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APPLICATION AND CERTIFICATE FOR PAYMENT ma document C702 dnstrucuom on reveis«sido iwtoKto» 2 <br />-------- ~~ APPLICATION NO: 3 - . <br />PCRIOO TO: 3/1/93 <br />VIA (ARCHITECT): <br />r»ct% <br />TO (OWNER): Krau8-Anderson Construction <br />525 South Eighth Street <br />Minneapolis I MN 55404 <br />PROIECT: City Hall & Public Works <br />Garage <br />Orono, MN <br />ARCHITECTS <br />PROIECT NO: <br />Distribution to: <br />□ OWNER <br />□ architect <br />□ CONTRACTOR <br />□□ <br />CONTRACT DATE. August 31, 1992 <br />CHANCE ORDER SUMKtARY <br />Change Orders approved in <br />prc\*iMt months by Owner <br />TOTAL <br />ADDITIONS DEDUCTIONS <br />tin 1 i;in? <br />:r reny . TOTALS <br />Net change by Change Orders <br />undersigned Contractor certifiet that to the best o( the Contractor's knowWge, <br />Inlonmiion and belief the \Mork co\«red by this Application (or Pa>inent has been <br />comoltied In accordarKe wHih the Contract Documents, that all amounts Iwe been <br />nald^ the Contractor for Work for which previous Certificates for Payment were <br />iuu^ and payments receh'ed from the Owner, and that current pa)ment shown <br />herein H now due <br />CONTRACTOR Ackley-OMi^ach» Inc . <br />2-10-93 <br />1. ORIGINAL CONTRACT SUM....................................S------^ <br />2. Net change by Change Orders .................................S <br />3. CONTRACT SUM TO DATE (Line 1 i 2).....................S <br />4. TOTAL COMPLETED & STORED TO DATE..................S <br />(Column G on C703) <br />5. RETAINACE: ^ <br />a. 10 % of Completed Work S------ <br />(Column D -t* E on C703) <br />b____% of Stored Material S ■ ' ■ <br />(Column F on C703) <br />Total Retainage (line 5a + 5b or <br />Total :n Column I of C703)....................... <br />6. TOTAL EARNED LESS RETAINACE.............................5 <br />(Line 4 less Line S Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate) <br />8. CURRENT PAYMENT DUE.........................................5 <br />9. BAUNCE TO FINISH, PLUS RETAINACE...................5 <br />____(Line 3 less Line 6)_______________ —------- <br />State of: Wisconsin County of: Milwaukee <br />Subscribed and sworn to before me this 10th / February 93 <br />Notary Public: ^ <br />My Commission expires: lit pr <br />jQS&AS <br />peraanegt^ <br />ARCHITECT'S CERTIH€aTE FOR PAYMENT <br />: <br />eies* rreTirirvrr ro* * *'* * *^,,'^** <br />AMOUNT CERTIFIED....................................................»-------------. <br />(Attach eupUnation if amount ctnifitd dUitts ftomjht amount appMd fOfJ <br />ARCHITECT: <br />This Certilicate s not negotiable. The AMOUNT CERTIFIED Is P*)****® <br />Contraclor nair,ed herein. Issuance, payment and acceptance of paym^are wiinow <br />pre|odrr«* to any rights of the Owner or Contractor under this Contract. <br />Date: