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APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION �
<br /> AIA DOCUMENT G702/CMa PAGE ONE OF PAGES
<br /> TO OWNER Kraus Anderson Construction r'"' '�'RQ�F�;�':r_,,, rty of Orono Police Dept. APPLICATION NO: 3 Distribution to:
<br /> 8625 Rendova Street NE ` "" ''� -�: . ;.;�,�130 Kelley Parkway �OWNER
<br /> PO Box 158 Orono,MN 55356-9387 PERIOD TO: 12/31/14 �CONSTRUCTION
<br /> - � .,
<br /> Circle Pines,MN 55014 �=� -= •� :'�r PROJECT NO: MANAGER
<br /> FROM CONTRACTOR: �ARCHITECT
<br /> �LlS-AfVCERSON�
<br /> Grazzini Brothers and Company CJ,��������`S CONTRACT DATE: �CONTRACTOR
<br /> 1175 Eagan Industrial Road
<br /> Eagan,MN 55121 VIA CONSTRUCTION MANAGER:
<br /> CONTRACT FOR: VIA ARCHITECT:
<br /> CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
<br /> Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been
<br /> Continuation Sheet,AIA Document G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid
<br /> by the Contractor for Work for which previous Certificates for Payment were issued and
<br /> payments received fi•om the Owner,and that current payment shown herein is now due.
<br /> 1 ORIGINAL CONTRACT SUM $ 16,605.00
<br /> 2. Net change by Change Orders $ CONTRACTOR: zini Brothers and Company
<br /> 3. CONTRACT SUM TO DATE(Line 1 f 2) $ ,� .
<br /> 4. TOTAL COMPLETED&STORED TO DATE $ /
<br /> (Column G on G703) Date: 1 l�(`�
<br /> 5. RETAINAGE:
<br /> a. %of Completed Work $ 1,526.25 State o£ Minnesota County o .
<br /> o umn�D+E on G703) Subscribed and sworn to bef re me this 11 �� '`'�2 Dec. ,�CroAy p b��50 N
<br /> b. /o of Stored Material $ Notary Public: `�1Q,�i�.v, �( ;
<br /> o umn F on G703 M Commission ex ires: r �l/31/17 � State of Minnesofa
<br /> �— � y p l ,�' My Commission Expires
<br /> Total Retainage(Lines Sa+Sb or • ,.,. � Jon ar 31, 201 7
<br /> Total in Column I of G703) $ 1,526.25 -
<br /> 6. TOTAL EARNED LESS RETAINAGE $ 28,998.75 In accordance with the Contract Documents,based on on-site observations and the data
<br /> (Lme 4 less Lme 5 1 otal) comprising this appl�cation,the(;onstruct�on Manager vid Architect certity to the
<br /> 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge,information and belief the Work has
<br /> PAYMENT(Line 6 from prior Certificate) $ 9,500.00 progressed as indicated,the quality of the Wark is in accordance widt the Contract
<br /> 8. CURRENT PAYMENT DUE $ . � � ..:_.,_... , �Documents,and the Contractor is entitled to payment of the AMOUN_ T;GERTIFIED.
<br /> ....
<br /> 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 1,526.25 �S � �
<br /> `(�,. 4.�'
<br /> (Line 3 less Line 6) AMOLJNT CERTIFIED $ ��� �l`_ `'
<br /> (Attach explanation if amount cerlified differs from the amount applied for. Inatial all
<br /> ota c anges approve figures on this Ap 'cation and on the Continuation Sheet that changed to conforns to the
<br /> in previous months by Owner $13,920.00 amount certif .
<br /> CONSTR TI N ER• l f !�
<br /> Total approved this Month $0.00 By: Date:
<br /> AR f r�.,
<br /> TOTALS $13,920.00 $0.00 By: Date: 1 I:J
<br /> NET CHANGES by Change Order $13,920.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
<br /> Contractor named herein.lssuance,payment and acceptance of payment are without
<br /> ' prejudice to any rights of the Owner or Contractor under this Contract.
<br /> AIA DOCUMENT G702/CMa APPLiCATION AND CERTIFICATION FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION 1992 EDITION AIA� �O 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
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