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� �� � RECEIVED �
<br /> �
<br /> . � D;o�+��=.��e.nt:.G732 T'" - 2009 NOV 2 4 2014
<br /> AiQ�_�icaf%��ar�d�Ce��ti�i�afe::for�R�yrn,��,t�;�;;Co tr,.u�tion:Manage Adviser Edition ���������N�
<br /> , �;��.. r.as° ,
<br /> TO�OWNER:C9tqltsf- ono�•. .,:,,, -- �: , •- "�;" .;.PRQ ECT:":roao .Q -_ qp en� m e •:�: .
<br /> � 2750"Kelley EnrkWay ` 2750 Kellby Purkway � �APPL1CATfON N0: ' DISTRtBUTION'T0:
<br /> Orono,MN 55356 Orono,MN OWNER
<br /> PERIOQ TQ� 1�1/30(2014 CON3TRt1CTI0N MANAGER
<br /> FROM ' � �swnntit Fire Protection ' VIA CO�ISTRUC710N �+�Anderson ARCHITECT
<br /> �� . CONtRAGT pkTE:
<br /> CONTRACTOR:�.575 MinnehahaAvenue W MANAGER: Po box 158 P.RdJ�CT NOS:,12-4310 � � CpNTRACTOR
<br /> y...
<br /> -St Paul MN 55�03• M � �: ' Cirole Pines,IVIN.55014
<br /> CONTRACT FOR;F�e�prinkJers„ � ', �.�M';�,�4,.�;Af�C�lTECrT•SKD 2ytchitects,;Inc,� OTHER
<br /> «.�� .�..�-.� �,_
<br /> CONTRAC�TQR'S`A�PLI,CA�Tt�OT+I;�F�C:�`J�P �F�(;EN°,I�' ., '. �_ - _� � ��uiiaecsi8n«t;.conttacto�c�ri�ss.�at.totbe,bestoftlfeConu'acWr's.knowledge, ��„�,
<br /> � ' in d
<br /> � ` � '•� ~' �`^�{' �_ - ' ? .. belieftiiel?�orkcovered:b hisA ` 'cat►on�for,�a
<br /> Applica6bn:is made.for payi�eiit;as;holivn�elow 7n,couneeticn•witti thg Contract.�_ _, . Y'� ..',�p� �. zY�eat�ias been coinpleted ia aocordance with tl�e
<br /> '^�� �-�a' �� ' Contract Docume�t►ts;:ti�at'a11.ari�oynts;7�ave b�n;paid by�the Contractor.for Work forwvhich previous
<br /> AIA- �-�- �` T-SU che`d.:(...: , y........ 28,850.. o hown�h eui s,. i -
<br /> DoCua3ent,G�03�,Continuatioa STieet;:is atta � �
<br /> 1:ORIGINAI:C � ,I�I; .:. .. , ' .............. � ' ,�'aXi?!��were issued'and�payments'received&om the Owner,end that curreiut p
<br /> 0 :. . ..... ..... $ 4 aov�%due. ayment
<br /> 2.NE7 CHqNGES;IN THE-WORK..:..::............. D.00:: ., - ,� .�.'
<br /> .«�„ • •. .. . .................... .$ . �� � � CONTRAC �Summit Fire ProtecUon
<br /> 3.GONTRACTSt1M�TODATE'(Llhe;13�2)... . ... .............. 28,8�0_00�� 1��„�'��
<br /> �.C�OMP,I'.�"'ETED A •$ By' � Date: �1.�
<br /> .. . ............:....�.. . .
<br /> 4.TOTpL,_ ND.<STORED'TO DAT�(Colii»i'ti�r.on G70�) .......... � 19,�29:50� � • -----�`�'
<br /> State of �
<br /> 5.RETAINACsE: '. - � CouIIly-Ot'.'Ramsey 1��'` �9r'MA.�n�.��,��n.,
<br /> � �Si• .. � •'A1��'`a.lte4�OP,ryM1iww.✓
<br /> a. S:U�O�" a/,�',�ompleted Work �� Subacribed"and aworn to,before `' � ° ' � � ' "
<br /> (C'd1uinr D�„�E on G7Q3j -: $�96.6:48 ma tlus . '��day of N ZN' � ` :�'-�- .
<br /> b. . '`., "%a of Stored Mateinal _ :'�'�y c,, : - .
