Laserfiche WebLink
{APPLICATION AND CERTIFICATE FOR PAYMENT madocum£ntc?02 (lusltuclions on reverse side) pace one of pacesTO (OWNER): City of Orono1335 Brown Road South Crystal Bay, MN 55323 PROirCT: City Hall & Public Works Garage - Orono, MN AITLICAIION NO: 0PERIOD TO:01-31-93FROM (CONTRACTOR): Gephart Electric Co., Inc VIA (ARCHITECT): Boarman, Kroos, Pfister3600 LaBore Road ^ AssociatesSt. Paul, MN 55110 222 North Second Street <br />CONTRACT FOR: Electrical Minneapolis, MN 55601 <br />ARCHliECT'S PROJECT NO:Disiribulion lo:□ OWNER□ ARCHITECT□ CONTRACTOR□□ <br />CONTRACT DATE: <br />c <br />( <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made (or Payment, as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document C703, is attached. <br />CH.XNCE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />lOFAL <br />hiumber" <br />JAN <br />Date Approved <br />ADDITIONS <br />0.00 <br />}0(-7 <br />. M,- « T •• ‘•y' •' V, <br />I /• ; •(TOTALS <br />DEDUCTIONS <br /><9,267.00> <br />1. ORIGINAL CONTRACT SUM.........................................S 279,400.00 <br />2. Net change by Change Orders.....................................$ <^.9,767.00^ <br />3. CONTRACT SUM TO DATE (Line 1 ±2).....................S _?7n^ 1 3T , nn <br />4. TOTAL COMPinED & STORED TO DATE..................$ _ 270^ ITT nn <br />(Column G on C703) <br /><v9 2fi7 -()()> <br />Ncl change by Change Orders <.9.267 ■ nn > <br />5. RETAINAGE: <br />a. XQ- % of Completed Work $ 27^013.30 <br />(Column D + E on C703) <br />b. --% of Stored Material S ■ <br />(Column F on C703) <br />Total Rptainage (Line 5a + 5b or <br />Total in Column I of G703)27,013.30 <br />The undersigned Contractor certifies that to lire best of the Contractor's knowledge, <br />information and belief the Work covered by titis Application for Payment has been <br />completed In accordance with the Contract Documents, that all amounts have been <br />paid by the ontractor for Work (or which previous Certificates for Payment were <br />issued and ; ayments received from the Owner, and that current payment shown <br />herein is now due. <br />6. TOTAL EARNED LESS RETAINAGE..................................$ 243, 119 70 <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate)...............$ ??n , 222.70 <br />8. CURRENT PAYMENT DUE..............................................$ 12, RQ? QQ <br />9. BAUNCE TO FINISH, PLUS RETAINAGE......................$ 27 ft 1 3 in <br />______(Line 3 less Line 6) <br />CONTRACTOR: Gephart Electric Co., Inc. <br />By: _Dale:1-20-93 My Commission expires: <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with tire Contract Oucuinents, based on un-sile observations and the <br />data comprising the above application, the Architect tcriifics lo the Owner that lo the <br />best o( the Architect's knowledge, inlormalion and belief the Work has progressed as <br />itHlicated, the quality of the Work is in accordance with the Contrart Drrcumcnis, and <br />the Contractor is entitled to payment of llie AMOUN1 CERTIIUIT. <br />fAMOUNT CERTIFIED <br />(Attach explanation if amount <br />ARCHIIECT: <br />Slate oi: Minnesota /County of: Ramsey <br />Subscribed and sworn to before mMnis 20th dwof j <br />Notary Public: y /_ J / J / <br />I notary puc; <br />U^^mount Mpp/i <br />By:. [)M <br />Ihis CcrtHkate Is not negotiable. Ihe AMOUNT CLRIIFIED is payable only to the <br />Contractor named herein. Issuance, payment and acceptance o( payment are without <br />prejudice lo any rights of the Owner or Contractor under this Contract. <br />AU OOCUMlNf U7§2 * AiTlK AllON At4{) i IRIilK All K)K I'ASMINI • KXAi 1*40) IDUION • AIA* • Mj 190i <br />tMI AMtJtICAN INS111UU Of ARCMMICTS. 1T)S NtW YORK AVINUf. N W., WASMINf.fON. O C. *nnnf.C7n*i9i3