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<br />APPLICATION ANO CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G7021 <br /> <br />PAGE ONE OF 2 PAGES <br /> <br />e <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 (CONTRACTOR]: Rochon Corporation <br /> <br />APPLlCA liON NO: <br /> <br />6 <br /> <br />PERIOD TO: <br /> <br />2B-Feb.Ol <br /> <br />VIA IARCHITECTI: Architectural Alliance <br /> <br />ARCHITECT'S <br />PROJECT NO: <br /> <br />3650 Annapolis Lane North, Suite 101 <br />Plymoutl1, MN 55447 <br /> <br />400 Clifton Avenue S. <br />Minneapolis, MN 55403 <br /> <br />CONTRACT FOR: General Construction <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br /> <br />CONTRACT DATE: <br /> <br />8/15/00 <br /> <br />CHANGE ORDER SUMMARY <br />Change Orders approved in ADDITIONS DEOUCTIONS <br />previous months by Owner <br /> TOTAL 0.00 <br />Approved this Month <br />Number Date Approved <br />1 1/22/2001 12,544.00 <br /> TOTALS 0.00 <br />Net change by Change Orders 12,544.00 <br /> <br />The undersigned Contractor certifies that to the best of the Contractor's <br />knowledge, information and belief the Work covered by this Application <br />far 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 Owner, and that current payment shown herein is now due. <br /> <br />CONTRACTOR: Rochon Corporation <br /> <br />By: <br /> <br />'2 <br /> <br /> <br />"'" <br /> <br />n. Vice President <br /> <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br /> <br />In accordance with the Contract Documents, based on on.site observations <br /> <br />and the data comprising the above application, the Architect certifies to the <br />Owner that to the best 01 the Architect's knowledge, information and belief the <br />Work has progressed as indicated, the quality 01 the Work is in acc ardance <br /> <br />with the Contract Documents, and the Contractor is entitled to payment <br /> <br />of the AMOUNT CERTIFIED. <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 IUne 1 +/-21. <br /> <br />2,942,000.00 <br />12,544.00 <br />2,954,544.00 <br />1,266,594.83 <br /> <br />" <br /> <br />4. TOTAL COMPLETED & STORED TO DATE..... ..... $ <br />(Column G on G7031 <br />5. RETAINAGE: <br />a._% of Completed Work <br />lColumn D + E on G703} <br />b. % of Stored Material <br /> <br />lCalumn Fan G703) <br />Total Retainage lUne 5a + 5b or <br />Total in Column I of G7031... <br /> <br />63,429.74 <br />1,205,165.09 <br /> <br />e <br /> <br />6. TOTAL EARNED LESS RETAINAGE.. <br /> <br />....$ <br /> <br />(line 4 less line 5 Totall <br /> <br />7. LESS PREVIOUS CERTIFICATES fOR <br /> <br />PAYMENT ILine 6 from prior Certificatel... <br /> <br />816,951.72 <br />388,213.37 <br />1,749,378.91 <br /> <br />6. CURRENT PAYMENT DUE..... <br />9. BALANCE TO FINISH, PLUS RETAINAGE. <br /> <br />(Line 3 less Line 61 <br /> <br />State 01; Minnesota <br /> <br />County of: Hennepin <br /> <br />Subscribed and Sworn to before me this 1st day of March, 2001 <br /> <br />Notary Public: <br /> <br />My Comm;,,;o" r;i8";;;:g;' <br />AMOUNT CERTIFIED........}...........,.... .....$ <br />(Attach explanation if amount certified differs from the amount applied for.) <br /> <br /> <br />This certificate is not negotiable. The AM <br />only to the Contractor named herein. Issuance, payment and acceptance <br />01 payment are wilhout prejUdice to any rights of the Owner or Contractor <br />under this Contract. <br /> <br />e <br />