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□:I ORtail.rr,tr9 <br />rr.rw <br />y^r.ip <br />k» rtw <br />.iifkiui <br />12 I9U <br />APPLICATION AND CERTIFICATE FOR PAYMENT ma document cm2 (Insltiicliuns on reverse side) PAr;r ONf or PAr.ivAnderson Construction Co 525 Soutlr 8th Street I’ROItCl: orono City llall/Publlc Works AITLICAIION NO: lMinneapolis, Minnesota 5540AFROM (CONTRACTOR): Twin City Acoustics, Tnc VIA (ARCIllItCI):8731 Bass Lake Road-New lloire, Mn. 55A2H Dislrilriilion lo:□ OWNf RPERIOD TO: January 31, lt^53M^CHITECT□ CONTRACTORAKCIIIIICT’S □PROIECT NO: □CONTRACT lOR: yv<~oustlcal Construet Ion ~/UrL^ac^r/^CONTRACT DATE:5-11-92CONTRACTOR'S APPLICATION FOR PAYMENT Applicalion is made (or Payment, as shown helow, in ronneclion vvilh Ihr Contract Cunlinualion Sheet, AIA Document C703, is allached.CHANGE ORDER SUMMARYCliange Orders approved in previous monlirs by OwnerTOTAL ADDITIONS DIDUCIIONSApproved Ihis MonthNumberr.R.#6 Dale Approved6-19-92IDECfEtS^D -92JAtL;,.u4993 ___195.00,887.00 <br />Ncl chant’e by Ch.in{»e Orders 1JJ82_,Q0. <br />T. ORIGINAL CONTRACT SUM.........................................$ 10.310.002. Net change by Change Orders .......................................S -3t06£tOQ» '~o —T. CONTRACT SUM TO DATE (I ine T ± 2)..........................S n ^ a011-^3 /ga/Qer.-1. TOIAL COMPtEIED & STORED TO DATE......................S 13,39 grOO ^(Column 3 on C7();T). .ETAINAGE:a. _19 % o( Completed Work S —1 r389~r00-/(7J/ erv (Column D 4 E on G70.T)b --------% of Stored Material $__________________(Column F on C7l)T)Total Retainage (Line 5a + 5b orTotal in Column I of G703).....................................$ . i , 339. UlF <br />^^WmnpIcHWWrirftWffflWre with the ( or>irari Documents, that all amounts have been <br />paid by the Contractor for Work l••r which previous Certificates for Payment were <br />issued and payments received from the C)wner. and that current payment shov,.i <br />liereii^ is now due. <br />tn> <br />h. TTTIAL EARNED LESS RETAINAGE.................................$ 4-^^^T-nn <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 0 from prior Certificate)...............$______-Q; <br />n. CURRENT PAYMENT DUE..............................................S 1 J ^Qt> <br />9. BALANCE TO FINISH, PLUS RETAINAGE......................$ 1,339 ftfl ^ <br />___(Line T less Line (>) <br />CONI Inc . <br />-Oave-BrinkeT D.tle: 1,—1993 My CrrmmissioAcapites: <br />Slate of. FJi^jwjosota olx/;?^llpnnepin <br />Subscribed aiu|^jrn to l/fj/re imVthis (Wof, <br />Notary Public : 5^!!. y <br />3-13-94 • ^ <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />hr ucordance with the Contract Documents, based on on-sili* oliservalions arul the <br />data comprising ilie above afrplicalion, the Architect cetlilies to tite Owner tliat lo the <br />Ik*sI of the Architect's knowlerfge, information and heliet llie Work has progressed as <br />indicated, the ipiality of the Work is in arcotdanr e with lire Coirlracl Dor unrenls, arrri <br />the Contractor is eirtillcd to payment of llie AMOUNI ITKIIIIFD. <br />AMOUNT CERTiEIED •. t...................................T.................$ <br />(Attach explaitation i( amount certified differs from the amount appUed for.. <br />AKClUTECf; <br />By:Dale: <br />Ibis Certificate is not iiegoliatric. The AMOUNT CCRFIFIFD is payable orriy to ihe <br />( ontrar tor named herein. Issuance, payment and acceptance of payment are wiihoul <br />prepidire lo .iny rights of the Owner or Contractor under this r'>ttlfat1. <br />AIA OOCUMtNT tiroi • At’PlICAIKK' AND tllUlHCAU fOR nSYMtNl • NtAV I'ilU IDJIUJN ♦ AIA* • c, l-MM <br />Itll AMlRtCAN INStlTUU or ARCIMliCtS. t?iS NLW YORK AVlK'll, tsi W., WASIIINC.ION. O.C. <br />WanillflQ; Uiilirenipa photr'‘”eirlnq vl''!»l»» U.S. copyilqW iawq And l« •uhjvcl lo leqiii r»n.*riiilon. <br />C702 t9tl