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Application and Certificate for Payment (substitute for AIA Document G702)Application Ho.: Application Date: Period To: La Force Job No.:06l/22t9l1/25/9314151TAC.i (*Nt oi mr.is •nisitioitiion li>:□ OVVNl R□ ARCIIIUCT DCONIRACIOR Uo <br />lectiun wil!i Ihc ronlf.Hl. <br />\ 156.288 <br />V - 5.068 <br />% 151.220 <br />S J_5P_l8_36_ <br />15i.083 <br />I 135>753 <br />j 125,^03 <br />I 157350^ <br />t l5.~467" <br />Y of <br />mm <br />[2ERTS <br />ZOXA <br />K ,..»cPIN COUNTY <br />iif SSTgaTg.! <br />H f* iH are withoiii <br />f iIm% ron(t4< I <br />Project Name: CITY HALL/PUBLIC W0R}%S FACTO: KRAUS ANDERSON BLDG DIV.525 SOUTH EIGHTH STREET MINNEAPOLIS. MN 55404 FROM: LA FORCE HARDWARE Si MFG. CO.P.O. BOX 10068 GREEN BAY, WI 54307-0068TRADE PAYMENT BREAIUDOWN IS ATTACHED.1. Orieinal Contract Sum .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ^ ^fi’oTs nn <br />3. Contract Sum to Date (line 1 + 2) . . . . . . . . . . . . 5 42.440.00 <br />4. Total Completed k Stored to Date (column G) . . . . . . . . . . . . . . => **ii.‘*4u.uu <br />5. Retainage: / o// nn <br />a. lO.OOZ of completed work (column D + E) . . . . S nn <br />b. lO.OOZ of Material Stored (column F) . . . . . . S -00 . . «n <br />Total Retainage (line 5a + 5b; or total column I) . . . . . . . . . . § <br />6. Total Earned Less Retainage (line 4-5 totals) . . . . . . . . . . . . v ^ <br />7. Less Previous Certificates for Payment . . . . . . . . . . . . . . . . . . ^ j4.uyo.ou <br />(line 6 from prior certificates) ^ 099.50 <br />8. Current Payment Due ...................................................................................................... . i’oAAnn <br />9. Balance to Finish, Plus Retainage . . . . . . . . . . . . . . . . . . . . ^ 4,z44.u <br />(line 3 less line 6) <br />The undersigned Contractor certifies that to the best of the Contractor's knwledge, <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 paid by <br />the Contractor for Work for which previous Certificates for Payment were issued and <br />payments received from the Owner, and that current payment showr. herein is now due. <br />CONTRACTOR: LA FORCE HARDWARE i MFG. CO. iMoX 1/22/93 <br />___________________^ « J________ <br />Not.ry PubUc. U% 7?My Coran'ssion .xpir^i <br />Based on oo-alte obsetv.tioos and the data <br />comprising the above application, the Architect certifies to the Owner t at to «e <br />of the Architect's knowledge, information and belief the Work has progressed as <br />he quality of the Work is in accordance with the Contract Documents, and the <br />entitled to payment of the AMOUl^T CERTIFIED. <br />AM0L7i’T CERTIFIED <br />JAN 2 5 1993 <br />ARCHITECT:_ <br />Date: <br />■'^Hs‘'6e;;;’a-ficate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />•'c6nVrircVot'*‘w^e herein. Issuance, payment and acceptance of payment are without <br />preludice to any rights of the Owner or Contractor under this Contract.