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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); City of Arden Hills
<br />4364 West Round Lake Rd
<br />Arden Hills, MN 55112-5794
<br />
<br />PROJECT: Arden Hills City Ha.11
<br />1245 West Highway 96
<br />Arden Hills, MN 55112
<br />
<br />FROM (CONTRACTOR): Rochon Corporation
<br />
<br />APPLlCA lION NO:
<br />
<br />10
<br />
<br />PERIOD TO:
<br />
<br />3D-Jun-Q1
<br />
<br />3650 Annapolis lane North, Suite 101
<br />Plymouth, MN 55447
<br />
<br />Minneapolis, MN 55403
<br />
<br />VIA (ARCHITECT): Architectural Alliance
<br />400 Clifton Avenue S.
<br />
<br />ARCHITECT'S
<br />PROJECT NO:
<br />
<br />CONTRACT FOR; General Construction
<br />
<br />CONTRACT DATE:
<br />
<br />BItS/DO
<br />
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />
<br />CHANGE ORDER SUMMARY
<br />Change Orders approved in ADDJTlONS DEDUCTIONS
<br />previQus months by Owner
<br /> TOTAL 12,544.00
<br />Approved this Month
<br />Number Date Approved
<br />2 6/30/2001 62,947.00
<br />3 6/30/2001 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 />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 />which previous Certificates Jor Payment were issued and payments received
<br />
<br />from the Owner, and that current payment shown herein is now due.
<br />
<br />CONTRACTOR: Rochon Corporation
<br />
<br />By:
<br />
<br />
<br />Date: July 1,2001
<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 />
<br />2,942,000.00
<br />114,084.93
<br />3,056,084.93
<br />
<br />2. Net Change by Change Orders............................
<br />3. CONTRACT SUM TO DATE (Line 1 +/.2).............. $
<br />4. TOTAL COMPLETED & STORED TO DATE...........
<br />(Column G on G703)
<br />5. RETAINAGE:
<br />a._% of Completed Work
<br />(Column D + E on G703)
<br />b._ % of Stored Material
<br />(Column F on G703)
<br />Total Retainage (Line 5a + 5b or
<br />Total in Column I of G703)
<br />
<br />.<1,121:1,189.86
<br />;;1.,42.1,-:>2-").:>'>
<br />
<br />/2-0, (./.,,,.,..(..
<br />I 16,1':'u.0 1
<br />
<br />6. TOTAL EARNED LESS RETAINAGE............... .,.... $ 1.,J61,I J ~ .El5
<br />(Line 4 less Line 5 Totall A, ~O'jq/~~ 31
<br />7. lESS PREVIOUS CERTIFICATES FOR
<br />
<br />PAYMENT (Une 6 from prior Certificate).....
<br />8. CURRENT PAYMENT DUE..............
<br />9. BALANCE TO FINISH, PLUS RETAINAGE",.......... $
<br />lline 3 less Line 61
<br />
<br />2,096,660.76
<br />:;!9t,9:'1.OCg Z64-/29'-l.~
<br />:'[1 :I[Ll.lJO
<br />IS"O>/lic'l.fjI
<br />
<br />State of: Minnesota
<br />
<br />County of: Hennepin
<br />
<br />Subscribed and sworn to before me this 1st day of July, 2001
<br />
<br />Notary Public:
<br />
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />
<br />My Commission expires: January 31, 2005
<br />
<br />In accordance with the Contract Documents, based on on-site observations
<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 />AMOUNT CERTIFIED..........................,....... l () ~ z.st-.;l
<br />(Auoch explanation if amount certified differs from the amount op~lied for.l
<br />
<br />ARCHITECT:
<br />
<br />By/~, l/rL/O(
<br />( I
<br />This certificate is not negotiable. The AMOUNT CERTIFIED is payable
<br />
<br />only to the Contractor named herein. Issuance, payment and acceptance
<br />of poyment are without prejudice to any rights of the Owner or Contractor
<br />under this Contract.
<br />
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