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APPLICATION AND CERTIFICATE FOR PAYMENT corrs�xucTiorr NraivaGEx-�visEx EDiTTON � <br /> AIA DOCLIMENT G702/CMa(Inawction on reverae side) PAGE ONE OF TWO PAGES <br /> CON1'RACTOR: Kraus Anderson PROJECT: Orono Police Station..- � ` _`i�'LICATION NO.: 4 Diatribution to: <br /> 8625 Rendova Street NE PO Box 158 2730 Kelley Parkwayi,; ; � P�RIOD TO: 12/31/14 OWNER <br /> Cirole Pines,MN 550014 Otono,MN 55336 PROJECT NOS.: BCONSTRUCTION <br /> ,. .-, '' ? MANAGER <br /> FROM CONTRACTOR: Minnesota Utilities&Excavating,LLC �' - � CONTRACT DATE: 7/29/14 ARCHITECT <br /> 13932 L.ake Drive ^ _ eCONT'RACTOR <br /> Forest Lake,MN 55025 ����`� -"~'^''r�&E Job# 5604&7609 <br /> VIA CONSTRUCTION MANAGER: �~ '' � "" �� <br /> CONTRACT FOR: Earfhwork 8c Utilitiea VIA ARCHITECT: <br /> CONTRACTOR'S APPLICATION FOR PAYMENT Tf'e underaigned Contractor certifies that to the best of the Contraotor's knowledge,info�mation and belief the Work <br /> oovered by this Application for Payment has been completed in aocordence wifh the Contract Doc�ents, that all <br /> Application is made for payment,es shown below,in cormecGon with the Conrtact amounla have been paid by the Con7aator for Work for which previous Certificates for Payment were iasued and <br /> Contmuahon Sheet,AIA Dacument G703,is adached payments received from the Owner,and that cwrent payment ahown hetein ia now due. <br /> 1. ORIGIl�IAL CONTRACT SUM $ 563,822.00 <br /> 2. P1et Change By Change Ordera $ 66,715.00 CO OR: i <br /> 3. CONTRACT SiJM TO DA1'E(Line 1+/-2) $ 630,537.00 By: Date:b �� <br /> 4. TOTAL COMPLETED&STORED TO DATE $ 606,42'7.00� <br /> ...�r.— - <br /> (ColumnGonG703) 5 of: Minnesota �� JN�QiyN�'R71S5 <br /> 5. RETAINAGE: County of: Washington 3 <br /> a 5% ofCompletedWork $ 30,321.35 Subscribedandaworntobefore � � �; StOte ot Mmflesotd <br /> �,� y�. My Commis•sion Expi�res <br /> (Columns D+E on G703) me thi�� f �/���y J o n u c57 y 31 , 2 O 1 6 <br /> b. 5% of Stored Material Notary Publi <br /> (Column F on G703) My Co xpires: 1/31/2016 <br /> Total Retainage(Line Sa+Sb or CERTIFICATE FOR PAYMENT <br /> Total in Column I of G703) $ 30,321.35 <br /> 6. TOTAL EARNED LESS RETAINAGE $ 576,105.65 In accordance with the Contract Documenta,based on on-site observations and the data comprising this applioation,the <br /> (Line 41ess Line 5 Total) Construction Manager and Architect oertify to the Owner that to the best of their knowledge,infocmation and belief the <br /> 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 512,726.40 �'OCk has progres.aed as indioated, the quality of the Work is in aocordance with the Contract Doauments, and the <br /> Contractor ia entiUed to payment of the AMOUNT CER'fIFIED. <br /> (Line 6 from prior Certifioate) <br /> 8. CURRENT PAYMENT DUE $ 63,379.25 � <br /> 9. BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTTFIED $ $ 63,379.25 � <br /> (Line 3 less Line 6) $ 54,431.35 (Attach explanation ef amount certifred d�ffers from the amount applied for. Initral all figures on this applrcat:on and <br /> on the Contimiation Sheet that changed to conform to the amount certifred) <br /> CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONSTRUC MANAGER: � <br /> Total changes approved in By: Date: lZ 3+ f <br /> 66,715.00 <br /> previous month by Owner AR <br /> Total approved this Month - By: Date: � <br /> TOTALS 66,715.00 - This Certifiaa is not negotiab e. The AMO CERTIFIED is payable only to the Contractor me herein. Isauance, <br /> NET CHANGES by Change Order 66,715.00 Payment and aoceptance of payment are without prejudice to any rigMs of the Owner or Contractor under thia Contract. <br /> THIS DOCUMENT HAS BEEN CREATED US1NO EXCEL 97. G702/CMa-1992 <br />