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.1^• s <br />•> <br />(Instructions on Toversc side) ^*ACt ON! 0! RAC!STO (OWNER); CITY OF ORONOP.O. BOX 66 CRYSTAL BAY, MN 55323FROM (CONTRACTOR): ZAHL EQUIPMENT COMPANY VIA (ARCHITECT): BO ARMAN & ASSC,3101 SPRING ST. N.E. 222 NORTH 2ND ST.MPLS., MN 55413 MPLL., MN 55401CONTRACT FOR: VEHICLE SERVICE EQUIP.APPLICATION .NO: 2 PERIOD TO.Distribution to*.K3 OWNER * E ARCHITECT □ CONTRACTOR ARCHITECT'S BID PACKAGE O PROIECT NO: .''3 □CONTRACT DATE: 6/15/92____________CONTRACTOR'S APPLICATION FOR PAYMENTCHANCE ORDER SUMMARYChange Orders approved In previous months by OwnerTOTAL ADDITIONS DEDUCTIONS <br />Approved this Month <br />• <br />Number Dale Approved <br />TOTALS <br />Net change by Change Orders <br />Application Is made (or Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document C703, is attached.1. ORIGINAL CONTRACT SUM.......................................S 3I,712 _.00-----------------2. Net change by Change Orders ...................................S 7., nn----------------3. CONTRACT SUM TO DATE (Line 1 ±2).......................S ---------------4. TOTAL COMPLETED & STORED TO DATE...................^ 23|3P7t 17-----------------(Column G on C703) <br />5. RETAINACE: <br />a. % of Completed Work $---------------------— - <br />(Column 0 + E on C703) <br />b. _% of Stored Material $ ---------------------------- <br />(Column F on C703) <br />Total Retainage (Line 5a + 5b or <br />Total In Column I of G703).................................^ <br />The undersigned Contractor certifies that to the best 01 me t-omraciors imuwicuH^*. <br />information and belief the Work covered by this Application for Payment has been <br />completed In accordance with the Contract Docunterts. that all amounts have been <br />paid by the 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; <br />f,. TOTAL EARNED LESS RETAINAGE................................S 23,367.17 -------------- <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PA’ .lENT (Line 6 from prior Certificate).............. <br />8. CURRE. PAYMENT DUE..........................................^ <br />9. BALANCE TO FINISH, PLUS RETAINACE....................B»3^4t03 <br />_____(Line 3 less Line 6) \ ■/ <br />Stale of:County pc <br />Date: <br />Subscribed and sworn to before me this <br />Notary Public: <br />My Commission expires: <br />RAMSEY courmrMV coMuaMOM ana <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />AMOUNT CERTIFIED <br />_ _ JUon fi amount cerw <br />In accordance with the Contract Documents, based on on-site observations and the ARCHITECT: <br />data comprising the above applicallon, the Architect ceililies lo the Owner that to the )^(Jir <br />best of lheArchit*c*'i knowledge, Iniormation and belief the Work has progressed as By:----------------------~ ~ t i^cnTicirr% • ’ uf tha <br />........ <br />(Attach explanatjpn if amountjcj^^fied^iffen amount applied *or.) <br />W4v^Date: <br />prejudice to any rights of the Owner or Contractor under this Contract. <br />AU pnniAtfNT C7'<’ • ApnirxTioM AND riKmicAif roa paymini • mv tsfli Fomorr • aia* • e mt C702-1983