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<br />APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G702)
<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 55112
<br />
<br />fROM (CONTRACTORl: Rochon Corporation
<br />
<br />APPLICATION NO:
<br />
<br />4
<br />
<br />PERIOD TO:
<br />
<br />31-Dec>00
<br />
<br />VIA (ARCHITECT]: Architectural Alliance
<br />400 Clifton Avenue S.
<br />Minneapolis, MN 55403
<br />
<br />ARCHITECT'S
<br />PROJECT NO:
<br />
<br />3650 Annapolis Lane North, Suite 120
<br />Plymouth, MN 55447
<br />
<br />CONTRACT FOR; General Construction
<br />
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />
<br />CONTRACT DATE:
<br />
<br />08/1512000
<br />
<br />CHANGE ORDER SUMMARY
<br />Change Orders approved in ADDITIONS OEDUCTIONS
<br />previous months by Owner
<br />TOTAL 0.00
<br />Approved this Month
<br />Number Date Approved
<br />TOTALS 0.00
<br />Net change by Change Orders 0.00
<br />
<br />The undersigned Contractor certifies thijt to the best of the Contractor's
<br />k:nowledge, 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 have been paid by the Contractor for Work: for
<br />
<br />which previous Certificates for Payment were issued ijnd payments received
<br />from the Owner, and that current payment shown herein is now due.
<br />
<br />By:
<br />
<br />
<br />Date: January 1, 2001
<br />
<br />Jeff
<br />
<br />ce President
<br />
<br />. .
<br />l~'" GRACf: ~: ;p.GHAPm ,
<br />~~', I\:OTt '; { i ,_,,': - 1.m~;~'::SOTA
<br />;,,'~, L'y C~- r.: ~ ~ ,:'~.;1. 31, 2005
<br />.""""^",,AlVv"N~"'^",~/v~~.
<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 />2. Net Change by Change Orders..
<br />3. CONTRACT SUM TO DATE (Line 1 +/-2).. . ......$
<br />4. TOTAL COMPLETED & STORED TO DATE
<br /> ICoiumn G on G703}
<br />5. RETAINAGE:
<br /> ,. % of Completed Work:
<br /> IColumn D + E on G703l
<br /> b. % of Stored Material
<br /> IColumn F an G703)
<br /> Total Retainage (Line 5a+5b or
<br /> Total in Column I of G703)... .
<br />6. TOTAL EARNED LESS RETAINAGE.. .$
<br /> IUne 4 less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR
<br /> PAYMENT (Line 6 from prior Certificate)..
<br />,. CURRENT PAYMENT DUE....
<br />9. BALANCE TO FINISH, PLUS RETAINAGE
<br /> (Line 3 less Line 6)
<br />
<br />2,942,000.00
<br />0.00
<br />2,942,000.00
<br />579,939.80
<br />
<br />28,996.99
<br />550,942.81
<br />
<br />e
<br />
<br />355,050.36
<br />195,892.45
<br />2,391,057.19
<br />
<br />State of: Minnesota
<br />
<br />County of: Hennepin
<br />
<br />Subscribed ond sworn to before me this 1st day of January, 2001
<br />
<br />Notary Public:
<br />
<br />.-<1.cuc'- ~ g +H
<br />
<br />My Commission expires: January 31, 2005
<br />
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />
<br />In accordance with the Contract Documents, based on on-site observations
<br />
<br />and the dijta comprising the above application, the Architect certifies to the
<br />Owner that to the best of the Architect's knowledge, information and belief the
<br />Work has progressed as indicated,the quality of the Work: is in acc ordance
<br />with the Contract Documents, and the Contractor is entitled to payment
<br />of the AMOUNT CERTIFIED.
<br />
<br />AMOUNT CERTIFI:I.~5;l.~~.?::'K$
<br />(Attach explanation if amount certified differs from the amount applied fOL)
<br />
<br />ARCH IT;' I J . j I. A,
<br />BY~~
<br />
<br />This certificate is not negotiable.
<br />
<br />
<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.
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