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<br /> Application and Cerfificate for Payment, Consfrucfion Manager as Adviser Edition
<br /> TO OWNER:City of Orono PROJECT: rono o ice ep en em e pppLICATION N0: 3 - ' DISTRIBU710N T0:
<br /> 2750 Kelley Parkway 2750 Kelley Pazkway OWNER
<br /> Orouo,MN 55356 Orono,MN PERIOD T0: 12/3]/2014 CONSTRUCTION MANAGER
<br /> FROM Summrt Fire Protection VIA CONSTRUCTION Kraus Anderson CONTRACT DATE: ARCHITECT
<br /> CONTRACTOR: 575 Minnehaha Avenue��' MANAGER: PO box 158 PROJ��T NOS: 12-4310 � � CONTRACTOR
<br /> St Paul,MN 55103 Circle Pines,MN 55014 FIELD
<br /> CONTRACT FOR:F�re Sprinklers VIA ARCHITEC7:SKD Architects,Inc. OTHER
<br /> CONTRACTOR'S APPLICA110N FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,informaticm and
<br /> belief the Work cwered Uy this Application for Payment has been completed in accordance with the
<br /> Application is made for payment,as sho«n below,in connection wiUi the Contract. Contract Documents,tl�at all amounts have been paid by the Contractor for Wo�k for�vhicl�previous
<br /> A[A Document G703T"',Conlinuation Shcet,is attached. Certificates for Payment were issued�nd payments received from t6e Owner,and that current payment
<br /> 1.ORIGINAL CONTRACT SUM............... ............................................$28,850.00 shown herein is now due.
<br /> 2.NET CHANGES IN THE WORK............. ............................................$0.00 CONTRACTOR:Summit Fire Protect�on
<br /> 3.CONTRACT SUM TO DATE(Line 1 f 2) .............................................$28,850.00 gy; Date; �,Z•1,,.7•�4
<br /> 4.TOTAL COMPLETED AND STORED TO UATE(Colum»G on G703)..............$27,263.25 State of: M '
<br /> 5.RETAINACsE: County of: sey
<br /> a. 5.00 %of Completed Work Subscribed and swom to befare RACHEL FRANCES ROBERTS
<br /> (Cohrum D+E o�v G703) $ 1,363.17 me tlris �1 d�y of,�•M��� Notary Publio-Minnesota
<br /> b. 4%of Stored Ntaterial Notary Public: ����Y�- �"h'�'OQM"�0"
<br /> (Colirrnl�FonG7U3 —�� ��.�,11�UV1�� ���1,2ot9
<br /> � $ My Commission exvires: 1-31-2015
<br /> Total Ketainage(Li,re,r sa+sh,ar Total in Colru�n I at C703J...................$ 1,363.17 CERTIFICAT� FOR PAYMENT
<br /> 6.TOTAL EARNED LESS RETAINAGE...... ............................................$25,900.08 � 1n accordance with ihe Contract Documeuts,based on evaluations of t6e Work and tl�e data comprising
<br /> (Line 4 miriers Line S TntalJ this application,the Construction Manager and Architect certify to the Owner that to•the best of lheir
<br /> 7.LESS PREYIOUS CER7IFICATES FOR PAYMENT.................................... 18,363.02 knowledge>information and belief the Work has pro�ressed as indicated,the quality of the�Vork is in
<br /> (Lt�ie 6,fi�orn pria•Certificale) accordauce witli the Contract Documents,end the Contractor is eniitled to payment of the AMOUN'I'
<br /> 8.CURRENT PAYMENT DUE....................... ......................................g 7,537.06 ��RTIFIED. fi 'S
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<br /> 9.BALANCE TO FINISH,INCLUDING RE7AINAGE AMOUNT CERTIFIEb.......................................................$ /� 3�
<br /> (Arlach explanatian if amou�Jt certified difJ'eis fro�r��he amaurot app/ied.Inilinl a11 figur•es on lhis
<br /> (Liue 3 ruinus Line 6) $ 2,949.92 Application an on the Continvalion Slteet ihal m•e ehanged to coi�orni with the amncmt certified)
<br /> CONSTRU N MANAGER;
<br /> BY� Date: �Z 30 �`�
<br /> SUMMARY OF CHANGES IN THE W(�RK AT�DITIONS DEDUCTIONS ARCH CT:(NOTE: Mrrlti le Prime ConU•ac�o�x are respo»sib/e for per;/'o ring portions of d1e
<br /> ?'otal changes appro�•ed in previous month::by Owner $ $ Pr e ' 1io17 fs�ol re�iiirecl.�
<br /> 1'otal approved this moitth,including Cunstrucliuu By: Date: � ��
<br /> Change birectives $ $ This CerU icate is not nego4i 1e.�'he AMOUNT CERTIFIED is payab onl to the Contraetor named
<br /> T'OTALS $ $ hetein.Issuan�e,payment and acceptance of payment are withoat prejudice ta any rights of lhe O�vner
<br /> NET CHANGES IN THE�VORK � or Contractor under this Contraet.
<br /> _:AUi"lC�hl You shvu!d sign an o�igin��� .l t'���rtrer,t i7ocument,on a�hich this text appears in RED An origiaal assurps lh�i cl�anges�rift nQt be obscurect.
<br /> AIA Document G732""-2009(fortnerty G702*"�CMa-1992).Copyright�1992 end 2009 by 7he American Inslitute of Rrchitects.All rights reserved.WARNING:This ItIA'IJocumenl is protected by U.S.Copyright Law and
<br /> tntemation�l 7rn�t�es Uaauti�o�izcd teprodr :�t�c�d'�tribnrtian qf ihEs AIA Oecurtent,�r»ny portlon ot It,may result Irt severe clvil a�d sntttifnal pettaltlPs,and caill be prosecuted to the m�ximum�xtent po�,ible uncier
<br /> 'F�������.purchasers are permiBed to reproduce ten(1U)coples of thls dncumeni when completed.To report copyrighl violallons of AIA Contract Documenls,e-mail The Rmerlean Instilule of Archltecls'legal c;ounsel,cnpyright@afa.arg.
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