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>F V?.CiSUNACE APPLICATION AND CERTIFICATE FOR PAYMENT oocwiwr C702 (insimrtom on .ov,-.... s,d,.i m.,ioN.o.—' -----------------— - ............. LI. 11 c D..ui;^ APPIICATK.^N NO: Tw >PROIECT: City Hall cS Public Works Garage - Orono, MNTO (OWNER): City of Orono1335 Brown Road South Crystal Bay, MN 55323FROM (CONTRACTOR): Gephart Electric Co., Inc .VIA (ARCHITECT); Boatman, Kroos, Pfister3600 LaBore Road & AssociatesSt. Paul, MN 55110 222 North Second StreetFlprtrical Minneapolis, MN 55^01CONTRACT FOR: Electrical Distribution to:□ OWNERPERIOD TO; 07/01/92 10 DARCHITECT07/31/92 □ CONTRACTORARCHITECTS □PROIECT NO; □CONTRACT DATE:CONTRACTOR'S APPLICATION FOR PAYMENTCHANCE ORDER SUMMARY _-----------------------------Change Orders approved in previous months by OwnerTOTAL additions dfductionsApptov^d IHVs IhonthNumber 1 Date Approved <br />PAC* • *^ « «»*»# ) ' totals <br />Net change by Change Orders ---------------------------------> <br />information and belief the Work covered by this Application for Paymeni has been <br />completed in accordance with the Contract Documents, (hat all amounts have been <br />paid^by the Contractor lor Work for which previous Certificates (or 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 />Date:07/17/92 <br />Application is made for Payment, as shown below, in connection w.th the Contract.Continuation Sheet, AIA Document C703, is attached., 279,400.001. ORIGINAL CONTRACT SUM.......................................5------------------------------2. Net change by Change Orders...................................S----- A 60“^c. CONTRACT SUM TO DATE (Line 1 ir2)........................S —- * ---------4 TOTAL COMPLETED «. STORED TO DATE S--------------------------------(Column G on G703)5. RETAINACE:a. IQ- % of Completed Work $ ---------(Column D + E on G70J)b. _% of Stored Material S---------------------------- <br />(Column F on C703) <br />Total Retainage (Line 5a + 5b or <br />Total in Column I of G703)....................................^ <br />6. TOTAL EARNED LESS RETAINAGE.................................5 <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate)..............S <br />8. CURRENT PAYMENT DUE.............................................\ <br />9. BALANCE TO FINISH, PLUS RETAINAGc......................5 ’ '— <br />_____(Line 3 less Line b) <br />Stale of; Minneso^ <br />Subscribed and swoi <br />Notary Public: <br />My Commission exp <br />4,981.70 <br />44.835.30 <br />22.311.00 <br />22.529.30 <br />TTiT <br />J <br />WXSHINQTOW CPUN% <br />9r12-^ <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on <br />data comorisine 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 ns <br />mdicated. the quality of the Work is in Documents, and <br />the Contractor is entitled to payment of the AMOUNT URTiriED. <br />AMOUNT CERTIFIED..........................................................'------------11 <br />(Attach explanation if amount certified differs from the amount apf^ed for.) <br />ARCHITECT; <br />'I'his Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein. Issuance, pavment and acc; .Manceof payrnent are without <br />prejudice to anv rights of the Owner or Cumraclor under this Contract. <br />Date; <br />r.707.1W1