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IICATION AND CERTIFICATE FOR PAYMENT To (OWNER): CityofOrono PROJECT: Lift Station 09 Renovation APPLICATION NO; 1FROM (CONTRACTOR): NewMech Companies, Inc 1633 Eustis Street SI. Paul. MN 55106 CONTRACT FOR: Mechanical Work PERIOD TO; 8-31-92VIA (ARCHITECT):Bonestroo, Rosene, Anderlik 4 Assc 2335 w Hwy 36 SI. Paul, Mn 55113 ARCHITECTS PROJECT NO:Ct ITRACTDATE;CONTRACTOR S APPLICATION FOR PAYMENT <br />Change Order Summary <br />Change Orders approved in <br />previous months by Owner <br />total <br />Approved this Month <br />CO # I Dale Approved <br />1 <br />ADDITIONS I DEDUCTIONS! <br />Application is made for Payment, as shown below, ir <br />with the Contract. Continuation sheet. AIA Documeitl <br />attached <br />•.nnecllon <br />’02Ais <br />I <br />I <br />I <br />I <br />$8.200 00 I <br />1. ORIGINAL CONTRACT SUM....................... <br />I 2. Net change by Change Orders..................... <br />-3. CONTRACT SUM TO DATE(Line 1+2)....... <br />I 4. TOTAL COMPLETED 4 STORED TO DATE. <br />I (Column G on G702a) <br />I 5. RETAINAGE. <br />$46,8^0.00 <br />$8,200.00 <br />$55,000.00 <br />$11.550.00 <br />I <br />I <br />I <br />I <br />TOTALS <br />Net change by Change Orders <br />$8,200 00 I <br />$8.200 00 <br />The undersigned Contractor certifies that to the best <br />of the Contractor's knowledge, information and belief <br />the Work covered uy this Application for Payment has <br />been compleled In accordance with the Contract <br />Documents, that all arrxxjnts have been paid by the <br />Contractor for Work for which previwjs Certificates <br />for Payment were Issued and payments received from <br />8ie Owner, tnd that current payment shown herein is <br />now due. <br />contractor . NewM^h Companies, Inc <br />Bv: ^ •------ <br />I 5% of Completed Work <br />I (Column D+E on G702a) <br />I of Stored Materials <br />I (Column F on G702a) <br />I Total Retainage(Line 5a+5b or <br />-• Total in Cloumn I on G702a)...................... <br />I 6. TOTAL EARNED LESS RETAINAGE........’ <br />- (Line 4 less Line 5 Total) <br />I 7. LESS PREVIOUS CERTIFICATES FOR <br />- PAYMENT(Line 6 from prior certificate)..... <br />8. CURRENT PAYMENT DUE...................... <br />P BALANCE TO FINISH.PLUS RETAINAGE. <br />(Line 3 less Line 6) <br />$577.50 <br />$577.50 <br />$10,972,50 <br />$10,972.50 <br />$44,027.50 <br />State of: Minnesota County of: Ramsey <br />Subscribed and sworn to before me this ^ 7'*’^ day of <br />Notary Public: ^ <br />My Commission expires: <br />Wayne Hen4umeirTrea< <br />Date 8-27-92 <br />XAA A. ■ <br />DIANE L. ROLLEFSON <br />NOTARY PU8L1C-MINNE$0TA <br />ramscy county <br />Mr Comm. Caplrtt Mor. 31, 1994 <br />■ VVVVVVVVVV'^Vvy v'W. . vwvV*/VY'eW'/WV ■ <br />ARCHITECrS CERTIFICATE FOR PAYMENT <br />In accordarwe with the Contract Documents, based on <br />on-site observations and the data comprising the above <br />application, the Architect certifies to the Owner that <br />to the best of the Architect's knowledge, information <br />and belief the Work has progressed as Indicated, the <br />quality of the Work is in accordance with the Contract <br />Documents, and the Contractor is entitled to payment <br />of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED........................ <br />(Attach explanation if amount certified differs from the <br />amount applied for) <br />ARCHITECT <br />By:Date; <br />This Certificate is not negotiable The AMOUNT CERTIFIED <br />is payable only to the Contractor named herein Issuance <br />payment and acceptance of payment are without prejudice <br />to any rights of the Owner or Contractor under this <br />Contract. <br />1