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V .APPLICATION AND CERTIFICATE FOR PAYMENT ma oucumcntc?02 (Inslfuclions on tcvoisc sitic) rAC.i i)Nf oi^I'A(;ivlO (QWNLK):City of Orono <br />133b Brown Road South <br />Crystal Bay, MN 5b323 <br />FROM (CONIRACIOR): <br />Vohnoutka Roofino & Sheet Metal <br />Co ., Inc . <br />CONFRACT FOR: Roofing & Sheet Metal <br />I’ROlfCI:Orono City lUill/PolicG and <br />Public Works Buildin9S <br />APPLICATION NO: 2 <br />I'CRIOD lO: 10/30/92 <br />VIA (ARCIIIIFCI): ARCIIIUCrS <br />Boarnmn Kroos Pflater and Assoc. PRORCTNO: 1124.04 <br />222 North Second Street <br />Minneapolis, MU 55401 CON1RACT UAIE: 5/11/92 <br />Disltibulion lu:□ OV\ IR <br />UlARCIIIUtT <br />IJ CONIRACIOR□ <br />(J <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Applicalioti is made lor PaynuMil, as shown below, in connecliun wilh the Conliatl. <br />Conlinualion Shed, AIA Uucuincnl G703, is atlached. <br />*X <br />CHANCE ORDER SUMMARY <br />Change Orders approved in <br />pieviuus monlirs by Owner <br />TOTAL <br />AUDI I IONS <br />2,512 <br />1)1 DUCI IONS <br />9,487 <br />^ri|^onlh <br />^■*rfalc Approved <br />(CT :: R 1 <br />/ -* <br />)'J2 <br />TOTALS 2,51’T"9,407 <br />Wi;*f;^rby’*Ch.^rRC orders (6,975) _ <br />I. ORIGINAL CONTRACT SUM.........................................S ■ <br />7. Nci change by Change Orders.....................................S —\ o.f " .^1 <br />3. CONTRACT SUM TO DATE (Fine T ± 2).........................S _L4.9 tJJL? <br />I. TOTAL COMPUTED & STORED TO DATE.....................S —t 25J <br />(Culunin G on G7UJ) <br />5 RL ;NAGE: <br />a. ^ Q % ol Compicled W iik $------9 ----------- <br />(Column 1) + C on G703) <br />b. _% of Slorcd Maleiial S----------------Q----------- <br />me unocisigneu cuniiuciui iiiiii lu mi: <»■ in»- ^ ..........> <br />inlormation and belief the Work covered by ihis Application lor IVymenI !>as been <br />compicled in accordance wilh Ihc ConIracI Documenls, that all amoiinis have been <br />p.iid by Ihc Coniraclotrfor Wc»rk lor which previous CrMlilicales lor Paymetrl were <br />issued anri paymenU received horn the Owner, niul lhat tir'enl payineni shown <br />herein is now due. <br />(Column F on G701) <br />Total Relainagc (Line 5a E Sb or ^ r'i a octa <br />lolal in Column I ol C703).....................................S-------- <br />(,. TOTAL EARNED LESS RETAiNAGE..................................% — <br />(Line *1 less Line 5 Tolal) <br />7. LESS PREVIOUS CERTIflCATES FOR <br />PAYMLNE (Line 6 hom prior Cctlilicalc)...............S — <br />n. CURRENT PAYMENT DUE..............................................^ 24^ 326 <br />•J BALANCE TO EINISII, PLUS RETAINAGE.......................S <br />(Line 3 less Line 6)______________________________________ <br />CONTRACTOR: Volmoutka Rooiing & Sheet Metal Co., Inc <br />.October 1992 <br />Stale of: County ol: yWCAAt/r-^ <br />Subscribed and sworn lo before me lliis day ol (X-iJrl-fA. ,1'J 3.J- <br />Nolary Public: QuOL/> <br />My Commission expires: ~ -------iv rim.nt;n.-<-OTA <br />AMOUNT ClRIlfllD............................................3^£>r'j'iAvg.2a.IKS <br /></ ll.ich e*/)/.ina(ron if amount cvilificd differs . >y. . <br />courirv <br />1 ■ y VI I III II^IVII <br />ATLCHITECrS CERTIFICATE FOR PAYMENT <br />In av"'' :,incc wilh Ihc Conlrat iments. based on oo site ohseix itioos and lire <br />ilala comprising the above applic. ...i, the ArchitccI«eitihes to lire Owner dial to the <br />best of lire Atchilccl's km,. ■ ,:dgc,itrformaUon and belief the Work lias ptogtesscil as py;--------------------------------- <br />indicated, Ibe riualily of Ihc Work is in accordance willi Ibe l.nniraci Oocuincnis, ami n^jj (jcipijtaic Is nol ncgtriiablc. The AMOUNI CLKIIFIIU is payable only to lire <br />ihc Coniraclof is cnlillcd lo pay.nenl of the AMOUNI CtRIII ICO. Conliactur named Itercin. Issuance, paytncnl and actcplanceof payment arc willmul <br />ARCiiiHCl; Uoaiinan Kroos Pfistcr and Associates <br />_________________Dale: <br />prejudice lo any riglils of the Owner or Coniraclor under lliis ConIracI. <br />AIA OOCUMCNI cm • ArmCAriOM Ar-O CIRIIIICAII IUK fAyMINI • MAY l•JllHl)mo^r • AlA- • <br />nil AMiiai All iNsiinm «»r ARaiimas. uis mw vmix avinui, nw. wasiiiik.ion. ot rirtv.C702 I003 <br />■ • ..< legal iMotec'ii'.'''