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AIA Type Document <br /> �r,`_ , -- - Appiication and Certification f_or Payment Page 1 of 2 , <br /> TO: City of Orono ' ���- - � Project: Orono Police Dept APPLICATION NO: 2-FINAL DISTRIBUTION TO: <br /> 2750 Kelley Parkway r�n ,. �. � PERIOD TO: 12/17/2014 X OWNER <br /> Orono, MN 55356 3 ���:- ' `� �- ARCHITECT <br /> CONTRACTOR <br /> FROM: Midwest Fence&Mfg. tC4�{�I��ilL'�`l�f�£C'�� SKD Architects, Inc. <br /> 525 E.Villaume Avenue �'� �'����`��S 11140 Highway 55, Suite A PROJECT NO: 90447 <br /> S. St. Paul MN 55075 Plymouth, MN 55441 <br /> CONTRACT FOR: Orono Police Dept CONTRACT DATE: August 1, 2014 <br /> CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information <br /> Application is made for Payment,as shown below,in connection with the Contract. and belief the work covered by this application for Payment has been completed in accordance <br /> Continuation Sheet,AIA Type Document is attached. with the Contract Documents,that all amounts have been paid by Contractor for Work for which <br /> previous Certificates for Payment were issued and payments received from the owner,and that <br /> 1. ORIGINAL CONTRACT SUM.................................. $ 29,900.00 current payment shown herein is now due. <br /> CONTRACTOR:Midwest Fence&Mfg. <br /> 2. Net Change by Change Orders............................ $ - 525 E Villaume Ave <br /> S.St.Paul,MN <br /> 3. CONTRACT SUM TO DATE(Line 1 +2).................... $ 29,900.00 � <br /> By: Date: /Z /7 l <br /> 4. TOTAL COMPLETED AND STORED TO DATE........... $ 29,900.00 State of: MN <br /> County of: Dakota �����r"� <br /> 5. RETAINAGE: Subscribed and Swq�to b�efore me this 17_ Day of 2014 ��� <br /> a. 5 %of Completed Work 1,495.00 Notary Public: �.�out�O�.Q BJIRBARAJ.R4ERKA <br /> b. %of Stored Material My Commission Expires: 1— —1 lq�ARYPI�LIC-M{NNESOTA <br /> Total retainage(Line Sa+Sb)............... $ 1,495.00 <br /> CERTIFICATE FOR PAYMENT • ��"���a�,2018 <br /> In Accordance with the Contrect Documents,based on evaluations of the Work and Data Comprising <br /> 6. TOTAL EARNED LESS RETAINAGE............................ $ 28,405.00 this application,the Construction Manager and ArchRect certify to the Owner that to the best of their <br /> (Line 4 less Line 5 Total) knowlage,information and belief the Work has progressed as indicated,the quality of the work is in <br /> 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT <br /> (Line 6 less prior Certificate) $ 25,569.25 CERTIFIED. ���� �� <br /> � <br /> / AMOUNT CERTIFIED......................................................5 <br /> 8. CURRENT PAYMENT DUE......................................... $ 2,835.75 ✓ (Attach explanation if amount certified differs from the amount applied. Inkial all figures on this <br /> 9. BALANCE TO FINISH,INCLUDING RETAINAGE Application and on ie Continuation Sheet that are changed to conform to the amount cert�ed.) <br /> (Line 3 less Line 6) $ 1,495.00 coNsrnu 1 MA �t <br /> CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS By: Date: /L D �7 <br /> ARC T:(NOT :if ftiple Prime Contractors are responsible for pertorming portions of the Project,the <br /> Total changes approved in Arc t equired) <br /> By: Date: j <br /> previous moMhs by owner This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the ont actor <br /> Total approved this Month - named herein. Issuance,Payment and acceptance of payment are without prejudice to any <br /> TOTALS - - rights of the Owner or Contractor under this Contract. <br /> NET CHANGES by Change Order - <br />