CCP 03-12-2001 - Laserfiche WebLink

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". . . e . APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G7021 !"AGE ONE OF 2 PAGES TO IOWNER): City 01 Arden Hills 4364 West Round Lak.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: 5 PERIOD TO: 1.Jan-Ql 3650 Annallohs Lane North, Suite 120 Plymouth, MN 55447 VIA (ARCHITECT]: Architectural Alliance 400 Clifton Avenue S. ARCHITECT'S PROJECT NO: Minneapolis, MN 55403 CONTRACT FOR: General Construction CONTRACTOR'S APPLICATION FOR PAYMENT CONTRACT DATE: 8/tS/DO CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS previous months by Owner TOTAL o.ao 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 AppliCijtion for 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 Owrler, and that current payment shown herein is now due. CONTRACTOR: Rochon Corporation By: Date: February 1, 2001 Jeff I . . '" GRACE L. BURGHARDT I NOTARY PUBLIC - MINNESOTA My Comm. Expires Jan, 31, 2005 . Application is made tor Payment, as shown below, in connection with the Contract, Continuation Sheet. Substitute AlA Document G703 is attached. '- ORIGINAL CONTRACT SUM. ................... . 2. Net Change by Change Orders.. 3. CONTRACT SUM TO DATE (Line 1 +1-21... ........$ 4. TOTAL COMPLETED 81 STORED TO DATE (Columrl G on G7031 5. RETAINAGE: . % of Completed Work (Column 0 +E on G7031 b % of Stored Material {Column F on G7031 Total Retainage (Line 5a +5b or Tota! in Column I of G703)......... 6. TOTAL EARNED LESS RETAINAGE ... (Line 4 less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificatel... 8. CURRENT PAYMENT DUE.. . 2,942,000.00 0.00 2,942,OOO.00 859,949.18 42,997.46 816,951.72 9. BALANCE TO FINISH, PLUS RETAINAGE.. (Line 3 less Line 6> . 550,942.81 266.008.91 2,125.048.28 State of: Minnesota County of: Hennepin Subscribed and sworn to before me this 1 st day of February. 2001 Notary Public: _-<J",. '-4 /2 iJ fJf '- <. ~ ;;Z CI~.) & '.":y"....C ",,,,,. . My Commission expires: January 31, 2005 ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED......... .......... ............ ..$ U?~,fJDg.q r In accordllncewith the Contract Documents, baseu on on-site observations and the data comprising the aboveapplicatiorl, the Architect certifies tothe Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as irldicated,the quality of the Work is in acc ordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. {Attach eXlJlanation ir amount certified diflers from the amount aplJlied lOLl ARCHITECT: . ../ /;1, 8y Id-JttffJU{.O lI"", ~/rJ~( i' I This certificate is rlOt negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named hereirl. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract.