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� NOV 2 4 2014 �� :.'�3,M�'... TM � � }(RpUS-ANDERSON� �•�: Document G732 009 CIRCLE PiNES Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: PROJECT: APPLICATi01V N0: DISTR�BUTION T0: City of Orono Orono Police Dpt. 04 Four OWNER 2730 Kelley Parkway PERIOD T0: CONSTRUCTIOP�MANAGER FROM VIA CONSTRUCTION Orono, MN 55356 CONTRACT DATE: 11/30/2014 ARCHITECT CONTRACTORkellington Construction, Inc. MANAGER: Kraus Anderson PROJECT NOS: / / CONTRACTOR FIELD CONTRACT FO�b1 North 2nd Street VIA ARCHITECT: OTHER inneanohs MN 55411 SKD Architects � The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and CONTRACTOR S APPLICATION FOR PAYMENT belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous AIA Document G703T"',Continuation Sheet,is attached. Certificates for Payment were issued and payments received from'the Owner,and that current payment 1.ORIGINAL CONTRACT SUM............................................................$ 198,250.00 shown herein is now due. 2.NET CHANGES IN THE WORK..........................................................$ -803.00 CONT R• Kelli gton Construction, Inc. 3.CONTRACT SUM TO DATE(Line 1 t 2) ............................................. $ 197,447.00 By: -5�� `�f��~ DaCe: 11/21/2014 4.TOTAL COMPLETED AND STORED TO DATE(Cplumn G on G703)..............�,T�� — State of: Minnesota 5.RETAINAGE: County of: Hennepin a. 5 %of Completed Work �►,` Subscribed and sworn to b JESSICA L.PL01fifMA'�) (Colzrmn D+E on G703J $ 3��1 • �.J me this 2 day o ember, 20 Motery Public b. 5 %of Stored Material Notary Public: Minnesota (Column F on G703) $ 0.00 My Commission expires: ��o�s �p�� 31,2019 .r Total Retainage(Lines Sa+Sb,or Total in Column I on G703)...................$ �� :ERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINA GE:.........:........................................�v,13f�,� n accordance with the Contract Documents,based on evaluations of the Work and the data comprising 7.LESS PREVIOUS CERTIFICATES — this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 minus Line 5 Total) FOR PAYMENT.......... .�r....�....................� „��}1� 1c�+owledge,information and belief the Work has progressed as indicated,the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOLTNT S.CURRENT PAYMENT DUE............................................ .......$ IFIED. � ........ �2�3 7 � 9.BALAMCE TO FINISH,INCLUDING RETAINAGE . AMOUNT CERTIFIED.......................................................$ �'(� � g'�j�� r/ (Attnch explanation ifamoatnt certified d�ers from the amozrnt applied.lnitaal all figztres on this (Line 3 minz�s Line 6) $ �21� 3�b� � Applicntion and oh the Continuation Sheet that are changed to conform with the amount certified.) CONST AG : Date: �Q,�„�� SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS A :I u � e Prrme ConlraGtors are responsib e for performing portions of the Total changes ap roved in previaus months b Owner $ 0.47 $ -803.47 Pr ' c I t' ation is nol reqt.rtred.) Total approved this month,inciuding Construction By: '` � Date: � Chan e Directives $ 1,442.10 $ -1,442.10 This Certi6cate is not negotiabie.The AMOLTNT CERTIFIED is paya e o ly to the ontractor named TOTALS $ $ _ herein.Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner NET CI3ANGES IN THE WORI� $ _ or Contractor under this Contract. CAUTION;You should sign an original AIA Contract Document,on which this text appears in R[D.An original assures that changes will not he obscured. AIA Document G732'*"-2009�formerly G702T"'CMa-1992).Copyright�1992 and 2009 by The Amencan Institute of Architects All rights reserved.WARNING:This AIA"Document is protected by U.S.Copyright Law and Internatfonal Treaties.Unauthorired reproduction or distribution of this AIA' Document,or any portion of it,may result in severe Civil and criminal penalties,and will be prosecuted to the maximum extent possibfe under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org.