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<br />e <br /> <br />e <br /> <br />e <br /> <br />APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G702) <br /> <br />PAGE ONE OF 2 PAGES <br /> <br />TO 40WNER): City 01 Arden Hills <br />4364 West Round lake Rd <br /> <br />Arden Hills, MN 55112.5794 <br /> <br />PROJECT: Arden Hills City Hall <br />1245 West Highway 96 <br />Arden Hills, MN 55 t 12 <br /> <br />FROM [CONTRACTORi: Rochon Corporation <br /> <br />APPLICATION NO: <br /> <br />6 <br /> <br />PERIOD TO: <br /> <br />28.Feb.Ql <br /> <br />3650 Annapolis Lane North, Suite 101 <br />Plymouth, MN 55447 <br /> <br />VIA [ARCHITECT!: Architectural Allian<;e <br />400 Clifton Avenue S. <br />Minneapolis, MN 55403 <br /> <br />ARCHITECT'S <br />PROJECT NO: <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 DEDUCTIONS <br />previous months by Owner <br /> TOTAL 0.00 <br />Approved this Month <br />Number Date Approved <br />1 1122/2001 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 />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 Owner, and that current payment shown herein is now due. <br /> <br />CONTRACTOR: Rochon Corporation <br /> <br />/ <br /> <br /> <br />Date: March 1, 2001 <br /> <br />By: <br />L.;. <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, Ihe 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 accordance <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 />" ORIGINAL CONTRACT SUM $ 2.942,000.00 <br />2, Net Change by Change Orders... $ 12,544.00 <br />3, CONTRACT SUM TO DATE (Line 1 +1-21 ..$ 2,954,544.00 <br />4, TOTAL COMPLETED & STORED TO DATE... .... $ 1.266,594.63 <br /> (Column G 011 G7031 <br />5, RETAINAGE: <br /> <br />a. % of Completed Work <br />(Columll O+E 011 G703l <br />b. % of Stored Material <br />[Column F on G703l <br />Total Retainage (Line 5a+5b or <br />Total in Column I of (703).. <br />6. TOTAL EARNED LESS RETAINAGE.. <br /> <br />....$ <br /> <br />63,429.74 <br />1,205.165.09 <br /> <br />(line 4less Une 5 Totall <br /> <br />7. LESS PREVIOUS CERTIFICATES FOR <br /> <br />PAYMENT iUne 6 ffom prior Certificate).. <br /> <br />816,951.-72 <br />386.213.37 <br />1,749,378.91 <br /> <br />8. CURRENT PAYMENT DUE.......... <br />9. BALANCE TO FINISH, PLUS RETAIN AGE <br /> <br />$ <br /> <br />tUne 3 less line 6) <br /> <br />State of: Minnesota <br /> <br />County 01; Hennepin <br /> <br />Subscribed and sworn to before me this 1st day of March, 2001 <br /> <br />Notary Public: <br /> <br />My Comm;,,;oo r;;;;;:8;5 <br />AMOUNT CERTIFIED..n...nl.....m........._...$ <br />(Attach explanation if emount certified differs from the amount applied for.) <br /> <br /> <br />This certilicate is not negotiable. The AM <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 /> <br />under this Contract. <br />