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APPLIC A/A DOCUMINT C702 P^Cf csf f'f 2 P'C!S <br />rp tO^n^f)City of Orono <br />1335 Brown Road <br />Crystal Bay, Minnesota 55323 <br />PROIECT Lift Station <br />Renovation <br />No. 8 APPiicAfiON so 3 Final <br />PiRion fRo*'T 11/28,'90 <br />12/19/90 <br />f'lM- milion If <br />; OWNER <br />I -vRCHlTfCT <br />1 CONTRACTOR <br />* ATTENTION CONTRACT FOR <br />Northwest Mechanical <br />/>32 Mi 11 Street, Box <br />! nnq I;»kp, MN <br />Inc. <br />40 <br />architects <br />PkOlfC T so <br />contract DAT! <br />f <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Eh ANCC OltOIll SUMMARV ' <br />Application i< made for Paxmeni a? fiHown below, in connection with the Contract. <br />Continuation Sheet, AIA Document G/03. i« attached <br />in ru#n|h« b% <br />0%*. *Wf <br />lOTAl <br />xi'niiiON I 't ! ^ t M <br />The present status ot tHf account ior this Contract »s as follows <br />ORfGlhAl CONTRACT SUM <br />t. — <br />Apprit\c*fi ln*r Month | <br />Ntiinbe*Dale Approved i <br />• <br />1 <br />1 <br />1 <br />totals <br />N«t cl««nRC bv Ch«nf« O»0*f <br />\e! c.-.mcr b\ Change Orders <br />CONTRACT SUM TO DAT! <br />TOTAL COMPIFTID & STORED TO DATE <br />•Column C on C"i>V <br />RETAINAGE------------% <br />or total in Column l on C‘OT <br />TOTAL EARNED LESS RETAINAGE <br />The undtnignetf Contractor cemne* that i** t^' m**; <br />and br-litf the vo\cH*d h\ m <br />h» kne i«\ <br />application io» <br />'yiffiffii has been i >^npleted m »H,mci u ih ih* Coni ran Doti <br />Jtnt^ that all amcNinti Ka^t be* i bv him u»r Wo-k whic*> <br />rertititaie^ tor Pasment i issued and p.r. mmt* o cmrc' <br />t«om the CKvne*. and that current pasment »no\\n hf n nm^ ciut <br />tot: NOKTHUEST MECHANICAL INC. <br />c 48.000.00 <br />c 00 <br />A 48.000.00 <br />C 48.000.00 <br />c 00 <br />. . . . S 48,000.00 <br />T ............$43,700.00 <br />CURRENT PAYMENT DUE <br />A.300.00 <br />(•niTT ■jTTtrr n <br />State of <br />Subscribed and sworn to before me this <br />Notarv Public <br />M\ Commission expires <br />Countv of <br />dav of <br />AROimECrS aRTIRCATE K)R PAYMENT AAtOUNT CERTIFIED <br />•n acfotdance %%rfh the Contract OcKumem* baser on aim <br />%ainoo and the data coatfmfifif the aho\f applicaiKm tK* Art»Htrr <br />fOftaif to thf Owner that the Worl K«t profte«NP*d i*- ifn <br />et hii linov\lrdfe iniormalio'' and t>rUr» <br />it *n acccMdance mth tiu Contract Dciru <br />____ifU Ml M C«Mi«CM>r i» eniilkd »o p«rn«ni ot ih« *>mOun T <br />oniriKi. <br />' Atijc*" eAp.',n,i(on ii amot/oi cfti I'fa •iC'T ’ trnou'it <br />ARCHITECT <br />B n ------1Itttt rrfi>iii-l^l --------------------- Da»f <br />Thu Certilicaic u not nepotiabt* Th« AMOUNT CERTiMfp i* p*vab<« onK to th» c. •'••tc- • <br />named Kerem tisuanct payment and accepiarKe of payment are without prefuc cs u* #n\ <br />rifbn of the Owner or Comrattor larsder Ihif Con ki <br />• iiWMUftOhtRNDCIRftNCAll TOR PAYQ<^t • apin fTiipffN^ • aitA • » Uti