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<br /> 4 superior NOV192014 �
<br /> painting & decorating, inc. KRAUS-ANDERSON�
<br /> APPLICATION AND CERTIFICATE FOR PAYMENT PAGE 1 OF 2 CIRCLE PINES
<br /> TO OWNER: City of Orono PROJECT: City of Orono Police Dept APPLICATION#: 2 DISTRIBUTIONTO:
<br /> 2750 Kelley Parkway 2730 Kelley Parkway OWNER
<br /> Orono,MN 55356 Orono,MN 55356 PERIOD TO: 11/30/2014 CONSTRUCTION MANAGER
<br /> FROM VIA CONSTRUCTION CONTRACT DATE: 7/29/2014 ARCHITECT
<br /> CONTRACTOR: Superior Painting 8�Decorating,inc MANAGER: PROJECT NOS: 90447 CONTRACTOR
<br /> 3543 88th Ave NE#100,Circle Pines,MN 55014-4108 FIELD
<br /> CONTRACT FOR: Painting VIA ARCHITECT: SKD Architects,tnc.11140 Highway 55,SteA,Plymouth,MN 55441 OTHER
<br /> CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's
<br /> knowledge,information and belief the Work covered by this Application for
<br /> Application is made for Payment as shown below,in connection with the Contract. Payment has been completed in accordance with the Contract Documents,that all
<br /> AIA Document G703,Continuation Sheet,is attached. amounts have been paid by the Contractor for Woric for which previous
<br /> Certificates for Payment were issued and payments received from the Owner,and
<br /> that current payment shown herein is now due.
<br /> 7. ORIGINAL CONTRACT SUM ........ .... .......�...... $ 21,701.00
<br /> 2. NET CHANGES IN THE WORK.......... .... ............. $ 648.00 CONTRACTO`� r���/�e ing,Inc. J� /� %
<br /> B : Date: � 11/17/2014
<br /> 3. CONTRACT SUM TO DATE(Line 1 +.2) $ 22,349.00 State of: MN '
<br /> County of: Anoka � - � • • � . t �
<br /> 4. TOTAL COMPLETED&STORED TO DATE $ 17,251.00 Subscribed and sworn to before ,, ' '� .�, .,_ ,' T '
<br /> (Column G on G703) me this 12day of ^/o� Le,iy _ _ �
<br /> 5. RETAINAGE � � �� �
<br /> , ,�., -,,. -, :�. •, • •-, .
<br /> a. 5% of Completed Work $ 862.55 Notary Public:��,�,���--- � �.� .- . -?
<br /> (Column J on Schedule of Values Draw Request)
<br /> b. 5% of Stored Material $ 0.00 My Commission e�ires: (-3���"i
<br /> CERTIFICATE FOR PAYMENT
<br /> Total Retainage(Line 5a+5b)... ... .. . .. .... . .. .. . .. . . . . . .. . . . $ 862.55 In accordance with the Contract Documents,based on evaluations of the Work and the data
<br /> comprising this application,the Construction Manager and Architect certify to the Owner that to the
<br /> 6. TOTAL EARNED LESS RETAINAGE.......... .... ............. $ 16,388.45 best of their knowledge,information and belief the Work has progressed as indicated,the qualiry of
<br /> (Line 4 less Line 5 Total) the Work is in accordance with the Contract Documents,and the Contractor is entitled to p�ent of
<br /> 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT.......... $ 5,955.55 the AMOUNT CERTIFIED. �
<br /> (Line 6 from prior Certificate) OUNT CERTIFIED......................................... �� ��3Z_�
<br /> 8 CURRENT PAYMENT DUE......... ........ .... ............. $ 10,432.90 (Attach explanation if amount certified differs hom the amount applied.Initial all figures on this
<br /> App/ication and on the Continuation Sheet that are changed to conform with the amount certified.)
<br /> 9 BALANCE TO FINISH,PLUS RETAINAGE..... .... $5,960.55 CONSTRU R:
<br /> (Line 3 less Line 6) By: Date: _ �
<br /> ARCHITE . ulf ' e Contractors are respo ib rming porfions
<br /> SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS of the Proj 's ' is not required.
<br /> Total chan es ap roved in revious months b Owner By: Date:
<br /> Total approved this month, including Construction Change $648.00 This Certificate is not nego iable. The A UNT CERTIFIED is payable only to the Contractor
<br /> Directives named herin. Issuance,payment and acceptance of payment are without prejudice to any
<br /> TOTALS $648.00 $0.00 rights of the Owner or Contractor under this Contract.
<br /> NET CHANGES IN THE WORK 5648.00
<br /> CAUTION: You should sign an original AIA Contract Document,on which this text appear in RED. An original assures that changes will not be obscured.
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