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APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION � AIA DOCUMENT G702/CMa PAGE ONE OF 2 PAGES TO OWNER: PROJECT: APPLICATION NO: 3 Distribution to: City of Orono City of Orono Police Deparlment Remodel&Expansion �OWNER 2750 Kelley Parkway 2730 Kelley Parkway PERIOD TO: 12/31/14 �CONSTRUCTION Orono,MN 55356 Orono,MN 55356 PROJECT NO: MANAGER FROM CONTRACTOR: �ARCHITECT WTG Terrazzo&Tile,Inc. CONTRACT DATE:7/29/14 QCONTRACTOR 12101 Nicollet Ave S Burnsville,MN 55337 VIA CONSTRUCTION MANAGER:KAMW CONTRACT FOR: Tiling as per Contract VIA ARCHITECT: SKD Architects,Inc. CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made Y'or payment,as shown below,in connection with the Contract. inYbrmation and belief the Work covered by this Application for Yayment has been Continuation Sheet,AlA Document G703,is attached. completed in accordance with the C:ontract llocuments,that all amounts ha�e been paid by the C:ontractor tbr Work Y'or which previous C;ertificates for Yayment were issued and payments received tiom the Uwner,and that current payment shown herein is now due. l. Ultl(i1NAL CUN'fKAC'1'SUM $ 40,U75AU 2. Net change by Change Urders $ CU ' C'1'UR: W'1'U' 'errazzo 8i'1'ile,lnc. 3. CUN'1'RAC'1'SUM'1'U llA'1'�(Line 1 t Z) $ 4. '1'U'1'AL(;UMYL�;'i'�ll 8c S'i'Ul�ll'1'U llA'1'� $ , (C;olumn(i on Ci7U3) By: _12/17/14 5. i�'1'A1NACi�: 1 'Nerguson-(;o oller a. 5 %of Completed Work $ 2,035.00 State of: i so o nty ot: llakota o umn ll+�on(i703) Subscribed d to betor �e ' � �ik.•+�a r 2014 b. 5 'Yo of Stored Material $ U.UO Notary Yubli • "_ �P I V ASCHKE o umn N on Ci7U3) My(;ommissi n e ires: f =w� NOT.ARY P '1'otal ltetamage(Lmes Sa+5b or MIMNESOTA Total in Column I of G703) $ 2,035.00 ' ' 6. TOTAL EARNED LESS RETAINAGE $ 38,665.00 In accordance with the Contract Documents,based on on-site observations and the data (Lme 4 less Lme� 1 otal) � compnsmg this apptication,the l;onstruction Manager and Architect certily to trie 7. L�;55 Y1t�V1UUS C:�R'1'1N'1C:A'1'�S�UK Uwner that to the best of their knowledge,information and belief the Work has YAYM�:N'1'(Line 6 from prior Certiticate) $ 25,167.4U progessed as indicated,the quality of'the Work is in accordance with the Contract 8. (;U1t1i�N'1'YAYM�N'1'llU� $::::�:::•::��::::::::.::.:.. '= �� llocuments,and the(;ontractor is entitled to payment of'the AMUUN'1'(;�K'1'1Nl�ll. .... .... . . 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 2,035.00 (Line 3 less Line 6) AMOLJNT CERTIFIED $ j�,�� C'� (Attach exp[anation iJ amount certified diJ}ers from the amount app[ied Jor. Initial al! ota c anges approve figures on this App 'cation and on the C'ontinuation Sheet that changed to conform to the in previous months by Uwner amount certifi . CUNS'1'RU '1 N ' 'R: '1'otal ap roved this Month $625.00 By: llate: �L 3� `'� � , ., . .. ., '1'U'1'ALS �625.00 $U.OU By: llate: NET CHANGES by Change Order $625.00 This Certificate is n t ne otiable. The OUNT CERTIFIED is yabl only to the Contractor named herein.lssuance,payment and acceptance of payment are without prejudice to any rights of the Uwner or(;ontractor under this C;ontract. AIA DOCUMENT G702/CMa�APPLICATION AND CERTIFICATION FOR PAYMENT�CONSTRUCTION MANAGER-ADVISER EDITION 1992 EDITION�AIA� �1992 G702/CMa-1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1745 NEW YORK AVE.,N.W.,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 -Certification of Document's Authenticity