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wVs^APPLICATION AND CERTIFICATE FOR PAYMENT aia document C702 'A(Instructions on reverse side) wet ONt of PAt,tS <br />TO (OWNER): <br />City of Orono <br />1335 Brown Road South <br />Crystal Bay, MN 55323 <br />FROM (CONTRACTOR): /• <br />^/v'c^cTT/>7//^5t7/iv£;’y^ <br />CONTRACT FOR: <br />PROlEa: <br />Orono City Hall/Police and <br />Public Works Buildings <br />APPLICATION NO: <br />PERIOD TO: <br />VIA (ARCHITECT): ARCHITECT S <br />Boarman Kroos Pfister and Assoc. PROIECT NO: 1124.04 <br />222 North Second Street <br />Minneapolis, MN 55401 contract DATE: <br />Distribution to: <br />□ OWNER <br />□ ARCHITECT <br />□ CONTRAC iOR□□ <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />,^DDITIONS DEDUCTIONS <br />'•'^Dale Approved <br />OCT <br />Vri'** <br /><?8 1Q()p <br />C<'''7'‘‘n!rfu>n (mlPTALS <br />Nel change bv Change Orders <br />Applic3lion is made (or Pavmenl. as shown below, in connection with (he Contract. <br />Continuation Sheet, AIA Document C703, is attached. <br />ifli.R27.nn <br />lO.TRR.nn <br />192.715.nn <br />192.215.00 <br />The undersigned Contractor certilies that to the best ot the Contractor's knowledge, <br />inlurmaiion and belijef the Work covered by this Application (or Payment has been <br />completed in accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor lor Work (or which previous Certificates (or Payment w're <br />issued and payments received (rom itie Owner, and that current payment shown <br />herein is now due. e* <br />CONTRACTOR: <br />^ l^c <br />OSOoG.. G. FOLUCMY <br />NOTARY m;CLIC • MINNES0T,\ <br />HENNEPIN COUNTY <br />MyCommtatlonEjVliwOcL IS. 1997 <br />1. ORICINAl CONTRACT SUM.......................................S <br />2. Net change by Change Orders...................................$ <br />3. CONTRACT S\JM TO DATE (Line 1=2).......................S <br />4. TOTAL CO/V1PLETED & STORED TO DATE...................S <br />(Column C on C/03) <br />5. RETAINACE: <br />a. _1Q % of Completed Work S 19,221.50____ <br />(Column D + E on C703) <br />b. --% o( Stored Material 5_________________ <br />(Column F on C703) <br />Total Reiainage (Line 5a 5b or <br />Total in Column I of C703I ...................................S <br />6. TOTAL EARNED LESS RETAINACE................................$ 172,993.50 <br />(Line 4 less Line 5 Total) <br />7. LESS pr' /lOUS CERTIFICATES FOR <br />PAiMENT (Line 6 (rom prior Certificate)..............S ■ 188/754rBO______ <br />8. CURRENT PAYMENT DUE............................................S i-,4Q -1.0O <br />9. BALANCE TO FINISH. PLUS RETAINACE.....................S 172,993.50 <br />_____(Line 3 less Line b* <br />19,221.50 <br />Slate of: Minnesota County of: Dakota <br />Subscribed and sworn to before me this ^ ^ day of (3C.f <br />Notary Public: <br />My Commission expires: <br />,199t <br />ARCHITECT'S CElrriFICATE FOR PAYMENT <br />In accordance with the Contract Documents, based on on-sile observations and the <br />d.Ma comprising 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 (fualiiy of the Work is in accnrdancc with the Coniraci Do.umcnis, and <br />the Contractor is entitled to pavmenl of the AMOUNT CERTIFIED. <br />AMOUNT CERTIFIED.........................................................S_______________ <br />(Alljch explanation i( amount certified differs ftom the amount applied tor) <br />ARCHITECT: Boarman Kroos Pfister and Associates <br />By:Date: <br />This CcMiticaie is not negotiable. The AMOUNT CERTIFIED is payable onlv to ih« <br />Contractor named herein. Issuance, pavmenl and acceptance ol payment are wiihou <br />preiudite to anv ngfiis ol the Owner or*Coniracior under this Contract