Laserfiche WebLink
Application and Certlficato for Payment <br />(substitute for AIA Document G702> <br />Project Name: CITY HALL/rUflLlt. V0RK5 FAC <br />Application Ho.: <br />Application Date: <br />Period To: <br />La Force Job No.: <br />0/ <br />2/23/93 <br />2/25/93 <br />14151 <br />TO: KRAUS ANDERSON BLDG DIV. <br />525 SOUTH EIGHTH STREET <br />MINNEAPOLIS, MN 55404 <br />FROM: LA FORCE HARDWARB & HI'G. CO. <br />P.C. BOX 10068 <br />GREEN BAY, WI 54307-0068 <br />35.465.00 <br />8,800.00 <br />44.345.00 <br />44,34 5.00 <br />TRADE P" iNT BREAKDOWN IS ATTACHED. <br />1. Original Contract Sum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ <br />2. Net Change by Charge Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . $ <br />3. Contract Sum to Date (line 1 + 2) . . . . . . . . . . . . . . . . . . . . . . . $ <br />4. Total Completed & Stored to Date (column G) . . . . . . . . . . . . . . . . $ <br />5. Retainage: <br />a. lO.OOZ of completed work (column D + E) . . . . . $ 47ir34-r5C hm\? <br />b. lO.OOZ of Material Stored (column F) . . . . . . . $ .00 <br />Total Retainage (line 5a + 5b; or total column I) . . . . . . . . . . . . $ <br />6. Total Earned Less Retainage (line 4-5 totals) . . . . . . . . . . . . . . $ <br />7. Less Previous Certificates for Payment . . . . . . . . . . . . . . . . . . . $ <br />(line 6 from prior certificates) <br />8. Current Payment Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ <br />9. Balance to Finish, Plus Retainage . . . . . . . . . . . . . . . . . . . . . . . $ <br />(line 3 less line 6) <br />The undersigned Contractor certifies that to the best of the Contractor’s knowledge, <br />information and belief the Work covered by this Application for payment has beer, <br />completed in accordance with the Concract Docum^ts, that all amounts have been paid by <br />the Contractor for Work for which previous CertjKicates for Payment were issued atid <br />payments received from the Owner, and that curj^nJi paymejit shown herein is now due. <br />41 42 4 ■ 58 <br />3-9,910.-50 <br />33.196.00.^ <br />l^7Un,^0 \5\u-50 <br />CONTRACTOR! LA FORCE HARDWARE & MFG. CO.Date: 2/23/93 <br />State of: Wisconsin County of: Brown _ . <br />Subscribed and syO^n to befp^e nie Jjuj _ _dI ^. '■ £T <br />Notary Public dJX C Ex rj <br />day of /.V it/i <br />My Commission expireSi <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, Based on on-site observations and the dat.i <br />comprising t.»e above application, the Architect certifies to the Owner that to the best <br />of the Architect’s knowledge, information *nd belief the Work has progressed as <br />Indicated, the quality of the Work is in accordance with the Contract Documents, and the <br />Contractor is entitled to payment of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$_ _ _ _ _ _ _ _ <br />ARCHITECT:By:Date: <br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein. Issuance, payment and acceptance of payment are without <br />prejudice to any rights of the OT-mer or Contractor under this Contract.