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�����°V�D <br /> APPLICATION AND CERTIFlCATION FOR PAYMENT • AIA DOCU�ENT CMA G�o2 PA6E OfJE OF t oF z 4 <br /> TO OWNER: City of Orono PROJECT: �rono Police Denartment Remode pppLICATION NO: 140015-00001 <br /> PO Box 66 2730 Kelley Parkway 11/30/2014 ��ue. <br /> Crystat Ba ,MN 55323 Orono,MN 5535 PERIOD TO: e1���p�R@ � <br /> Y �PINe <br /> FROM cotv�rxncrott: Envision Glass,Inc. vwAxcxrrEcr: SKD Architects,Inc. <br /> CONTRACT DATE: <br /> 2962 Cleveland Avenue North 11140 Highway 55 pROJECT NOS: 140015 <br /> Roseville,MN 55113 plymouth,MN 55441 <br /> CONTRACT FOR:GLASS&GLAZING <br /> CONTRACTOR'S APPLICATION FOR PAYMENT <br /> Application is made for paymeny as shown below,in connection with the Contraa. The undersigned ContraMor certifies that to the best of the Conhactot's knowledge,information and belief tl�e <br /> Continuation Sheet,AIA Document(i703,is attaclud. Work cover�by this Application for Payment has bcen completed in accordance with the Condact Documents, <br /> ' 4,Z.�Q v y� that all amwnts have been paid by the Contraaor for Work for which previous Certificates for Payment were <br /> 1. ORIGINAL CONTRACI'SIJM S �� issued and payments received fram the Owner,and that curtent payment shown herein is now due. <br /> 2. Net change by Change Orders s 0.00 conrTRa,croR: Envision Glass,Inc. <br /> 3. CONTRAC'f SUM TO DATE(Line!f 2) S�� p��`�' <br /> 4. TOTAL COMPLETED&STORED TO S ��.� State: � <br /> 5. RETA(NAGE: County: jtg�p�y <br /> 5.� �_ j ` u <br /> s. %of Completed Work S ���`� By: � L . Date: `�� 1�` � 1 <br /> b. %of Stored Material S Subsaibed and swom to before me Uiis ��� day of'/d���►^r�-�!� <br /> Total Retainege(Lines Sa+56 or '7�.—t r�j <br /> Tatal in Column I ofG703) S �� N Pu ' <br /> 6. TOTALEARNEDLESSRETAINAGE S �� -� MyCommissionexpires: `�/ ■ ���.���1f CHERYLANN STADLER <br /> (Line 4 Less Line 5 Total) �"'" �/ <br /> 7. LESS PREV[OUS CERTIFICATES FOR � p,pp ARCHtTECTS CERTIFICATE FOR P �oT�Y�u - �T <br /> My Commissaon Expires <br /> PAYMENT(Line 6 from}uior Certificate) S [n accordance with the Contract Documents,based on on-site ob � � ata compr�'���py 3��2019 <br /> app[icaHon,the Arcliitect certifies to the Owner that to the best of t o g�y�' f� • <br /> �7^�Z'� �lief the Work 6as progressed as indicated,the qualiry of the WarR�i1� i wi i ihe�ommct <br /> 8. CURRENT PAYMENT DUE S Jv Docum�ts,and the Conhacror is eptitled to payment of the AMO[11V'I'CERT[FIED. <br /> 9. BALANCE TO FINtSH,INCLUDING REI'AINAGE S ��.��� ..�� 'CERTIFIED... .............S � O� _� <br /> (Line 3 less Line 6) 1 <br /> ADDI ON DEDUCTION c t <br /> Total changes approved B Date• <br /> in previous months by Owner <br /> Total a oved this Month CONSTRUCTION MANAGER: <br /> TOTALS <br /> NE'C CHANGES by Change Order By: Date: <br /> This Certificate is not negotiable. The AMOIINT CERTIFIED is payable only to the <br /> Conlraclor named herein.(ssuance,payment and acceptance of paymeM are without <br /> 'udice to an ri lits of Ute Owner or Co�ror under this Conhact. <br />