CCP 03-12-2001 - Laserfiche WebLink

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). APPLICATION AND CERTIFICATE FDR PAYMENT (SUBSTITUTE AlA DOCUMENr G7021 TO lQWNER): CIty of Arden Hills 4364 West Round Lake Ad Arden Hills, MN 55112-5794 PROJECT; Arden Hills City Hall 1245 West Highway 96 Arden Hills, MN 551 12 FROM (CONTRACTOR): Rochon Corporation PAGE ONE OF 2 PAGES . APPLICATION NO: 5 PERIOD TO: l-Jlln-Ol 3650 Annapolis Lane North, Suite 120 Plymouth, MN 55447 VIA [ARCHITECT): Architectural Alliance 400 Clifton Avenue S. Minneapolis, MN 55403 ARCHITECT'S PROJECT NO: CONTRACT FOR: General Construction CONTRACTOR'S APPLICATION FOR PAYMENT CHANGE ORDER SUMMARY Change Orders approved in ADDITIONS DEDUCTIONS previous months by Owner TOTAL 0.00 Approved this Month Number Date Approved TOTALS 0.00 Net changa bv Change Orders 0.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge,inlormation and belief the Work covered by this Appl ication 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 lrom the Owner, and that current payment shown herein is now due. CONTRACTOR: Rochon Corporation By: Date: February 1. 2001 J,t J. · """" GRACE L. BURGHARDT e NOTARY PUBLIC - MINNESOTA I . My Comm. Expires Jan. 31, 2005 . . CONTRACT DATE: 8115100 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. Net Change by Change Orders...... , ,. CONTRACT SUM TO DATE (Line 1 +/-21- , 4. TOTAL COMPLETED & STORED TO DATE .......... $ (Column G on G703l 5. RETAINAGE: ,. % ol Completed Work (Column D+ E on G7031 b - % of Stored Material (Column F on G703) Total Retainage ILine Sa+Sb or Total in Column 1 of G703).. 6. TOTAL EARNED LESS RETAINAGE ., (Line 4 less Une 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificatel 2,942,000.00 0.00 2,942,000.00 859,949.18 42,997.46 816,951.72 . 8. CURRENT PAYMENT DUE. 550,942.81 266,008.91 2,125,048.28 9. BALANCE TO FINISH, PLUS RETAINAGE.. (Une 3 less Line 6) State of: Minnesota Countyaf: Hennepin Subscribed and sworn to before me this 1St day of Febr\,lary, 2001 Notary Public: ~j^CC c ,-,;1 0 c '''1''''''# January 31, 2005 My Commission expires: ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED... ...............,........$ aGrarl .9{ . In accordance with the Contract Documents, based on on.site observations and thedat<l comprising the above application, the Architect ce rtities to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated,the quality of the Work is in ac cardance with the Contract Dor:uments, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. IAttachexplanaLionifamountcertilieddiflelslromtheamoulltapplied lor.) ARCHITECT: BY~D'" z/e/of I , This certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights af the Owner or Contractor under this Contract. .