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G732 CMa APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF 2 PAGES TO OWNER: PROJECT: APPLICATION#: �4'?j Distribution to: City of Orono Police Department Orono Police Dept Renovation ,.._, __.,, __ PERIOD TO: 12/31/14 proJect#90447 ��A _:'"'�PROJECT NOS: Owner " , -��' Const. Mgr FROM CONTRACTOR: VIA ARCHlTECT: _ _. , CONTRACT DATE: 07/29/14 Architect Kraus Anderson SKD Archltects � x COntractOr ICa�ifi.s.'c3��^^ :,�''_ -s.,,,� CONTRACT FOR: Sierra Metals, Inc. �`°��'= e'"�';T.� - CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contredor cerdfies that to the best of the Conhactor's knowledge,information and belfef � Application is made for payment,as shown below,in connection with the Contract. the Work covered by this Applicatlon for Payment has been completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certiticates Continuation Sheet is attached. Tor Payment were issued and payments r�celved from the Owner,and that current peyment shown therein is now due. . GINAL CONTRACT SUM--------------------- $ 35,072.00 CONT • �;,:�:�'i�#change by Change Orders---------------a $ lo• �.�.'�ONTRACT 3UM TO DATE(Ltne 1 +/-2) $ �^ �. By: lO V 4.TOTAL COMPLETED 8 STORED TO DATE� 35,924.00 Tina R Keller (Column G on ConHnuadon Sheet) State of: MINNESOTA NOTARY PU81,1� 5. RETAINAGE: Countyof: Q �� m MiNIV��OTA, Mr co�►as�on r��rr�iao�s a. 5.0% of Completed Work $ 1,796.20 Subscribed and sworn to before- (Columns D+E on Continuation Sheet) me this � day of b. of Stored Material $ � ( olumn F on Continuation Sheet) Notary Public: Total Retainage(Line 5a+5b or My Commission ex ires: Total in Column 1 of Continuation Sheet-- $ 1,796.20 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LES3 RETAINAGE--------- $ 34,127.80 In accordance with Contract Documents,based on on-site obseroations and the deta comprfsing (Line 4 less Lirte 5 Total) appBcadon,the A►chitect cer8fles to the Owner that to the best of the Architect's knowledge,information 7. LESS PREVIOUS CERTIFICATES FOR PAYM ENT and belfef the Work has progressed as indicated,the quality of the Work is in accordence with the Contract Documenta,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. (Line 6 from prior Certificate)-----------------� $ 31,096.35 8.CURRENT PAYMENT DUE......................... $ 3,031.45 �/ � I �, 9.SALANCE T�FINISH,INCLU�INi ETAINAGE AMOUNT CERTIFIED--------------------S (Line 3 less Llne 6) 1CW� $ �Q�2-(� �ZC� CONSTRUCTI N MANAGER: By: Date: �L�3a ,� , HAN E RDER UM ARY ADDI I N DEDUCTI N ARCH Total changes approved in previous months b Owner $4,622.00 -$3,770.00 By: Date: � Total a roved this Month Thfs Cerdficate is not negotiable. The AMOUNT CERTIFIED Is peyable onlyto the Cont ctor amed TOTALS $4,622.00 -$3,770.00 herein. Issuance,payment and acceptance of peyment are without preJud�e to any dghts of the Owner NET CHANGES b Chan e Order $852.00 ot Contractor under this Contract.