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I. <br />TO (OWNER): City of Orono1335 Brown Road South Crystal Bay, MN 55323 <br />FROM (CONTRACTOR): Inc .VIA (ARCHITECT): Boarman, Kroos. Pfister3600 LaBore Road , . . ^ <br />c*. D I cciin ^ Associates <br />PI ^ North Second Street <br />CONTRACT fO»: Electrical_ _ _ _ _ _ _ _ _ _ _ _ _ Minneapolis. MN 55401 <br />PERIOD TO: 02/28/93 <br />ARCHITECT’S <br />PROJECT NO: <br />CONTRACT DATE: <br />Distributiori to:□ OWNER□ ARCHITECT <br />□ CONTRACTOR□□ <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />ADDITIONS DEDUCTIONS <br />Approved this Month <br />Number Dale Approved <br />TOTALS <br />•Net change bv Change Orders <br />Application is made (or Payment, as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document G703, is attached. <br />1. ORIGINAL CONTRACT SUM......................................$ 279,400.00 <br />2. Net change by Change Orders...................................$ <br />3. CONTRACT SUM TO DATE (Line 1 i 2).......................$ <br />4. TOTAL COMPLETED & STORED TO DATE...................5 <br />(Column C on C703) <br />5. RETAINAGE: <br />(2.419.00) <br />276.981.00 <br />276.981.00 <br />a.)• of Completed Work S >^98.10 <br />(Column D + E on C703) <br />b. ■„ % of Stored Material S____0.00 <br />• Mc v.unudcior ceriifies inai lO ino Desi oi the Contractors knowledge, <br />information and belief ihe 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 Ihe Contractor for Work for which previous Certificates for Payment were <br />issued and payments received from the Owner, and that current payment shown <br />herein is now due. <br />CONTRACTOR Gephart Electric Co., Inc. <br />Jl LI^ <br />(Column F on C703) <br />Total Retainage (Line 5a + 5b or <br />Total in Column I of C703).....................................S >689. 10 <br />6. TOTAL EARNED LESS RETAINAGE................!..!!!!! S ^49,282.90 <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 frorr, prior Certificate)................S 243,124. 10 <br />8. CURRENT PAYMENT DUE.............................................< 6.158.80 <br />9. BALANCE TO FINISH, PLUS RETAINAGE.......................5 77.698.10 <br />(Line 3 less Line 6) <br />By:.D.ttc:03/15/93 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on-site observations and the <br />data comprising the above application, the Architect ccitifies to the Owner ihai to the <br />l>est of the Archiiecf's knowledge, information and belief the Work has proi’ressed as <br />indicated, the qoaliivot the Work is in accordance with the Contract Documenis. and <br />Ihe Contractor is entitled to pavmeni oi Ihe AMUUNI CERriFICD. <br />Slate of: Minnesota County of: Ramsey <br />Subscribed and sworn to betore me thisj>^vL5«i>4»%es,«Ki«>*'»|w'^cch-. ..19.•93 <br />No»n-P>iWic:^4,j, - VIKGIHIA A. PASHII'ui ' <br />My Commission eM)ires: roTAu pui.ic - <br />------ . - ■ * < ^_______gAM^^Y *‘^ri!lfY <br />AMOUNT CERTIFIED.............................. ft*?.. bW/i <br />(Attach explanation if amount certified difie^J^m the'amount applied for.) <br />ARCHITECT: <br />— Dale: