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/APPLICATION AND CERTIFICATE FOR PAYMENT AIA document C702 (Itisuuclions on reverse side) ('ACit)Nrof 2TO (OWNER):City of Orono <br />1335 Drown Road South <br />Crystal Day, MN 55323 <br />PROJECT:Jrono City llall/Police and <br />Public Works Duildings <br />APPLICATION NO: 1 <br />PERIOD TO: 10/31/92 <br />CONTRACT FOR: <br />VIA (ARCIinECI): ARCHITECT'S <br />Doarman Kroos Pfistor and Assoc. PROJECT NO: 1124.04 <br />222 North Second Street <br />Minneapolis, MN 55401 CONTRACT DATE: 5/11/92 <br />Dislribulion lo:□ OWNER <br />□ ARCHIIECT <br />□ CONIKACIOR□□ <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />CHANGE ORDER SUMMARY <br />Change Orders approved in <br />previous months by Owner <br />TOTAL <br />additions deductions <br />’ l5ale Approved <br />OCT 2 <br />K rmt<;-/ <br />; 1992 <br />jid^nton <br />r f'tfio.iritctiou Company totals <br />Ncl change by Change Orders <br />Application is made (or PaymenI, as shown below, in connection willi the Coniracl. <br />Continuation Shech AIA Document G703, is attaclied. <br />1. ORIGINAL CONTRACT SUM.........................................$ 99---------- <br />2. Net change by Change Orders.....................................$ <br />3. CONTRACT SUM TO DATE (Line 1 ± 2)........................$ 78,745.00 <br />4. TOtAL COMPLETED & STORED TO DATE.....................$ 21,0^8...Q.Q <br />(Column G on C703) <br />5. RFTAINACE: <br />a. 3-Q % of Completed Work $ —2,106.80----- <br />(Column D + E on G703) <br />b. _% of Stored Material $ <br />The tindorsigttcd Contractor ccrtilies that to the best o( the (lioniractor's knowledge, <br />inlurmation and beliel the Work covered by this Application (o: Payment has bernr <br />completed in accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor Tor Work lor which previrrus Cerlilicatcs fur Payment were <br />issued and payments received Irom the Owrrer, and that currein payment shown <br />herein is ttow due. <br />(Column F on C703) <br />Total Relainage (Line 5a + 5b or <br />loial In Column I ol C703).....................................I —2,10 6_^8£ <br />6. TOTAL EARNED LESS RETAINACE.................................S 18.961.-20L <br />(Line 4 less Line 5 Total) , <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Ccriilicalc)S <br />CONTRACTOR:Hoffer's,Inc. <br />Uy:George Mims <br />8. CURRENT PAYMENT DUE...............................................$ 18,961^20---------- <br />9. BALANCE TO FINISH, PLUS REIAINAGE.......................S 59,783.80 <br />______(Line 3 less Line 6)__________■A>'.^,,AA.^.\v/vNWAAA/v\w\A/vvvv«/wr <br />Stale Coimiyfi^^ <br />5.U,c,ibcdand>«,.n,0bcl,^„0iJ,is, <br />___10/2.1Z.92 <br />Notary Public:^ <br />My Commission expires:' <br />^ *9 n My Commiuion ExpirM Feb 23.1986 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br />In accordance will* the Corrtracl Documents, based otr on site observations and the <br />data comprising the above application, the Architect cerlilies lo the Owni*f that to the <br />best ol ibe ArcbilecT's knowledge, inloimalion and belie! Ibe Work has logresscdas <br />indicated, the quality ol the Work is in accoidance with the Contract Documents, and <br />the Contractor is entitled to payment ol the AMOUNT CERIIFIED. <br />AMOUNT ClRIlMtU <br />(Attach explanation if amount certified differs from the amount applied for.) <br />ARCHIIECT: Doarman Kroos Pfister and Associates <br />By:Dale: <br />Ibis Ccrlilicale is not ncP'-licL'". The AMOUNT CERTIFIED is payable only lo the <br />Contractor named hert.n. Issuance, payment and acceptance ol payment are without <br />prejudice to any riglils ol lire Owner or Contractor under this Coniracl. <br />AIA Ot)CUAUNI C7M • AITIIC a IION AND LTKIlilcAtl lOH I'AYMtHI • MAY IM) tOlIKJN • AIA* • %> IWI <br />tilt AAtmiCAN INSIIIUIl or AKt.lllllCIS. I7IS NIW ttJilK AVINUI. N W.. WASIUHr.lOH. O.C. 10006 G702-I983