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....' r' \ e e e .. APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G702) PAGE ONE OF 2 PAGES TO (OWNER): City of Arden Hills 4364 West Round La.k.e Rd Arden Hills, MN 55112.5794 PROJECT: Arden Hills City Hall 1245 West Highway 96 Arden Hills, MN 55112 FROM (CONTRACTOR); Rochon Corporation APPLICATION NO: 2 PERIOD TO: 31-0ct-OO 3650 Annapolis Lane North, Suite 120 Plymouth, MN 55447 VIA (ARCHITECTl: Architectural Alliance 400 ClIfton Avenue S. Minneapolis, MN 55403 ARCHITECT'S PROJECT NO: CONTRACT FOR: General Construction CONTRACT DATE: 08/15/2000 CONTRACTOR'S APPLICATION FOR PAYMENT CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS previous months by Owner TOTAL 0.00 Approved this Month Number Date Approved TOTALS 0.00 Net change by Change Orders 0.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application far Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. By: . J GRACE L. BURGHARDT " NOTARY PUBLIC - MINNESOTA .. . My Comm. EXPires Jan. 31, 2005 .V\..~..~.~ "r., ^ ........... ."tI'V....,r^...,.. ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the above application, the Architect certifies to the Owner that 10 Ihe best of the Architect's knowledge, information and belief the Work has progressed as indicated,the Quality of the Work is in ace ordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. Application is made for Payment, as shown below, in connection with the Contract, Continuation Sheet, Substitute AlA Document G703 is attached. ................... $ 2,942,000.00 0.00 2,942,000.00 195,338.09 1. ORIGINAL CONTRACT SUM.. 2. Net Change by Change Orders.. 3. CONTRACT SUM TO DATE lLine 1 +{-21 4. TOTAL COMPLETED & STORED TO DATE $ $ $ (Column G on G703) 5. RETAINAGE: a._ % of Completed Work (Column D + E on G703) b _ % of Stored Material (Column Fan G703) Total Retainage lline 5a + 5b or Total in Column I of G703}.... 6. TOTAL EARNED LESS RETAINAGE ... 9,766.90 185,571.19 (Line 4 less Line 5 Total) 7, LESS PREVIOUS CERTIFICATES FOR PAYMENT lUne 6 from prior Certificate)..... $ 8. CURRENT PAYMENT DUE.."................ ............ $ 52,723.74 132,847.45 2,756,428.81 9. BALANCE TO FINISH, PLUS RETAINAGE. (Line 3 less Line 6) $ State of: Minnesota County of: Hennepin Subscribed and sworn to before me this 1st day of November, 2000 N'''<YP"bl;~A.<.-= ;t g~d My Commission expires: January 31, 2005 AMOUNT CERTIt,.t:/?l~.'t..2.1r- iAttach explanation if amount certified differs from the amount applied for.l ARCHITECT /i ,/. /11. By ~1f"6'" This certificate is not negotiable_ The AMO 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.