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FROM (CONTRACTOR): Amcrcct, Inc. <br />CONTRACT FOR: Bid Packaqo No. 9 <br />VIA (ARCHITECT):PERIOD TO:q/3j^/92ARCHITECT'S PROJECT NO: <br />CONTRACT DATE: 7/20/92 <br />Distribution to:□ OWNER□ ARCHITECT□ CONTRACTOR□□ <br />CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document C703, is attached. <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />total <br />ADDITIONS DEDUCTIONS <br />Approved Ihiv Month <br />Number -. 1 Qate; Approved <br />Alli'i <br />—T . ”............................. <br />!: )'l‘.)2 <br />.. TOT\lS <br />Net change by Change^jD.ders ! <br />fiiv ii'rimu) iiiai lu lilt* ut*M iJi lilt* i^oniruclOf S Kni)WU‘(iJ»t?, <br />information and belie) the Work covered by this Application for Paymr nt 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 t'ertilicates for Payment were <br />issued and payments received from the Owner, and that current payment shown <br />herein is ttow due. <br />CONTRACTOR: Anierect, Inc. <br />— ■.•Date:8/26/92 <br />ARCHITFCT'S CERTIFICATE FOR PAYMENT <br />In accordance ’rith tfie Conir.ici Documents, based on on-site observations and the <br />data comprising; the above application, the Arc hiiect c eitifies to the Owner that to the <br />best of the Architect's knowlecige, information and belie) the Work has progressed as <br />indicated, the quality of the Woik is in accordance with the C ontracl DcM uments, and <br />the Contractor is entitled to payment of the AMOUNI CERTIFIED. <br />A** CTW • AWIC Allow AND C IKIIIK All fOU PA>MlNr*MAV ITBl tDITION • MA* • t 1%) <br />IMI AMftKAN iNsrmn* oi am mimcis. ns wtw >ork avinu. sw. washinc.io.w. oc .•uii* <br />1. ORIGINAL CONTRACT SUM..........................................$ <br />2. Net change by Change Orders......................................$ <br />3. CONTRACT SUM TO DATE (Line 1 i 2).........................$ <br />4. TOTAL COMPLETED & STORED TO DATE.....................$ <br />(Column Ci on C'i7(M) <br />5. RETAINAGE: <br />a. -IB. % of Completed Work <br />(Column () + E on C70)) <br />b. --‘!'u of Stored \taterial <br />15,145.00 <br />-0- <br />15,145.00 <br />12,045.00 <br />$1,204.50 <br />$ <br />(Column F on G7())l <br />Total Kelainage (I ine Sa i 5b or <br />Total in Column I of C7()l)......................................$ <br />h TOTAL EARNED LESS RETAINAGE..................................$ <br />(line 4 less line 5 Total) <br />7. I ESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate)...............$ <br />8. CURRENT PAYMENT DUE...............................................S <br />9. BAUNCE TO FINISH, PLUS RETAINAGE.......................$ <br />______(line 3 less line 6) <br />1,204.50 <br />10,840.50 <br />-0- <br />10,840.50 <br />4,304,50 <br />State of: Minnesota <br />Subscribed and sworn to bac^.m^his . August .19 <br />Notary Public: T <br />My Commission expires: <br />AMOUNT CfinirifD.........i.t............................................ .......................—m. A f <br />(Attach explanation if amount certified differs from the amount applied for.) <br />ARCHITECT; <br />By:Dale: <br />This Certificate i- not negotiable. The AMOUNT CERTIfltD is payable only to the <br />Contractor nam ,d herein. Issuance, payment and acceptanceof payment are without <br />preiud.r** to ^ny rights of the Owner or Contractor under this Contract. <br />€’.'•2.1913