04-26-1993 Council Minutes HRA2 - Laserfiche WebLink

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A pplication and certificate for payment a,a document c702 ii„s,.uc o„ „vo„. s,dei .0.0.,«APPLICATION NO: JwOPERIOD 10:12/17/92FROM (CONTRACTOR): ^ ,Midwest Asphalt CorporationP.O. Box 5477 CONTRACT FORi^cEpi?^* nnciA . Minneapolis, Minnesota 55401 rowTOArT ^atc—--------------action Q251Q Bituininoiis Paving____________________________ contract date: May 11. 1992 TO (OWNER): City of Orono proiect: Orono Municipal Facility1335 Brown Road South Orono, MinnesotaCrystal Bay, Minnesota 55323 Kroos, Pfister » Assoc no222 N. 2nd St. PROJECT NO:Distribution to:□ OWNER□ ARCHITECT□ CONTRAaOR□□ CONTRACTOR'S APPLICATION FOR PAYMENT o CHANCE ORDER SUMMARY Change Orders approved in previous months by Owner TOTAL ADDITIONS 1 DEDUCTIONS Approved this Month Number Date Approved 1 2 11/12/92 12/09/92 14,398.00 6,C60.00 TOTALS 20.458.00 Net ciiai .» > ’ Change Orders + 20,458.00 Application Is made (or Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document C703, is attached. o inc unur. . lira uoniracior certifies Ihai lo the besi of Ihe Confraclor's knowledge, informat'o*. and belief the Work covered by this Application for Payment has been completea In accordance with the Contract Documents, that all amounts have beet» paid by the Contractor for Work for which previous Certificates for Payment were ssued and payments received from the Owner, and that current payment shown herein is now due. CONTRAaOR: MIDWEST ASPH.ALT‘CORPORATION By ^ 1. ORIGINAL CONTRACT SUM......................................$ 2. Net change by Change Orders...................................$ 3. CONTRACT SUM TO DATE (Line 1 ± 2)................!..! S 4. TOTAL COMPLETED & STORED TO DATE...................$ (Column C on C703) 5. RETAINAGE: a. —Ly. % of Completed Work $ 5,873.50 (Column D + E on C703) b. —IL % of Stored Maleri.-il t “ 0 - (Column F on C703) Total Retainage (Line 5a + 5h or Total in Column I of C703)...................................j 6. TOTAL EARNED LESS RETAINAGE...............................% (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate)..............$ 8. CURRENT PAYMENT DUE............................................j 9. BALANCE TO FINISH, PLUS RETAINAGE.....................S _____(Line 3 less Line 6) 41.100.00 20.458.00 61.558.00 58.735.00 5.873.50 52.861.50 47.407.50 t),454.00 8.696.50 Date: State of: /MrNN£scr/» County of; H Subscribed and sworn to before me this Notary Public: My Commission expires: /.^ ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the above application, the Architect rerlilies to the Owner that to the ^st of th* Architect's knowledge, informafion and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Doruments, and the Contractor is entitled lo payment of the AMOUNT CE ki IFIED. fiEORiX'^9 NOTARY PUBUC • MINNESOTA HENNEPIN COUNTY My powwiliilon npir— KV-1^9e ^ J2- AMOUNT CERTIFIED........................................................ ^_____________ (Attach explanation if amount certified differs from the amount applied for,) ARCHITECT: By:Date: ^DOCUMENT C701 • APPUCATION AND CERTIFiCATt FOR i’'AYMlNr • MAY 19«J lOITION • AIA* • Cf 196) Wi AMERICAN INSTITUTI OF ARCHITtOS. 17)5 NEW YORR AVfNUf. N W.. WASMINCION. O.C 20006 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only lo Ihe Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of Ihe Owner or Contractor under this Contract. G702-19I3 4 |. r. I I • « • <