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APPLlL-iTION AND CERTIFICATE FOR PAYMEN M \ noi UMCI^T C702 I'sr.E ON! I'F PX<.£'i <br />TO (Owner):City of Orono <br />1335 Brown Road <br />Crystal Bay, Minnesota 55323 <br />p.^OlECr Lift St it ion No. 8 <br />Renovation <br />APPIU ATION N(T 1 <br />PFK.OnfKOM <br />10/24/90 <br />DiitrihuLon to <br />□ OWNER <br />□ AKtUlTECr <br />n contractor <br />□ <br />ATTENTION;CONTR VCi fOK <br />Northwest Mechanical Inc. <br />432 Mill Street, Box 40 <br />__Lonn Lake, MN 5S3S6-------------------- <br />ARCHITECT S <br />PKOlfCT NO <br />CONTR,\CT DATE 8/2.3/90 <br />LI <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />CHANCE ORDER SUMMARY <br />Change Orders approved <br />in previous months by <br />Ow ner <br />total <br />Approved lhi> Mor.ih <br />Number Date Approved <br />ADDITIONS DtOuCIujN' <br />TOTALS <br />Net change by Change Orderi <br />Cunlinualion Sheet, AIA Dotumenl C703, i> attjcheij <br />Tht* p estMit >t iius of the jccount tor this Contract is as follows: <br />48,000.00ORIGIN U CONTRACT SUM ..................................................S <br />Net change by Change Oulerj ................................................$ <br />CONTRACT SUM TO DATE.......................................................S <br />00 <br />48.000.00 <br />TOTAL COMPLETED & STORED TO DATE........................S- <br />(Column G on C.'OU <br />5______o;. ............................................S- <br />9,520.00 <br />RETAINAGE 476.00 <br />or t.jljl in Column I on C'O) <br />TOTAL EARNED LESS RETAINAGE .........................................$-9,044.00 <br />The undersigned Contractor certifies that to the be»; of hu kno Altdgo <br />information and belief the Work covered by thu Application for <br />Payment has been completed in accord.»nce v\ith the Contract Docu ­ <br />ments, that all amounts have been paid by him for Work for v.hich <br />previous Certificates for Payment were issued and pj>ment, rec.-i.eci <br />from the Owner, and that current payment sho.vn here.n is now due <br />LESS PREVIOUS CERTIFICATES FOR PAYMENT............S-00 <br />CURRENT PAYMENT DUE.................................................S-9,044.00 <br />CQ^^CTOR: NORTHWE <br />iTi I f £«:Miinn7r. ri <br />State of <br />Subscribed and sworn to before me this <br />Notary Public. <br />My Commission expires: <br />County of: <br />day of <br />ARCHITECT'S dERTIFICATE FOR PAYMENT AMOUNT CERTIFIED ..........................................................$. <br />In accordance with the Contract Documents, based on on-site ob>er <br />vations and the data comprising the ibove application, the Architect <br />certifies to the Owner that the Wor\ has progres.ed to the point <br />indicated, that to the best of his knowledge, information and belief, <br />the quality of the Work is in accordance with the Contract Docu ­ <br />ments; and that the Contractor is entitled to payment of the AMOUNT <br />CERTIFIED. <br />(Attach exphnilion if amount certified differs from the amount applied for.) <br />ARCHITECT: <br />Date: <br />This Certificate is not negotiable The AMOUNT CERTIFIED is payable only to the Contractor <br />named herein Issuance, payment and acceptance of payment are without prejudice to any <br />right, of the Owner or Contractor under this Contract. <br />AIA OOCU.MINT C7fl2 • APPLICATION AND CERrifiCXTE fOri P ayment • APRIL ViTn EOH.O n • AU*- • 19:b <br />THE A.MERICAN INSTITUTE Of ARCHITECTS. 1735 NEW YORK AVENUE, N W , UA.SHINCTON, DC 20006 G702 —1978