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A�'�LICATION AND CERTIFICATION FOR PAYMENT RTL Inv # 14-282-3 TO CONSTRUCTION MANAGER: PROJECT: Orono Police Department APPLICATION NO: 3 ` Kraus Anderson PO Box 158 Circle Pines,MN 55014 `�` ' - '" PERIOD TO: 11/30/2014 ,��`��='�'° - ° � •• FROM CONTRACTOR: RTL Construction,Inc. �'' •• � �` ' NOV ,�� L�:, • 4000 Valley Industrial Blvd S RTL JOB NO: 14-282 Shakopee,MN 55379 KRAUS-ANG��,�.},a$ Ci�CLE PItJES CONTRACTORS APPLICATION FOR PAYMENT The undersigned contractor certifies that to the best of the contractor's knowledge,information and belief the Work covered by this application for payment has been 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 payments received from the owner,and that current payment shown herein is now due. 1.)ORIGINAL CONTRACT SUM ................ $110,900.00 CONTRACTOR: RTL Construction, Inc. 2.)Net Change by Change Orders................... $0.00 3.)Contract Sum to Date .............................. $110,900.00 // /� / / 4.)Completed and Stored to Date ................... $101,380.30 BY. Date: L/ 5.)Retainage ........................................... $5.069.03 � _ _ A � _.� 6.)Total Earned less Retainage...................... $96,311.27 State of: MN County of: �j��c� _ -� KELSIE ANN PIEPGRAS ,,,�.,, 7.)Less Previous Certificates for Payment......... 52,125.08 Subscribed and sworn efore t ' `� day of N�V �� =��'•�. Notary Public ;� . ;��''�; Minnesofa 8.)Current Payment Due.............................. $44,186.19 � Notary Public: .c�. -. ,�,�.� ��T�.� My Comm. Expires 9.)Balance to Finish,Including Retainage......... $14,588.73 My Commission Ex �s: 1/31/20 5 �'�'" �an 31, 2ot5 CHANGE ORDER SUMMARY Additions Deductions CERTIFICATE FOR PAYMENT Total changes approved previously In Accordance with the Contract Documents,based on on-site observations and the data Comprising the application,the Architect certifies to the Owner that to the best of the Architects Total approved this month Knowledge,information and belief the Work has progressed as indicated,the quality of the work is Totals In accordance with the Contract Documents,and the Contractor is entitled to payment of the NET CHANGES by Change Order 0.00 .°+1�'10iJNT CERTIFIED. (q AMOiJNT CERTIFIED.............. $ —I�`� U`,Q\= (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the Continuation Sheeet that are changed to conform with amount certif:ed.) Construction M ate: L'��1..� . Archi ct: By: Date: � � �I