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APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION � AIA DOCUMENT G7OZ�CMCI PAGE ONE OF PAGES TO OWNER Kraus Anderson Construction PROJECT: City of Orono Police Dept. APPLICATION NO: 2 Distribution to: 8625 Rendova StreetNE �� 2730 Kelley Parkway aOWNER �� PO Box 158 �.�;�$�'�,� Orono,MN 55356-9387 PERIOD TO: 11/30/14 �CONSTRUCTION Circle Pines,MN 55014 PROJECT NO: MANAGER FROM CONTRACTOR: �Ov �� 2�14 �ARCHITECT Grazzini Brothers and Company ANp�R�ON� CONTRACT DATE: �CONTRACTOR 1175 Eagan Industrial Road ��CL�P�N�S Eagan,MN 55121 VIA CONSTRUCTION MANAGER: CONTRACT FOR: VIA ARCHITECT: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application�s made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application fa�Payment has been Continuation Sheet,AIA Document G703,is attached. completed in accordance with the Contract Documents,that all amounts Ilare been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner,and that current payment shown herein is now due 1. ORIGINAL CONTRACT SUM $ 16,605.00 2. Net change by Change Orders $ CONTRACTOR: Grazzi Brothers and Company 3. CONTRACT SUM TO DATE(Line 1 f 2) $ � , �. 4. TOTAL COMPLETED&STORED TO DATE $ f< l� l (Column G on G703) y: Date: 5 RETAINAGE: a. %of Completed Work $ 500.00 State of• Mmnesota Cou f. o umn D+E on G703) Subscribed and sworn to before me th�s 17 Ndg�SddYt�R.OLSON b. %of Stored Material $ Notary PuUlic: (�� 4 Notary Pubiic o umn F on G703) My Conm7ission expires. / 1/31/17 � _ s Stote of Minnesota Total Retainage(Lines 5a+�b or (. My Commission Expires � 017 Total in Column I of G703) $ 500.00 6. TOTAL EARNED LESS RETAINAGE $ 9,500.00 In accordance with the Contract Documents,based on on-site observations and the data (L�ne 4 less Ltne 5 1 otal) compnsing this apphcat�on,the(;onstruct�on Manager and Arclirtect cerhty to the 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge,infonnation and belief the Work has PAYMENT(Line 6 fi•om prior Certificate) $ 950.00 progressed as indicated,the quality of the Work is in accordance w�th the Contract 8. CURRENT PAYMENT DUE $ . .. .. ,5 . � Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 21,025.00 .�-�)�� (Line 3 less Line 6) AMOCJNT CERTIFIED $ �> � >V (Attach explanahon famount certifted differs frorn the amount applied for Initiu!u1l ota c anges approve figures on this App(ication und on the Continuatson Sheet that changed to conforn�to the in previous months by Owner amount cerl' C C N R: Total approved this Month $13,920 00 Date• /�. , A � TOTALS $13,920.00 $0.00 By: Date• � NET CHANGES by Change Order $13,920.00 This Certificate is not negotiable. The AMOLJNT CERTIFIED is paya le only o the Contractor named herein.Issuance,payment and acceptance of payment are without prejudice to any nghts of the Owner or Contractor under this Contract. AIA DOCUMENT G702/CMa APPLICATION AND CERTIFICATION FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION 1992 EDITION AIA� �O 1992 G702/CMa-1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1745 NEW YORK AVE,N W,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 -Certification of Document's Authenticity