<br /> Notary Public: ,- :.r.�.�.,��,�, �
<br /> (ColumxFonG703J , , $ MvCommissionexnires:�•1c31-2015 ' � ' � - � ,-��
<br /> t . -
<br /> Toral�RetaiAage,(Lines Sa+Sb,or.Total tn Colt,mml on:G70�)....................�966.48�. � ;: _ -CERTIFtC�A, �("��..PAYM
<br /> 6.TOT.t e�4 mm��Line S ETAINAGE':........................:......................... �• ��� �.^ � Documen T a,
<br /> � EN
<br /> A . $1,8,363:02`` In accordance1v�nth iha ConttacC� ,b sed on evalnations of the Work anci 1,he data:comprising
<br /> (L,. . , �... +tal,j" .. `, ; . , this l pon e ConstrucuondVlaou andArclucect ' . '
<br /> r :e .
<br /> AP I�_ ,th `
<br /> 7.LESS�PREVIOUS;CERTIFfCATES:FOR PAYMENT.....:...:..:....................... 13;703.76 �+ g��,'"m ry °" " ��� � s,� � � ��e Owne_ ut tha• t of t6eu�
<br /> B�' � fY r th 'to bes
<br /> , : . kno led infvnnation�erid eF'the?W�oik-ha rogressed as,indicated,�tha yualiry of the Work is in
<br /> S.CURR�ItPAYMENI'.UE..cate.::................:..:...i ' - ., �' =. w• �. - accot'dance�ivith Contract o en Coatractor.�senUtledt y�nentof UNT
<br /> (� .�' P ��, ) , 1he D'cuiri ts;�und lhe o pa iha AM0
<br /> ,. , „ (e 4;659:26 : _ , ..
<br /> �� ERTiFIED.
<br /> � ...........................�_ r
<br /> 8.BAL'pN�ETO�FiN113H;INCLUDING R�T'AINAGE � ; AMOUNT CERTIF1Eb........:......................
<br /> - - , ........................$ �l�S�j��
<br /> � (Atlach explanatfon:f a»rou,rtt cert�ed d'4Q''ers from 1he amourrt app/ied.InfriQl.aTt,�?gures on thts
<br /> ' (�ine 3 minus�Ltne 6) $ 10,486.98 Appliauiohqnd on the Cos!lmtatfon Sheet that are changed to conform w�lh 1he amount cert�ed.)
<br /> , CONSTRUC�
<br /> .. . ,,. �ate: 1 a.����.�"
<br /> SUMMA'liY OF�GHANGES 1N THE-WORK : �1: �` .:,, ADDITIONS �DEDUGTIONS R : O • ; ulti i� Contraeiors are res onsible or "
<br /> Total cban�es a""ioved in revious'atonths b OwnbrN'�e: $; � ,�� •' F � P ,�' perfor,xtng portians of the
<br /> $ - ;alinnfsnotreguired) � �
<br /> Total approved this month,-iacldding:ConstnicGori° � By: �" Date:
<br /> Chaa e Directivea- -�$; $ Tlus"Certi ioste is;noE n otlable.Ttie;AMO(1NT CERTTFIED is payabie on y to the ntractor named
<br /> "" TOTAL'S::s$� ' $ - herein;Issuance,,payment and acceptance of payment are wilhout prejudice to any righu of the O�vner
<br /> NET C '�i GE TN TtIE WORK• ` � w,�, ' ' • or Ccntracior under this�ontract.
<br /> " CAUTIoN�:iYou shouldslgn,an.orC inal�AlA�Cant�ac�Do4ument,;u�.�whfch this=textappears.in RED..An orlginal.assures.that.changes:will not be.obscured.
<br /> AIA Dociiinetit,G732TM-2DG8(tortnerty.�G702!!+CMa-1992):;Copyriyht�.1992and 2009'by The Artierioan Ins6tute ofiArchitects,-AII Hghts reseryed.WARNING:This AIA Documant is pwtectod by U.S.Copyright Law and
<br /> Intemallonai Traatfos.Unauthorfzed rap►oducUon or distribuNon of this AIA°Document,or any porlion.of 1t,may result in savere civiband•oriminal p�nalGas,and'will be prosecutad to the maximum extant possiWa under
<br /> the law.Purchasere are permitted to reproduce len(10)coples of lhis document when completed.Ta report copyrlght vlo�tfona ot AIA Cohlraet�ocuments,amall The American InsUlule of Architects'legal counsel,copyright�ala,org.
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