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' IW <br />APPLlC.«VlON AND CERTIFICATE FOR PAYMENi AIA DOCUMENT C702 PACE ONE OF 2 PACES <br />TO (Ovuu'r)City of Orono <br />1335 Brown Road <br />Crystal Bay, Minnesota 55323 <br />PKOilcr Lift Station No. 8 <br />Renovation <br />APPLICATION NO 3 Final <br />PtKIODFROM; J1/28/90 <br />TO 12/19/90 <br />ATTENTION CONTRACT FOR: <br />Northwest Mechanical Inc. <br />432 Mill Street, Box 40 <br />I akp^ _______ <br />ARCHITECT'S <br />PROIECT NO <br />Distribution to: <br />G OWNER <br />D ARCHITECT <br />□ CONTRACTOR <br />□□ <br />I nnq CONTRACT DATE: <br />CONTRACTOR'S APPLICATION FOR PAYMENT Applicalirrn is m.idc for Pavincnt, as shown below, in connection with the Contract. <br />Conliiiualion Sheet, AIA DocumenI C703, is attached. <br />CHANCE ORDER SUMMARY <br />C ♦•.mcr ')•(!• r. .•(•proved <br />ir; pri*\M»U' hv <br />()w nef <br />fOTAL <br />.MinmoN- ^ no*-’' <br />* App»LU» cl 111'.* Mtml!' <br />P.ilc Apprtnrc <br />The piesent status of the account for this Contract is as follows: <br />ORIGINAL CONTRACT SUM.........................................S-----^8,000.00 , <br />00Nel chjn^e b\ Change Orders .....................................S--------------- <br />CONtRACT SUM TO DATE .........................................S-----48,000.00 <br />TC'IAIS <br />\et chaf)gc b> Change Order* _ <br />TOTAL COMPLETED & STORED TO DATE...................S-----48,000,00 <br />(Column G on G*03‘ <br />REIAINAGE---------------%.............................................$-------------------00. <br />or total in Column I on G703 <br />TOTAL EARNED LESS RETAINACE ................................S-----48,000.00 <br />The iindorficnrd Contractor ccriiiic^ that t »|hi* l>e*>t f*» hi* kruTwietlgt* <br />intormat.on and behet the \N(>rk tovciod h\ thi* Application lor <br />Payment has been completed in ,ict(>rdanci* with the Crmhact D(ku - <br />I mcnt>. that all amounb have been paid b\ him tor Work lor which <br />' previnu^ Certiticatcs lor Pavincnt were ovuoci and p.ivments irceivcd <br />irom the Ovvner. and that current pa>mcnl shown herein is now due <br />LESS PREVIOUS CERTIFICATES FOR PAYMENT...........$___^.^.r^OOiOO <br />CURRENT PAVMENT DUE <br />4,300.00 <br />i <br />It <br />CTOR:NORTHWEST MECHANICAL INC. <br />/TfX Date: 12/l!)/90•xmfikaK^rrr iflisrmrir: <br />State of <br />Sub*»cr:b(‘d and sworn to before me this <br />N'otar\ Public: <br />Mv Commission expires: <br />Countv of: <br />day of ,19 <br />ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED ....................................................S <br />In accordance with the Contract Dot 'menis. iMsed on on-<iie obser <br />\ations and the data comprising the above application, the AKhiieci <br />certifies to the Owner that the Work ha< progressed to the point <br />indicated, that to the best of his knowledge, iniormation and belief, <br />the quality of the Work is in arcordance with the Contract Docu* <br />» mcnls: and that the Contractor is entitled to payment of the AMOUNT <br />CFRTIflEO. <br />f Affach explanation if amount certified difiers from the amount applied loi.i <br />ARCHITECT: <br />Date <br />This Cerldicaie is not negotiable The AMOUNT CERTIFIED is payable only to the Contractoi <br />named nerein Issuance, payment and acceptance of payment are without preiudice to «ny <br />rights of the Owner or Contractor under this Contract. <br />AIA OOCUMHif cm • AmiCATION and CIRTIFICATI for PAYMI n ; • APRIl 1978 {DITIOS • AIA« • t 1978 <br />TNI AMIttCAN HHtlTUTf Of ARCHITICT5 1715 NfW YORK AVfNUI. N.W., WA5HINOTON. DC TOrm G7t2 — 1»7f