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��C�iv�� <br /> APPLICATION AND CERTIFICATE FOR PAYMENT co STRUCTION MANAGER-ADVISER EDITION � <br /> AIA DOCUMENT G702/CMa NOV � � �n�a PAGEONEOF 2 PAGES <br /> TO OWNER: PROJECT: APPLICATION NO: 2 Distribution to: <br /> City of Orono City of Orono Police Department R ' 1�� aOWNER <br /> 2750 Kelley Parkway 2730 Kelley Parkway C� �N��$ERIOD TO: 11/30/14 XaCONSTRUCTION <br /> Orono,MN 55356 Orono,MN 55356 PROJECT NO: MANAGER <br /> FROM CONTRACTOR: �ARCHITECT <br /> WTG Terrazzo&Tile,Inc. CONTRACT DATE: 7/29/14 �CONTRACTOR <br /> 12101 Nicollet Ave S <br /> Bumsville,MN 55337 VIA CONSTRUCTION MANAGER:KAMW <br /> CONTRACT FOR: Tiling as per Contract VIA ARCHITECT: SKD Architects,Inc. <br /> CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, <br /> Application is made tbr payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Yayment has been <br /> Continuation Sheet,AIA Document Ci7U3,is attached. completed in accordance with the Contract llocuments,that all amounts have been paid <br /> by the(:ontractor tor Work for which previous(;ertiticates Y'or Yayment were issued and <br /> payments received f'rom the Uwner,and that current payment shown herein is now due. <br /> 1. URIUINAL CUN'1'KAC'1'SUM � 4U,U75.UU <br /> 2. Net change by C;hange Urders $ (;UN'1' ''UR: W"1'Ci'' rrazzo 8c'1'ile,lnc. <br /> 3. C:UN'1'1tAC;'1'SUM'1'U llA'1'�;(Line 1 f 2) $ , . <br /> 4. '1'U'1'AL C:UMYL�'1'�ll�i S'1'Uft�ll'1'U llA'1'� $�`p��'�� <br /> (Column Ci on U703) By: te: _11/2U/14 <br /> 5. li�;'1'A1NACi�:: el 'erguson- ntroller <br /> a. 5 %of Completed Work $ ��l.�l� State ot: n so C T: llakota <br /> o umn ll+�on Ci7U3) Subscribed d to before this ,lg, U 4 <br /> b. 5 %of Stored Material $ U.UU Notary Yublic: '"'' ' �{j�� " <br /> o umn N on U703) My(;ommissi ex res: � _`' � NOTARY PUBLIC <br /> '1'otal Ketainage(Lmes Sa+Sb or % <br /> ''� �: MINNES <br /> missmn xpires an.31,2078 <br /> Total in Column I of G703) $ 13a�.loC� <br /> 6. TOTAL EARNED LESS RETAINAGE $�� �(�,,�{t� In accordance with the Contract Documents,based on on-site observations and the data <br /> (Lme 4 less Lme J 1 otal) � compnsmg this applicanon,the l:onsuucrion Manager and Archrtect certiiy to the <br /> 7. L�;SS YK�;VIUUS C�R'1'1N1CA'1'�S NUR Uwner that to the best of their knowledge,information and belief the Work has <br /> YAYM�N'1'(Line 6 f'rom prior C;ertiticate) 1[�{,L, � 1.141.90 grogressed as indicated,the quality of the Work is in accordance with the C'ontract <br /> 8. (;URft�N'1'YAYM�N'1'llU�; �:•- � ,p�`s, � "bocuments,and the C;ontractor is entitled to payment ofthe AMUUN'1'(;�K'1'iN'l�ll. <br /> 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ I''��.�l3a..(oC� ,� <br /> (Line 3 less Line 6) AMOUNT CERTIFIED $ �(�-� �� <br /> (Attach explanation iJ amount certified difjers from the amount app[ied for. lnitial al! <br /> o c anges approve figures on this App[ication and on the Continuation Sheet that changed to conJorm to the <br /> in revious months by Uwner amount certif' <br /> CU " A �R: <br /> '1'otal approved this Month $625.UU Uate: -�. <br /> '1'U'1'ALS $625.UU $U.UU y: llate: v <br /> NET CHANGES by Change Order $625.00 This Certificate is not negotiable. T'he AMOLJNT CERTIFIED is payable on y to the <br /> C:ontractor named herein.lssuance,payment and acceptance of payment are without <br /> prejudice to any rights of the Uwner or C;ontractor under this C:ontract. <br /> AIA DOCUMENT G702/CMa�APPLICATION AND CERTIFICATION FOR PAYMENT•CONSTRUCTION MANAGER-ADVISER EDITION 1992 EDITION AIA��m 1992 G702lCMa-1992 <br /> THE AMERICAN INSTITUTE OF ARCHITECTS,1745 NEW YORK AVE.,N.W.,WASHINGTON,DC 20006-5292 <br /> Users may obtain validation of this document by requesting of the license a completed AIA Document D401 -Certification of DocumenYs Authenticity <br />