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' L'>APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMI NT C,7U2 Ilnsimcnons on reverse side) PACl ONI o ‘ 3 I*ACISro (OWNER):PROJECT:APPLICATION NO: 4 OisiribuliuM lo:City of Orono Orono City Uall/Polico and □ OWNER1335 Brown Road South Crystal Day, MN 55323 Public Works Buildiiigs PERIOD TO: 8-31-92 □ ARCHITECT□ CONTRACTOR <br />FROM (CONTRACTOR);VIA (ARCHITECT):ARCHITECT'S □ <br />Allied Mechanical Systems <br />340 Michigan St., Hutchinson, MN 55350 <br />Boarman Kroos Pfister and Assoc. <br />222 North Second Street <br />PROJECT NO; 112 4.04 □ <br />CONTRACT FOR: Mechanical Work Minneapolis, MN 55401 CONTRACT DATE; <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />vc;. <br />tc-. •* <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />previous monihs by Owner <br />TOTAL <br />Approved ll>iy Month <br />Number <br />1 V fI <br />. • «• • <br />Dale Approved <br />• « <br />j <br />ADDITIONS <br />7-29-92 <br />. ( ' .*;%t 1 TOTALS <br />DEDUCriONS <br />8,086.71 <br />3^QSSull <br />Net change by Change Orders (8,086.71) <br />nuA .71) <br />913.29 <br />91.910.00 <br />The undersigned Coniraclur ciirlilics that to Ihe best ol l)te (loniraclor's knowledjje, <br />inlorination and belief the Work covered by this Apfilicalion for Payment has been <br />(iiiii|ilei< I in at tordant e witli 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 />Mechanical Systems of Hutchinson, Inc* <br />Application is made for l\iymenl, as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document C703, is attached. <br />1 ORIGINAL CONTRACT SUM...................................... . $ 390,000.00 ______ <br />2. Net change by Change Orders ........................ ..........S . <br />J. CONI RACT SUM TO DATE (l ine 1 i 2).. ...................S - <br />4 TOTAL COMPLETED & STORED TO DATE.....................$ . <br />(Column C on C#70i) <br />5. RETAINAGE: <br />a. 10 % of Completed Work $ 5,576*00______ <br />(Column D f fc on C70T) <br />b. 19-_ % of Stored /.Aatenal $ 3iQ15 *QQ______ <br />(Columr. F on ('i7()T) <br />Total Retainage (Line 5a » jb or <br />Total in Column I ol C'i70D.....................................$ . <br />G. TOTAL EARNED LESS RETAINAGE..................................$ . <br />(I me A less I me 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Ime G Irom prior Cerlilicate)...............$ . <br />0 CURRENT PAYMENT DUE...............................................$,_______________ <br />‘J UAtANCE TO FINISH, PLUS RETAINAGE......................S 299,194.29 <br />(Line 3 less I me 6) <br />9.191.00 <br />82.719.00 <br />49,638.00 <br />33,081.00 <br />u4.Date: <br />Slate of. Mlnnesojta <br />Subscribed and fworn/o heltar <br />Notary Public <br />My Commissiof^ mkOf/v2>pifcs:/ <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on site observations and llie <br />data comprising the above application, the Architect certifies to the Owner that to the <br />lies! ol the Architect's knowl*?dgc, information and hcliel the Work has ()rogressod as <br />indiiated. the (juality of the Work is m accordance with the Contract Documents, and <br />the Contractor is entitled to payment o( the AMOUNT CfRllFlFD. <br />Counlyof: McLeod <br />’^t&-97 <br />OeCKYOS' <br />fA!iv»>uni.ic.n <br />LVl Fnn rpi <br />AMOUNT CERTIMED . V......................-------------------------------------------------------------- <br />(Aiiilch CMf)lanii(/on if ,imoun( ctrfified differs from the <br />ARCFiiHCT: Boarman Kroos Pfister and Associates <br />By:________________________________________ Date: _____________________ <br />This Cerlilicate is not negotiable The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein. Issuance, payment and acceptance of payment arc without <br />pre|u(lite to any rights ol Ihe Owner or Contractor under this Contract. <br />AIA OOCUMINI c;02 • AmiCATlON ANO aKilhl AU K)« IVnYMIi 'O • MAY Pia) IDlllON • AIA* • ^ l‘>ai <br />till AMtmCAN INSnruU OF AFCHITICIS. TDS NIW YOKK AVINUI, NW. WASMINCION DC ilMKW,C702 I983 <br />WAMNINCi: Unlicensed photocopying violates U S copyrlghi Uw% and Is sub}ect lo Segal prosecution.