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<br />-~ <br />e <br /> <br />e <br /> <br />e <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />Project: <br />Owner: <br />Owner No.: <br />Contractor: <br />BRW Job No.: <br /> <br />2001 Seal Coa~ng Project <br />City of Arden Hills <br /> <br />ALLIED BLACKTOP <br />37951-017-2001 A <br /> <br />Application Date: <br />For Period Ending: <br /> <br />7/5/91 <br />6/30/01 <br /> <br />Original Contract Amount: <br />Contract Amendments: <br />Contract Amount To Date: <br />Total Amount of Worll Complete To Date: <br />Material Suitably Stored On-Site but not <br />Incorporated into Work: <br />Gross Amount Due To-Date: <br />Less 0.00% Retainage: <br />Amount Due To-Date: <br />Less Previous Payments: <br />Total Due This Application: <br /> <br />$35,900.34 <br />$16,287.11 <br />$52,187.45 <br />$52,187.45 <br /> <br />$0.00 <br />$52,187.45 <br />$0.00 <br />$52,187.45 <br />$0.00 <br />$52,187.45 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br /> <br />Contractor: ALLIED BLACKTOP <br /> <br />By: <br /> <br />Date: <br /> <br />The work on this project and the application for payment have been reviewed and the <br />amount shown is recommended for payment. <br /> <br /> <br />SRW, Inc. <br />By: <br /> <br />Date: <br /> <br />//~/O/ <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page 1 of4 <br /> <br />~0/20' d 92S9 UE 21:9 <br /> <br />M~El <br /> <br />02:v1: 1: 002-S0-lnr <br />