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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUX1ENT C702 (Instructions on reverse side) i*ac;e ONt or i*.v;csTO (OWNER): Citv of Orono1335 Brown Road South Crystal Bay, MN 55323 PROJECT. City Mall & Public Works Garage - Orono, MN APPLICATION NO:ThreePERIOD TO: 08/31/92 <br />FROM (CONTRACTOR): Gephart Electric Co., Inc .VIA (ARCHITECT): Boa rman, Kroos, Pfister <br />3600 LaBore Road & Associates <br />St. Paul, MN 55110 222 North Second Street <br />CONTRACT FOR: Electrical Minneapolis. MN 55401 <br />ARCHITECT'S <br />PROJECT NO: <br />Oistribulion lo:□ OWNER□ ARCHITECT <br />□ CONTRACTOR <br />□□ <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 C703, is attached. <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />ADDITIONS DEDUCTIONS <br />Approved this Month <br />Number Date Approved <br />TOTALS <br />; Net change bv Change Orrlers <br />1. ORIGINAL CONTRACT SUM............................................$ <br />2. Net change by Change Orders........................................S <br />3. CONTRACT SUM TO DATE (Line 1 r 2)...........................S <br />4. TOTAL COMPLETED & STORED TO DATE......................$ <br />(Column G on C703) <br />5. RETAINAGE: <br />a. ___% of Completed Work $ 7,226. ____ <br />279,400.00 <br />279,400.00 <br />72,267.00 <br />(Column D + E on C'Oi) <br />b.____“o of Stored Material 0.00 <br />llv und(‘rMgned Contr.ii tor « ertilies that lo the host oi the Contrat tor ’s knowleili>e. <br />iniormaiion and heliei the Work covered hv this Appliialion lor Pacmenl has heen <br />completed in accordaine with the Contract Documents, that all amounts have hec*n <br />paid by the Contractor lor Work lor which previous Cerlilicales lor Pavineni were <br />issued and payments received irom the Owner, and that current payment shown <br />h«*rein is now due. <br />(Column F on C703) <br />Total Rctainage (Line 5a 5b or <br />Total in Column I ot C703)........................................S <br />6. TOTAL EARNED LESS RETAINAGE....................................S <br />(I me 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />7,226.70 f <br />65,040.30 <br />PAYMENT iLine ti from prior Certificate)................S 44,835.30 <br />«. CURRENT PAYMENT DUE..................................................$ 20,205.00 <br />•). BALANCE TO FINISH, PLUS RETAINAGE........................ 5 214,359.70 <br />dine 3 less Line h) <br />C'ONTR.'XCTOR. Geph.irC Klectric Co,, Inc. <br />Bv: — i.Dale:WtlQhl <br />Sijie ot: Minnesota <br />Subscribed and sworn lo b <br />Notary Public: <br />My Commission expires: <br />liiMi <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In aiiiirdame with the i ontrait Documents, based on on-site observations and the <br />data t omprisim* the ibo\e application, the .Architett certitics ‘o the i)wner that to the <br />bi'st ot thi» An hit»M t > knnwledi;e. mtormation and hehet the Work has proi^ressed as <br />tndti att*d, the v|iialtt\ >\ itu* Work is in accordani e with the C.dnirai t Dot umenis. ami <br />Du* * onir.Mtof % .'nhilrd lo nasment ot the Ai\\()liNI v IRTIFIII') <br />AMOUNT CERTIFIED <br />notary public -j <br />WASHING TO|V.commi;.'.jon -/yr : <br />(Attach c\f)lanation ti anumnt cvrtitiod differs from the amount applied for.) <br />AKCHMirT: <br />lU:Date: <br />lliis ('er.'ificale is not negotiable. Ihe AMOUNT ( LKTIflLD is pavable onlv to thi* <br />Cuintractor named horein Usuance*. payment and acceptance ot pa\ment are without <br />f)fejudu e to anv ru;lils of the (jwner or Conif.ii tor under this Contra»!. <br />i <br />#v* <br />■< <br />‘i <br />■■« <br />Ul iHKUMlsi • ^rriu MU n woiikiau \u jk i'wmim • m w oiiiun * %i\ • <br />♦ *1 ♦ I j • - • . ♦ ♦ I, , . • , I t . , <br />imi r,Tin