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APPLICATION AND CERTIFICATION FOR PAYMENT RTL Inv # 14-282-4 <br /> TO CONSTRUCTION MANAGER: PROJECT: Orono Police Department APPLICATION NO:4 <br /> Kraus Anderson �� <br /> PO Box 158 � :����� <br /> Circle Pines, MN 55014 ��'�1� <br /> PERIOD TO: 12/31/2014 <br /> FROM CONTRACTOR: D�C �� �' '�}�� <br /> RTL Construction,Inc. <br /> 4000 Valley Industrial Blvd S RTL JOB NO: 14-282 �l��µ�`�Q�R�pNcB� <br /> Shakopee,MN 55379 ��r��F�C'!���`� <br /> CONTRACTORS APPLICATION FOR PAYMENT The undersigned contractor certifies that to the best of the contractor's knowledge,information <br /> and belief the Work covered by this application for payment has been completed in accordance with <br /> the Contract Documents,that all amounts have been paid by the Contractor for Work for which <br /> previous Certificazes for Payment were issued and payments received from the owner,and that <br /> current payment shown herein is now due. <br /> 1.)ORIGINAL CONTRACT SUM ................ $110,900.00 CONTRACTOR: RTL Construction, Inc. <br /> 2.)Net Change by Change Orders................... $0.00 <br /> 3.)Contract Sum to Date .............................. $110,900.00 "'� ' <br /> 4.)Completed and Stored to Date ................... $110.900.00 `"$Y: 'f�G �;;��� Date: ��-�(o -� <br /> 5.)Retainage ........................................... $5.545.00 �� <br /> 6.)Total Earned less Retainage...................... $105,355.00 State of: County of: �lu�.�+' 7�, <br /> 7.)Less Pre��i,�us Certificates for Pa;�ment......... 96,31 l.27 Subscribed and swo before ' �� day of I�C�V�� <br /> - KELSIE AWN �'IFPGRAS <br /> ,,,„.... <br /> S.) Cu<«n�Pa�mcnt Due.............................. $9,043.73 �/ Notary Yublic: � - ��� '��''• Netary Pu6tir. <br /> 9.)Balance to I'iui�l� Iucludin Retaina�c......... �5,545.00 M Commission Ex s: 1/31/201 =���y'�'�=' �����eSota <br /> , g b Y ':?S�r` PJIy Cemm Expires <br /> "'" Jan 31, 2015 <br /> CHANGE ORDER SUMMARY Additions Deductions CERTIFICATE FOR PAYMENT <br /> Total changes approved previously In Accordance with the Contract Documents,based on on-site observations and the data <br /> Comprising the application,the Architect certifies to the Owner that to the best of the Architects <br /> Total approued this month Knowledge,information and belief the Work has progressed as indicated,the quality of the work is <br /> Totals In accordance with the Contract Documents,and the Contractor is entitled to payment of the <br /> NET CHANGES by Change Order 0.00 AMOLJNT CERTIFIED. �� <br /> AMOiJNT CERTIFIED.............. $ L���� � <br /> (Attach explanation if amount certified d�ers from the amount applied.Initial all figures on this <br /> Application and on the Continuation Sheeet that are changed to conform with amount certified.) <br /> Constructio anager: <br /> By: Date: r L � �`'� <br /> Arc 'tect: <br /> By: Date: ( <br />