11-09-1992 Council Packet - Laserfiche WebLink

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G702 (Instructions on reverse side) application NO; FivePERIOD TO: 10-31-92ARCHITECT'S PROJECT NO: 1124.04CONTRACT DATE:R^ct ONI or PACISDrstribution fo:□ OWNER□ ARCHITECT□ CONTRACTOR□□connection with the Contract. lA DocumenI G703,attached.kCT SUM................................... ) 342.5 00.00igeOrders.................................i 13.E .0.75)a DATE (Line 1 i2).....................t 328.629.25& STORED TO DATE..................$ 313.415.00C703)sit'd Work $ 31.342.00 on G703) Material $ ^ -0- 1703) t 5a + 5b or ilofC703)...................... i 31,342.00 I RETAINACE.............i 282.071.nn f 5 Total) mriCATES FOR 6 from prior Certificate).............$ 213,087.00 due ........................................... 68,986.00 T, PLUS;inAINAGl.................. J_4^,5i6.25 6) J. WATRUD )'#JTARY PUBLIC-JIWNESOrA $ DAKOTA COUNTY My Oonntotofr EipIrM Fd>. 10.1994 } mount cerf./Jed differs from the amount applied fo Dale: legotiable. The AMOUNT GERTIEItD is payable only to the in «u^ce, payment and acceptance of payment are without of^e Owner or Contractor under this Contract. /application and certificate for payment AIA document C702 (instructions on reverse side) paci onc or PACtsTO (OWNER):City of Orono 1335 Drown Road South Crystal Day, MN 55323 FROM (CONTRACTOR):/\/oTertis/CoAfST/tUCT/OA/ CONTRACT FOR:PROjECF:Orono City llall/Police and Public Works Duildings APPLICATION NO: 3 PERIOD TO;Distribution to:□ OWNER□ ARCillTECTV,A,MCM,UCn: ARCH,UC,S REg^WDoarman Kroos Pfister and Assoc. PROJECT NO: 1124.04 ^ □222 North Second Street nrT'»M iqqtMinneapolis, MN 55401 CONTRACT DATE: 'CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection Continuation Sheet, AIA Document G703, is attached. •CHANCE ORDER SUMMARYChange Orders approved in previous months by OwnerTOTAL ADDITIONS DEDUCTIONSApproved ihls MonthNumberDate Approved • TOTALS Ncl change by Change Orders Company1. ORIGINAL CONTRACT SUM......................................2. Net change by Change Orders......................................S3. CONTRACT SUM TO DATE (Line 1 ±2).........................S4. TOTAL COMPLETED & STORED TO DATE.....................$ O f <2 «(Column G on G703)5. RETAINACE:a. % of Completed Work S v — (Column D + E on G703) b. _% of Stored Material S------------------------------ (Column F on C703) Total Retainage (Line Sa + Sb or Total in Column I of G703)CO ^ 1 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application lor Paymcnl has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates lor Payment were ‘ issued and payments received from the Owner, and that current payment shown herein is now due. CONTRACTOR; ? DONNA J.MIREAUIJ NOTARY PUBUC-MINNESOn WASHINGTON COUNTY My Comm Expires 3-B-97 6. TOTAL L.LRNED LESS RETAINACE..................................S S'.f/ (Line 4 less Line 5 Total) " -• 7. LESS PREVIOUS CERTIFICATES FOR , PAYMENT (Line 6 from prior Certificate)...............S / 8. CURRENT PAYMENT DUE...............................................$------ 9. BALANCE TO FINISH, PLUS RETAINACE.......................$ //.3, (Line 3 less Line 6) ___________ By: ^ iNUisiiy ruuiii.; AjJl^rrLZXJ Jy ^ ■■ Date: ^ ^ .13^ *r^ My Commission expires: 3- 5 Stale of: PfU County of: Li3oJSiKv^a ‘Von_> sworn to before me this ^3 r l day of DCTi WlJm/rL Subsc ribed and sworn to before me this ^3r.di day of Dcfot>e.r SA AMOUNT CERTIFIED............................................................5 (Attach explanation if amount certified differs from the amount applied ford ARCHITECT: Doarman Kroos Pfister and Associates ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with Ihe ConIracI Dotumcnis, based on on-silc observations and the data comprising the above application, the Architect cerlilics to the Owner that to the best of the Architect ’s knowledge, infotmalion and belief ihc Work has progressed as gy; Indicated, the quality of Ihc Work Is in accordance with Ihc Coniraci Documcnis, and j|,|j cctlilicale Is not ncgoliabic. The AMOUNT CERTIFIED Is payable only lo Ihe ihc Coniraclor is cniillcd lo paymcnl of llic AMOUNT CERTIFIED. Coniraclor named herein. Issuance, payment and acceptance of payment arc wllhoul Dale: prejudice to any rights of ihe Owner or Contractor under this Coniraci AIA DOCUMtNT C7*I • AmiCAtlON AND aRIlflCAIt lOR rAVMlNI • KtAY 1983 tUlIION • AIA* • © 1981 Till AMimCAN INSIITUU Of ARCIiniOS. 171S NtW YORK AVlNUf. N.W., WASMINCION, D.C. 20006 • •*. M....*/. .u.i.A.M.l... ..lAt.f.. 11 rnnvrlnia Iaw^ ind ts Subicct to ICQsl prosecution. G702-1983