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<br />APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G702)
<br />
<br />PAGE ONE OF 2 PAGES
<br />
<br />TO (OWNER I: 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 (CONTRACTORl: Rochon Corporation
<br />
<br />APPLICATION NO:
<br />
<br />PERIOD TO:
<br />
<br />3650 AnniJpolis LiJne North. Suite 101
<br />Plymouth, MN 55447
<br />
<br />VIA IARCHITECT]: Architectural Alliance
<br />400 Clifton Avenue S.
<br />Minneapolis, MN 55403
<br />
<br />ARCHITECT'S
<br />PROJECT NO:
<br />
<br />CONTRACT FOR: General Construction
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />
<br />CHANGE ORDER SUMMARY
<br />Change Orders approved in ADDITIONS DEDUCTIONS
<br />previous months by Owner
<br /> TOTAL 12,544.00
<br />Approved this Month
<br />Number Date Appro~~~
<br />2 6/3012001 62,947.00
<br />3 6130/2001 38,593.93
<br /> TOTALS 101,540.93
<br />Net change by Change Orders 114,084.93
<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 />lor 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 Certilicates for Payment were issued and payments received
<br />from the Owner, and that current payment shown herein is now due.
<br />
<br />By:
<br />
<br />
<br />Date: July 1, 2001
<br />
<br />CONTRACT DATE:
<br />
<br />10
<br />
<br />30-Jun-Dl
<br />
<br />8/15/00
<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 +f-2}.. ...........$
<br />4, TOTAL COMPLETEO & STORED TO DATE. ....... $
<br /> lColumn G on G703)
<br />5. RET AINAGE:
<br /> % of Completed Work
<br /> teolumn 0 + E an G7031
<br /> b. % of Stored Materia!
<br /> (Column F on G703)
<br /> Total Retainage (Line 5a+5b or
<br /> Total in Column I of G7031..
<br />6, TOTAL EARNED LESS RETAINAGE....... .,'
<br /> (Line 4 less Line 5 Total)
<br />7, lESS PREVIOUS CERTIFICATES FOR
<br /> PAYMENT (Une 6 from prior Certificatel..
<br />8, CURRENT PAYMENT DUE..
<br />9. BALANCE TO FINISH, PLUS RETAINAGE
<br /> jLine3 less Une 6)
<br />
<br />State of: Minnesota
<br />
<br />County of: Hennepin
<br />
<br />2,942,000.00
<br />114,084.93
<br />3,056,084.93
<br />
<br />1:, 1;:8, ~5S.e6
<br />~14z..1, 529 .e'S"<,')
<br />;f,4-;).\, Gb<t,/'bS.
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<br />/1. c ; ,., 1+' -j-<P .
<br />H!.B,iBB.61
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<br />1,5UUJI.JJJ "q&
<br />~, 3{oO, 9/S- '?, :.'..
<br />:.;.. "3cC1 \.~'::)\ ::., (
<br />;2.04,1-S4-,~3 ...........,
<br />L,[)J[),':'~".,,, d-C>C\Ll;.:c:&3,d-'t
<br />y'06,D71.09) (,..:\~,'( 'rf~'.-~\:- "
<br />:'(;a,asa.88 "?'~J,w:-r
<br />'7 S5 I Id'\ , 54-
<br />
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />
<br />2-0
<br />
<br />1...rzr. p 3
<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 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 />of the AMOUNT CERTIFIED.
<br />
<br />Subscribed and sworn to before me this 1st day of July, 2001
<br />
<br />Notary Public:
<br />
<br />My Commission expires: January 31, 2005
<br />
<br />AMOUNT CERTIFIED. .....,.,..,.....,..........$
<br />
<br />IAttach explanation if amount certified differs from the amount a plied lor.]
<br />
<br />::7/~
<br />
<br />.,/lu/61
<br />.
<br />
<br />This certificate is not negotiable. The AMOUNT CERTIFIED is pavable
<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 />urlderthis Contract.
<br />
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