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'A \(Instructions on reverse si de) »^Ct QNt Of PM.tSAPPLICMION NO: Distribution to;□ OWNERPERIOD TO; □ architect□ CONTRACiORARCHITECT'S □. PROIECT NO: 1124.04 □CONTRACT DATE;__________________________nent. as shown below, in connection with the Contract. Kument C703» is attached......................j 10^ Si-i .on <br />[ORED TO DATE..................S _ ]9?.i215i.Qfl <br />) <br />work S-lialZLiQ-------- <br />:703) <br />lerial S ------- ■— <br />1) <br />+ 5bor 19.221.50 <br />C703)................................ 172.993.^ <br />ETAINACE................................» —------------------- <br />Total) K.Afn^.UO <br />FiCATES FOR <br />rom prior Certihcate)..............» a^frl .90 <br />............;..................! 172^993.so Z <br />I_______________________________ <br />County of; Dakota <br />1 before me this dayolOC-T <br />APPLICATION AND CERTIFICATE FOR PAYMENT aia document G702 (Instructions on reverse side) pace one of pacesTO (OWNER): City of Orono1335 Brown Road South Crystal Day, MN 55323 PROJECT: Orono City Hall/Police and Public Works BuildingsFROM (CONTRACTOR): Steenberg-Watrud Const. VIA (ARCHITECT):10255 Inver Grove Trail Inver Grove lies., MN 55076CONTRACT FOR:APPLICATION NO: FivePERIOD TO; 10-31-92ARCHITECT'S PROJECT NO: 1124.04CONTRACT DATE:Drstribvtion to;□ OWNER□ ARaTlIECT□ CONTRACIOR□□CONTRACTOR'S APPLICATION FOR PAYMENTCHANCE ORDER SUMMARYChange Orders approved in previous months by OwnerTOTAL ADDITIONS DEDUaiONS <br />• <br />Number ”bate .Approved <br />T2GI992 <br />>r>n <br />C^i2\P2nV TOTALS <br />Net change by Change Orders <br />Application is made for Payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, ij attached.1. ORIGINAL CONTRACT SUM......................................$ 342,500.002. Net change by Change Orders ..................................3. CONTRACT SUM TO DATE (Line 1 2)...................... 5 328,629.254. TOTAL COMPLETED & STORED TO DATE...................$ 313,415.00(Column C on G703)5. RETAINAGE: <br />a. 10 % of Completed Work $ 31.342.00 <br />(Column D + E on C703) <br />b____% of Stored Material $-0- <br />The undersigned Contractor certifies that to the best of the Contractor's knowledge, <br />information and belief the Work covered by this Application for Payment has been <br />completed in accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor for Work for which previous Certificates for Payment were <br />issued and payments received from the Owner, and that current payment shown <br />herein is now due. <br />CONTRACTO^:^ Ste^^erg-Wat^d Construction, Inc <br />,, . 10-23-92 <br />(Column F on C703) <br />Total Retainage (Line 5a + 5b or -j/o nn <br />Total in Column I of G703)..................................S 31,342.00 <br />6. TOTAL EARNED LESS RETAINAGE...............................$ 282.Q73.QQ <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate)..............$ 213,087.00 <br />8. CURRENT PAYMENT DUE..........................................$ <br />9. BALANCE TO FI^SH, PLUSRnAINAGE.....................$ 4^,55,6.25 <br />_____(Line 3 letfLine 6) ' ^ <br />State of: <br />Date: <br />c\ /O Coui <br />Subscribed Ikid^M^rn fcybefoi^'mjt tbfs <br />Notary Public: <br />My Commissiartexpires: <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accorda.ice with the Contract Documents, based on on-site observations and the <br />data comprising the above application, the Architect certifies to the Owner that to tne <br />i.aci iha Arz-hitori'c knnwIpHee. information and belief the Work has progressed as <br />BARAJ.WATRUD <br />.ary pubuc —^hiunesota <br />DAKOTA COUNTY <br />_ MyCommbalooE*pliMFcb. 10.1994 <br />........................... <br />$____________________AMOUNT CERTIFIED................................................... <br />(Attach explanation if amount certified differs from the amount applied lot <br />ARCHITECT: <br />Bv;Date: