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CCP 03-12-2001
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CCP 03-12-2001
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<br />". <br /> <br />. <br /> <br />. <br /> <br />e <br /> <br />. <br /> <br />APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G7021 <br /> <br />!"AGE ONE OF 2 PAGES <br /> <br />TO IOWNER): City 01 Arden Hills <br />4364 West Round Lak.e 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 (CONTRACTOR): Rochon Corporation <br /> <br />APPLICATION NO: <br /> <br />5 <br /> <br />PERIOD TO: <br /> <br />1.Jan-Ql <br /> <br />3650 Annallohs Lane North, Suite 120 <br />Plymouth, MN 55447 <br /> <br />VIA (ARCHITECT]: Architectural Alliance <br />400 Clifton Avenue S. <br /> <br />ARCHITECT'S <br />PROJECT NO: <br /> <br />Minneapolis, MN 55403 <br /> <br />CONTRACT FOR: General Construction <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />CONTRACT DATE: <br /> <br />8/tS/DO <br /> <br />CHANGE ORDER SUMMARY <br />Change Orders approved in ADDITIONS DEDUCTIONS <br />previous months by Owner <br />TOTAL o.ao <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 that to the best of the Contractor's <br />knowledge, information and belief the Work covered by this AppliCijtion <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 and payments received <br />from the Owrler, and that current payment shown herein is now due. <br /> <br />CONTRACTOR: Rochon Corporation <br /> <br />By: <br /> <br /> <br />Date: February 1, 2001 <br /> <br />Jeff <br /> <br />I <br /> <br />. <br /> <br />. <br />'" GRACE L. BURGHARDT I <br />NOTARY PUBLIC - MINNESOTA <br />My Comm. Expires Jan, 31, 2005 <br />. <br /> <br /> <br />Application is made tor Payment, as shown below, in connection <br />with the Contract, Continuation Sheet. Substitute AlA Document <br />G703 is attached. <br /> <br />'- ORIGINAL CONTRACT SUM. ................... . <br />2. Net Change by Change Orders.. <br />3. CONTRACT SUM TO DATE (Line 1 +1-21... ........$ <br />4. TOTAL COMPLETED 81 STORED TO DATE <br /> (Columrl G on G7031 <br />5. RETAINAGE: <br /> . % of Completed Work <br /> (Column 0 +E on G7031 <br /> b % of Stored Material <br /> {Column F on G7031 <br /> Total Retainage (Line 5a +5b or <br /> Tota! in Column I of G703)......... <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 Certificatel... <br />8. CURRENT PAYMENT DUE.. . <br /> <br />2,942,000.00 <br />0.00 <br />2,942,OOO.00 <br />859,949.18 <br /> <br />42,997.46 <br />816,951.72 <br /> <br />9. BALANCE TO FINISH, PLUS RETAINAGE.. <br />(Line 3 less Line 6> <br /> <br />. <br /> <br />550,942.81 <br />266.008.91 <br />2,125.048.28 <br /> <br />State of: Minnesota <br /> <br />County of: Hennepin <br /> <br />Subscribed and sworn to before me this 1 st day of February. 2001 <br /> <br />Notary Public: <br /> <br />_-<J",. '-4 /2 iJ fJf <br />'- <. ~ ;;Z CI~.) & '.":y"....C ",,,,,. . <br /> <br />My Commission expires: January 31, 2005 <br /> <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br /> <br />AMOUNT CERTIFIED......... .......... ............ ..$ <br /> <br />U?~,fJDg.q r <br /> <br />In accordllncewith the Contract Documents, baseu on on-site observations <br /> <br />and the data comprising the aboveapplicatiorl, the Architect certifies tothe <br />Owner that to the best of the Architect's knowledge, information and belief the <br />Work has progressed as irldicated,the quality of the Work is in acc ordance <br />with the Contract Documents, and the Contractor is entitled to payment <br /> <br />of the AMOUNT CERTIFIED. <br /> <br />{Attach eXlJlanation ir amount certified diflers from the amount aplJlied lOLl <br /> <br />ARCHITECT: . ../ /;1, <br /> <br />8y Id-JttffJU{.O lI"", <br /> <br />~/rJ~( <br />i' I <br />This certificate is rlOt negotiable. The AMOUNT CERTIFIED is payable <br /> <br />only to the Contractor named hereirl. 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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