and the <br />data comprising the above application, the Architect certifies to the Owner tha^ lo tlie <br />best of the Arclutect ’s knowledge, infcumation and belief the Work piogre^sed as <br />indicated, the (juality of the Work is in ac (ordaiu e with lire Conlrar I l)ucun.e ils, and <br />the < ontraclur is enlillcd lo payment of the AMOl NT CtRIIFIED. <br />AMOUNT ClRIiriEU.................... <br />(Arf.ich explanation if amount ccr <br />ARUtltlCF; <br />ANOKA COUNTY <br />My CuMu lMlon E«pH« S«pt 23,1638 <br />mt applied lor.) <br />Ily; <br />lY-fTot negotiable. T <br />D.,.: <br />lids Cerlificatc negotiable. The AMOUNT CTRTiriED is payable only to <br />Cot tractor named herein. Issuance, payment and acceptance of payrnenl are will <br />prejudice to any rigfrts of ihr Owner or Contractor under this C.onlr«Kt. <br />AU DOCUMiHT C7H * AITUCAIION AND ( IRIinrjMi fOt r^VMlNI • MAT rwi fimirjN • AIA* • © 1*WI <br />lie AAMRH AN INSIHUIl CK AirillUCIS, DIS NIW ItMU. AViNia, N VV. WAMlINCnirN. DC 2QD»