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/L.;PLICATION AND CERTIFICATE FOR PAYMENT ��a '� CONSTRUCTION MANAGER-ADVISOR EDITION AIA DOCUMENT G702/Cma �a�� <�� '�� • TO(OWNER): PROJECT: APPLICATION NO.: 4 Distribution to: City of Orono City of Orono Police Department(��OV �`� 2��4 PERIOD TO: 11/30/2014 OWNER 2750 Kelley Parkway Remodel and Expansion PROJECT NO.S: 1225.00 CONSTRUCTION Orono, MN 55356 KR,�US-ANnERSON� MANAGER CIr�CLE Pf(�icS ARCHITECT FROM: CONTRACT DATE: 7/29/2014 CONTRACTOR Minnetonka Plumbing Inc. CONTRACT NO.: Category 22A 520 South River Street VIA CONSTRUCTION MANAGER: Kraus Anderson Construction Co. Plumbing&HVAC PO Box 1080 VIA ARCHITECT: SKD Delano, MN 55328 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Applicadon is made for payment,as shown below,in connection with the ConVact. informaGon and belief the Work covered by this Application for Payment has been Continuation Sheet,AIA Document G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and 1. ORIGINAL CONTRACT SUM $ 380,300.00 payments receiv d om the wner,and that current payment shown herein is now due. .............................................................. 2. Net Change by Change Orders $ 849.00 .......................................................... 3. CONTRACT SUM TO DATE $ 381,149.00 CONTRA • i o a P mbing Inc. 4. TOTAL COMPLETE 8�STORED TO DATE $ 297,917.00 ( ) ................................. By: ' Date: 11/20/2014 Column G on G703 5. RETAINAGE: a 5 °�o of Completed Work $ 14,895.85 State of: Minnesota County of: Hennepin (Column D+E on G703) Subscribed and sw n to before e thi:20th day of November, 2014 b 5 "� of Stored Material $ 0.00 Notary Public: � � (Column F on G703) My COmmISSi 2� 01/31/2020 ��M�`.iSf�;�!N�K DEBOER Total Retainage(Line 5a+5b or $ 14,895.85 �'. �i�N.'riY Pu8L1C-MINNESOTA Total in Column I on G703) CERTIFICATE FOR PAYMENT ` " �' '-' � 6. TOTAL EARNED LESS RETAINAGE $ 283,021.15 In accoMance with the Contract Documents,based on on-slt�`6t1��14'�'tloPrs�n2Yd5 a ( ) comprising this appllcation,the ConsVuction Manager and Architect certify to the Owner Line 4 less Line 5 Total 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 228,280.25 that to the best of their knowledge,information and belief the Work has progressed as (Line 6 from prior certificate) indicated,the quality of the Work is in accordance with the Contract Documents,and the 8. CURRENT PAYMENT DUE $ 54,740.90 ✓ Contractor is entitled to payment of the AMOUNT CERTIFIED. � ............................... 9. BALANCE TO FINISH,PLUS RETAINAGE $ 98,127.85 `� ( ) ................................� AMOUNT CERTIFIED $ �.��V__� Line 3 less Line 6 (Attach explanation if amount differs from the amount applied for. Initial all figures on CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS this Application and on the Continuation Sheet that are changed to conform to the Total changes approved in_ amount certified.) previous months by Owner ANA rson ConsVuction Company By: Date: \. Total approved this Month 849.00 A � � By: Date: TOTALS 849.00 0.00 This Certifipte is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance,payment and acceptance of payment are without NET CHANGES by Change Order 849.00 prejudice to any rights of the Owner or Contractor under this ConVact.