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<br />APPLICATION ANO CERTIFICATE FOR PAYMENT ISUBSTITUTE AlA DOCUMENT G7021
<br />
<br />TO (OWNER!: City ot 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
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<br />APPLICATION NO:
<br />
<br />6
<br />
<br />PERIOD TO:
<br />
<br />28.Feb.Ql
<br />
<br />VIA (ARCHITECTI: Architecwral Alliance
<br />
<br />ARCHITECT'S
<br />PROJECT NO:
<br />
<br />3650 Annapolis lane North, Suite 101
<br />Plymouth_ MN 55447
<br />
<br />400 Clitton Avenue S.
<br />Minneapolis, MN 55403
<br />
<br />CONTRACT FOR: General Construction
<br />
<br />CONTRACT DATE:
<br />
<br />8115/00
<br />
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />
<br />CHANGE ORDER SUMMARY
<br />Change Orders approved in ADOITiONS DEOUCTlONS
<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 (Ind 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 />Date: March 1. 2001
<br />
<br />By:
<br />
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
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<br />In accordance with the Contracl 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 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 entilled 10 payment
<br />
<br />of the AMOUNT CERTIFIED.
<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 />1. ORIGINAL CONTRACT SUM........... 2,942,000.00
<br />2, Net Change by Change Orders....... ............"...... 12,544.00
<br />3, CONTRACT SUM TO DATE IUne 1 +1.21 2,954,544.00
<br />4, TOTAL COMPLETED & STORED TO DATE 1,268,594.83
<br /> (Column G on G7031
<br />5, RETAINAGE:
<br /> , % of Completed Work
<br /> (Column O+E on G703)
<br /> b - % of Stored Material
<br /> (Column Fan G703)
<br /> Total Relainage (line Sa + 5b or
<br /> Total in Column I of G7031 .......$ 63,429.74
<br />6, TOTAL EARNED LESS RETAINAGE.. ,,$ 1,205,165.09
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<br />.
<br />
<br />(line 4 less Line 5 TOla1]
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<br />7. LESS PREVIOUS CERTIFICATES FOR
<br />
<br />PAYMENT (line 6 from prior Certificate)..... $
<br />
<br />816,951.72
<br />388,213.37
<br />1,749,378.91
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<br />8. CURRENT PAYMENT DUE
<br />9. BALANCE TO FINISH, PLUS RETAINAGE
<br />(Une 3 less line 6)
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<br />$
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<br />State of: Minnesota
<br />
<br />County of: Hennepin
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<br />Subscribed and sworn to before me this 1st day of M<lrch, 2001
<br />
<br />Notary Public:
<br />
<br />My Comm'''''o r;~0;;;~8;5
<br />AMOUNT CERTIFIEO.........lmmm............$
<br />(Attach explanation it amount certified differs from the amount applied for.1
<br />
<br />:p;;'~~/f~~/~
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<br />Thi, ","Ii"" i, oot o",,,,bl,, Th. AM"'~ci~D i, p'y,bl,
<br />only to the Contractor named herein. Issuance, payment and acceptance
<br />of payment are without prejudice to any righls of the Owner or Contractor
<br />
<br />under this Contract.
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