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APPLICATION AND CERTIFICATE FOR PAYMENT aia document G702 (instructions on reverse sido PAct qni of2 pActsTO (OWNER): KRAUS ANDERSON CONSTRUCTION CO.PRO)FCT:0R0N0 MUNICIPA ‘CILITY APPLICATION NO: 2 Distribution to:525 South 8th St.ORONO, MN Q OWNERMPLS, MN 55AOA PERIOD TO:Complete □ ARCHITECTAttn: John Davies □ CONTRACTORFROM (CONTRACTOR): GOEBEL FIXTURE CO.VIA (ARCHITECT):ARCHITECT'S □528 Dale Street PROIECT NO:□Hutchinson, MN 55350 <br />CONTRACT FOR: 818 Architectural Woodwork CONTRACT DATE: 5-U-92 <br />CONTRACTOR'S APPLICATtON FOR PAYMENT <br />CHANCE ORDER SUMMARY---------——-----------------------------r <br />Change Orders approved in <br />previous months by Owqer <br />______________ TOTAL <br />ADDITIONS DEDUCTIONS <br />^ppioweJ. t iTie -liRn i h <br />Number Date Approved <br />1 ‘.i <br />lkraLt.s-A.1.- <br />1 A • • <br />1993 <br />.. t ‘eCVl! <br />Pjmnaiwi <br />1 Net change by Change Orders <br />r\ppi 1 l> llldLJtr l\J I fii <br />Conlinualiun Sheet, AIA Docotrcnl C703, is attached. <br />1. ORIGINAL CONTRACT SUM......................................$ <br />2. Net change by Change Orders .. .1. .................S <br />3. CONTRACT SUM TO DATE (Line 1 i 2).......................S <br />4. TOTAL COMPLETED & STORED TO DATE...................S <br />(Column C on C703) <br />5. RETAINAGE: <br />a. IQ- % o( Completed Work $ A »0^91 OQ---------- <br />(Column D + E on C703) <br />b. _% of Stored Material S---------------------------- <br />A3.621.00 <br />(3.027.00) <br />AO.59A.O0 <br />40.59A.00 <br />The undersigned Comraclor certities that to the best ot tnc i.oniranor s KnowieoKc, <br />information and belief the Work covered by this Application for Payment has been <br />completed In accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor for Work for which previous Certificates lor Payment were <br />Issued and paymems received from the Owner, and that current payment shown <br />herein is now due. <br />(Column F on C703) <br />Total Retainage (Line 5a -t 5b or <br />Total in Column I of C703)...................................S <br />6. TOTAL EARNED LESS RETAINAGE...............................S <br />(Line 4 less Line 5 Total) <br />A.059.00 <br />36.S3S.no <br />7. LESS PREVIOUS CERTIFICATES r^R <br />PAYMENT (Line 6 (ron^flUrVedificate)..............S ■|199.00 , <br />CONTRACTOR;GpEBEL FIXTURE CO. <br />8. CURRENT PAYMEN <br />9. BALANCE TO, <br />(LL_ ................aucit ?■______________ <br />•i. 336.00 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordarsce with the Contract Documents, based on on site observations and the <br />data comprising the above application, the Architect certifies to the Owner that to the <br />best of the Architect's knowledge, information and belief the Work has progressed as <br />indicated, the quality of the Work is in accordance with the Contract Documents, and <br />the Contractor is entitled to payment of the AMOUNT CERTIIIED, <br />rv.i ' .. r" <br />Date: February 18, 1993 <br />No^TnibliiQ^f^ /T?, <br />My C^niissioitmpiies:De(.g„,i,ej> <br />County of:McLE0D <br />day of February ,1993ruhis X8th dj <br />AMOUNT CERTIFIED <br />(Attach expidnalion if amount certified diffen from the amount apnUed for.) <br />ARCHITECT: <br />By:Date: <br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the^ <br />Contractoi named herein. Issuance, payment and acceptance of payment are without <br />prejudice to any rights of the Owner or Contractor under this Contract.