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I IAPPLICATI^)N CERTIFICATE FOR PAYA^ENT AIA I^(^(JUM[NT C]702 (InslnKtionsonrcvrr’ipsidt’) f’ACf ONI Of ^ I'AC.lslo (OWNER); CITY OF ORONO PROlfCI: CITY HALL & PUBLIC WORKS GARAGE APPLICATION NO;-TAfo <br />PtKIOD TO:^ -"7/3\ <br />FROM (C0NT»;ACT0R): TED MANNSTEDT & SONS,INC VIA (ARCHITECT):ARCHITECT'S <br />PROltCT NO: <br />Oisiribution to: * <br />□ OWNER <br />□ ARCHITECT <br />□ CONTRACTOR□□ <br />CONTRACT TOR: STRUCTURAL STEEL, STEEL JOISTS, METAL DECK & MISC. METALS CONTRACT DATE: ^ ^ ^ ^ 2 <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made' (or Payment, as shown below, in conneclion with the Contfail <br />Continuation Sheet, AIA Document G703, is attached. <br />CHANGt ORDIR SUMMARY <br />Change Orders approved in <br />previous monihs by Owner <br />TOTAL <br />ADDIIIONS DIDUCIIONS <br />^’►»fPd, this^Munlh <br />Number Date‘Approved <br />JUI. <br />• •••it <br />Uy: <br />L .‘fHJr.* . V , •. TOTALS <br />Ncl change by ClAiigc/Ofders <br />1. ORIGINAL CONTRACT SUM............................................. ^50,760.0Q <br />2. Ncl change by Change Orders.........................................S <br />3. CONTRACT SUM TO DATE (Line 1 ±2)...........................<50.760.00 <br />4. TOTAL COMPLETED & STORED TO DATE.......................S 7.1 56.00 <br />(Column G ort C70I) <br />5. RETAINAGE: <br />a. --% of Completed Work $___________________ <br />(Column U + E on G703) <br />b. _% of Stored Material $ <br />(Column F on G70J) <br />Total Retainage (Line 5a ^ 5b or <br />lotal in Column I of G703).........................................S 716.00 <br />Ihe undersigned Conti.u tor certifies that to the best of the Contrac tor's knowledge, <br />inloimation and belief the Work coveted by ibis Application lor Payment has br*en <br />(ompic'led in accordance with the Contract Documents, that all amounts havi* b«*en <br />p.iid by Ihe Contractor (or Work (or whic h previous CoilKIcales (or Payment svere <br />issued arcci paymtuils received from the C)wncr, and that current payment shown <br />herein is now due. <br />6. TOTAL EARNED LESS RETAINAGE.....................................$ 6.440.00 <br />(Line 4 less line Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 frc?m ftrior Cerlilicale)................% 2,500 .00 <br />fl. CURRENT PAYMENT DUE...................................................$ 3.940.00 <br />9. BALANCE TO FINISH, PLUS RETAINAGE.........................<44,320,00 <br />(Line 3 less line 6) <br />( ONIRACIOK: <br />DaleiTZfetLte^^- <br />Sfsife of: Minnesota County of: HcMinepln <br />Sut)scril)ed and sworn lo before me tins 27 July <br />Notary Public: <br />My ('ommission expires: <br />;19 92 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In M i onlam e v* mIi iIh» ( onirac t Doi uments. bast'd tin tin sik* tilist'i valions anti ihe <br />dal.i t onipriMni; the alrtive applir atinn. the Arc liilt't 11 erfifies lo Ihe Owner dial lo llie <br />besi of ihe Art hilec W knowledge, informalitin and heliel Ihe Wtirk has progressetl as <br />iiidii aled, Ihe tjualily of Ihe Work is m m (ordaru e wilh die C'onirat 11 )tu umenis. and <br />die Cuntraiiur is enlided lo payment of Ihe AMOUNT CIKTIHU). <br />AMOUNT CrRTIflFD................................................................. 1 3,940>00 <br />(At(jih ex/)/.m,i//ofi if nmntint cvrttfird differs from the amount ctppUvd for.) <br />AKCIIIIICI: <br />By:i:)ate: <br />This C.erlifjcale is not nt'goliabie. The AMOUNT CfKTIFIFD is payable only to du <br />Conirat lor named herein. Issuance, payment and acceptance of payment are widiou <br />prejiidit e lo any riylils of die Owner or Contraclor under Ihis Contract. <br />AIA IKKilMINI C.7f2 • An*l K AMON ANO i |Kllf K All f()R rAYMIN! • MW Ilfil flMTlON • AIA' • C llfW <br />nil AMfRM AN INSfllUn OP ARnillK IS. ins NIVV YOHA AVINUI N W WASMINt.ION Of /nnnt,