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APPLICATION AND CERTIFICATE FOR PAYMENT AIA document G702 (instructions on reverse side) R^CEONCOP PACESTO (OWNER): City of Orono1335 Brown Road South <br />Crystal Bay, MN 55323 <br />PROIECT: Orono City Hall/Police and Public Works Buildings APPLICATION NO: Three <br />PERIOD TO: 3-31-92 <br />FROM (CONTRACTOR): <br />St“cnberg-Watrud Construction, Inc. <br />10235 Inver (Jrove Trail <br />VIA [ARCHITECTl: Boarman n;roos Pfister & Assoc. <br />CONTRACT <br />I^ver drove Hts., MN 55076 <br />222 North 2nd St. <br />Minneapolis, MN 55401 <br />ARCHITECT'S <br />PROJECT NO: 1124.04 <br />DbtnbufiorT fo:□ OWNER <br />□ ARCHITECT <br />□ CONTRACTOR□□ <br />CONTRACT DATE: <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document G703, is attached. <br />CHANGE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />ADDITIONS DEDUCTIONS <br />TOTAL <br />Approved Ihjs Month t > <br />Number Date Approved <br />/•i!*• <br />» # .• ‘ TOTALS <br />Net change by Change Orders <br />1. ORIGINAL CONTRACT SUM.........................................$ 342,500.00 <br />2. Net change by Change Orders .....................................$ ( 13,870.75) <br />3. CONTRACT SUM TO DATE (Line 1 i2)........................$ .328,629.25 <br />4. TOTAL COMPLETED & STORED TO DATE....................$ 149,000.00 <br />(Column G on C703) <br />5. RETAINAGE: <br />a. JiL % of Completed Work $ 14,682 .00______ <br />(Column D + E on G703) <br />b. IQ.. % of Stored Material $ 218.00______ <br />(Column F on G703) <br />Total Rctainage (Line 5a + 5b or <br />Total in Column I of C703).....................................$ ,900.00 <br />The undersigned Contractor certifies that to the best of the Contractor ’s knowledge, <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 for Payment were <br />issued and payments received from the Owner, and that current payment shown <br />herein is now due. ^ <br />CONTRACTOg: . .S;iT^^nBRG;^/yJi <br />f). TOTAL EARNED LESS RETAINAGE..................................$ 134,100.00 <br />(Line 4 less Line 5 Total) <br />» 7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate)...............S 110,799.00 *s <br />8. CURRENT PAYMENT DUE..............................................$ 23^^301-00 <br />9 BALANCE TO FINISH, PLUS RETAINAGE......................$ 19^.529.25 <br />(Line 3 Line 6) ^ ^ <br />By: <br />TRACTS:[TONSTRUCTION, INC. <br />8-27-92Dale: <br />State of; / ^ <br />lefpr <br />Notary Public: / ^ ‘ <br />My Commissidrrexpires; <br />m J. WATRUD ; <br />MINNESftTA ; <br />UNTT^ ; <br />___ HyCoiMrlMlonEjiplrMF«b.lQ.t904 : <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Conlratl Documenls, based on on site observations and the <br />data comprlsin^ 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 m accordance with the Contract Documents, and <br />the Contractor is entitled to pa/rnent of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFicD...........................................................S <br />(Attach explanatiof} tf amount certified differs from the amount applied for.) <br />ARCHITECT: <br />By:Date: <br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein. Issuance, payment and acceptance of payment are wiihour <br />prejudice to any rights of the Owner or Contractor under this Contract. <br />AIA OOCUMINI C,7«J • AmiCAriON AND ( IRIlfK AU fOR PMMINT • .MAY IlHl IDITIO.N • M\' • « m\ <br />iHf CMI«M ISSlimU fM \K(Ml|MIS inSNIWSOKIi NVINI'I NW VV\SM|.\(.ll VN T