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CCP 01-08-2001
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CCP 01-08-2001
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<br />e <br /> <br />tit <br /> <br />tit <br /> <br />APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G7021 <br /> <br />TO (OWNER): City of Arden Hills <br />4364 West Round Lake Rd <br />Arden Hills, MN 55112.5794 <br /> <br />PROJECT: Arden Hills City Hall <br />1245 West Highway 96 <br />Arden Hills, MN 551' 2 <br /> <br />PAGE ONE OF 2 PAGES <br /> <br />APPLlCA liON NO: <br /> <br />3 <br /> <br />PERIOD TO: <br /> <br />30.Nov-OO <br /> <br />FROM (CONTRACTOR): Rochon Corporation <br />3650 Annapolis Lane North, Suite 120 <br />Plymouth, MN 55447 <br /> <br />VIA (ARCHITECT): Architectural Alliance <br />400 Clifton Avenue 5. <br />Minneapolis, MN 55403 <br /> <br />ARCHITECT'S <br />PROJECT NO: <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />CONTRACT DATE: <br /> <br />06/15/2000 <br /> <br />CONTRACT FOR: General Construction <br /> <br />CHANGE ORDER SUMMARY <br />Change Orders approved in ADDITIQNS DEDUCTIONS <br />previous months by Owner <br />TOTAL 0.00 <br />Approved this Month <br />Number Date Approved <br />TOTALS 0.00 <br />Net l:hange by Change Orders 0.00 <br /> <br />The undersigned ContraclOr certifies that to the best of the Contractor's <br />knowledge, information and belief the Work covered by this Application <br />for Payment has been completed in accordance with the Contract <br />Documents, that all amounts hCl-ve been paid by the Contractor for Work for <br />which previous Certificates for Payment were issued and payments received <br />from the Owner, and that current payment shown herein is now due. <br /> <br /> <br />Date: December 1, 2000 <br /> <br />By; <br /> <br />. . <br />i~"<' GRpr;: I., 8iJRGHARDT I <br />.~~, r,lel' ~ 'r '7;..i~ - MINNESOTA <br />'J I. '/ C.:; [;.)tres Jan. 31, 2005 <br />. . <br /> <br />Application is made for Payment, as shown below, in connection <br />with the Contract, Continuation Sheet, Substitute AlA Document <br />G703 is attached. <br /> <br />1. ORIGINAL CONTRACT SUM........ <br /> <br />2,942,000.00 <br />0.00 <br />2,942.000.00 <br />373,737.22 <br /> <br />2. Net Change bV Change Orders................ <br />3. CONTRACT SUM TO DATE lLine 1 +1.21.............. <br />4. TOTAL COMPLETED &. STORED TO DATEn <br />(Column G on G703) <br />5. RETAINAGE: <br />a _ % of Completed Work <br />IColumn 0 + E on G703) <br />b._% of Stored Material <br />IColumn F on G7031 <br />Total Retainage (Line Sa +5b or <br />Total in Column I of G703iu... <br /> <br />18,686.86 <br />355.050.36 <br /> <br />6. TOTAL EARNED LESS RETAINAGE..... <br />(Line 4 less Line 5 Total) <br />7. LESS PREVIOUS CERTIFICATES FOR <br />PAYMENT (Line 6 from prior Certificate)..", .$ <br /> <br />185,571.19 <br />169,479.17 <br />2,586,949.54 <br /> <br />8. CURRENT PAYMENT DUE......m......................... <br />9. BALANCE TO FINISH, PLUS RETAINAGE............. <br />IUne Siess Line 61 <br /> <br />State of: Minnesota <br /> <br />County of: Hennepin <br /> <br />Subscribed and sworn to before me this 1st day of December, 2000 <br /> <br />Notary Public: <br /> <br />~,~~~ <br /> <br />My Commission expires: JanuCl-ry 31, 2005 <br /> <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br /> <br />In accordance with the Contract Documents, based on on.site observations <br />and the data comprising the above application, the Architect certifies to the <br />Owner that 10 the best of the Architect's knowledge, information and belief the <br />Work has progressed as indicated,the quality of the Work is in acca rdance <br />with the Contract Documents, and the Contractor is entitled to payment <br />of the AMOUNT CERTIFIED. <br /> <br />AMOUNT CERTIFIEO..ltft,.Y.?fl...t7. <br /> <br />(Attach explanation if amount certified differs from the amount applied far.1 <br /> <br />ARCH'TECT,~~~~fIWtF <br />Bl(j/;l(illt~ ~:/ / ~/( t{ I rfb <br /> <br />This c6rtificate is not negotiable. The AMOUNT ClRTIFIED IS ~aY8ble <br />only to the Contractor named herein. Issuance, payment and acceptance <br />of payment are without prejUdice to any rights of the Owner or Contractor <br />under this Contract. <br />
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