CCP 01-08-2001 - Laserfiche WebLink

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e tit tit APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G7021 TO (OWNER): City of Arden Hills 4364 West Round Lake Rd Arden Hills, MN 55112.5794 PROJECT: Arden Hills City Hall 1245 West Highway 96 Arden Hills, MN 551' 2 PAGE ONE OF 2 PAGES APPLlCA liON NO: 3 PERIOD TO: 30.Nov-OO FROM (CONTRACTOR): Rochon Corporation 3650 Annapolis Lane North, Suite 120 Plymouth, MN 55447 VIA (ARCHITECT): Architectural Alliance 400 Clifton Avenue 5. Minneapolis, MN 55403 ARCHITECT'S PROJECT NO: CONTRACTOR'S APPLICATION FOR PAYMENT CONTRACT DATE: 06/15/2000 CONTRACT FOR: General Construction CHANGE ORDER SUMMARY Change Orders approved in ADDITIQNS DEDUCTIONS previous months by Owner TOTAL 0.00 Approved this Month Number Date Approved TOTALS 0.00 Net l:hange by Change Orders 0.00 The undersigned ContraclOr certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts hCl-ve 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. Date: December 1, 2000 By; . . i~"<' GRpr;: I., 8iJRGHARDT I .~~, r,lel' ~ 'r '7;..i~ - MINNESOTA 'J I. '/ C.:; [;.)tres Jan. 31, 2005 . . Application is made for Payment, as shown below, in connection with the Contract, Continuation Sheet, Substitute AlA Document G703 is attached. 1. ORIGINAL CONTRACT SUM........ 2,942,000.00 0.00 2,942.000.00 373,737.22 2. Net Change bV Change Orders................ 3. CONTRACT SUM TO DATE lLine 1 +1.21.............. 4. TOTAL COMPLETED &. STORED TO DATEn (Column G on G703) 5. RETAINAGE: a _ % of Completed Work IColumn 0 + E on G703) b._% of Stored Material IColumn F on G7031 Total Retainage (Line Sa +5b or Total in Column I of G703iu... 18,686.86 355.050.36 6. TOTAL EARNED LESS RETAINAGE..... (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate)..", .$ 185,571.19 169,479.17 2,586,949.54 8. CURRENT PAYMENT DUE......m......................... 9. BALANCE TO FINISH, PLUS RETAINAGE............. IUne Siess Line 61 State of: Minnesota County of: Hennepin Subscribed and sworn to before me this 1st day of December, 2000 Notary Public: ~,~~~ My Commission expires: JanuCl-ry 31, 2005 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 the best of the Architect's knowledge, information and belief the Work has progressed as indicated,the quality of the Work is in acca rdance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIEO..ltft,.Y.?fl...t7. (Attach explanation if amount certified differs from the amount applied far.1 ARCH'TECT,~~~~fIWtF Bl(j/;l(illt~ ~:/ / ~/( t{ I rfb This c6rtificate is not negotiable. The AMOUNT ClRTIFIED IS ~aY8ble 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.