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APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AIA DOCUMENT G702) PAGE ONE OF 2 PAGES TO(OWNER): City of Arden Hills PROJECT: Arden Hills City Hall APPLICATION NO: 7 4364 West Round Lake Rd 1245 West Highway 96 Arden Hills,MN 55112-5794 Arden Hills,MN 55112 PERIOD TO: 31-Mar-01 FROM(CONTRACTOR): Rochon Corporation VIA(ARCHITECT): Architectural Alliance ARCHITECT'S 3650 Annapolis Lane North,Suite 101 400 Clifton Avenue S. PROJECT NO: Plymouth,MN 55447 Minneapolis,MN 55403 CONTRACT FOR: General Construction CONTRACT DATE: 8/15/00 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment,as shown below,in connection CHANGE ORDER SUMMARY with the Contract,Continuation Sheet,Substitute AIA Document Change Orders approved in ADDITIONS DEDUCTIONS G703 is attached. previous months by Owner TOTAL 12,544.00 1. ORIGINAL CONTRACT SUM............................... $ 2,942,000.00 Approved this Month 2. Net Change by Change Orders............................ $ 12,544.00 Number Date Approved 3. CONTRACT SUM TO DATE(Line 1+/-2)..............$ 2,954,544.00 4. TOTAL COMPLETED&STORED TO DATE........... $ 1,568,470.80 (Column G on G703) 5. RETAINAGE: TOTALS 0.00 a._%of Completed Work Net change by Change Orders 12,544.00 (Column D+E on G703) The undersigned Contractor certifies that to the best of the Contractor's b._%of Stored Material knowledge,information and belief the Work covered by this Application (Column F on G703) for Payment has been completed in accordance with the Contract Total Retainage(Line 5a+5b or Documents,that all amounts have been paid by the Contractor for Work for Total in Column I of G703)......................... $ 78,358.84 which previous Certificates for Payment were issued and payments received 6. TOTAL EARNED LESS RETAINAGE......................$ 1,490,111.96 from the Owner,and that current payment shown herein is now due. (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR CONTRACTO Rochon Corporation PAYMENT(Line 6 from prior Certificate)..... $ 1,205,165.09 8. CURRENT PAYMENT DUE.................................. $ 284,946.87 By; Date: April 1,2001 9. BALANCE TO FINISH,PLUS RETAINAGE............. $ 1,464,432.04 f Wel n-Vice President (Line 3 less Line 6) State of: Minnesota County of: Hennepin Subscribed and sworn to before me this 1st day of April,2001 ■/1/,y^\l ^n^AAAAA--~AAAAA■ C GHARDT Notary Public:� o d 'IC-MINNESOTA �,. � rs Jan.31,2005 ■w�vwvwev ■ My Commission expires: January 31,2005 ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED�. In accordance with the Contract Documents,based on on-site observations (Attach explanation if amount certified differs from the amount applied for.) and the data comprising the above application,the Architect certifies to the Owner that to the best of the Architect's knowledge,information and belief the ARCHITECT: Work has progressed as indicated,the quality of the Work is in accordance /�_/ � I b with the Contract Documents,and the Contractor is entitled to payment By:`T///� A0 Date: of the AMOUNT CERTIFIED. This certificate is not negotiable. The AMOU14T CE IFIED is payable only to the Contractor named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.