<br />e
<br />
<br />APPLICATION AND CERTIFICATE FOR PAYMENT ISUBsrlTUTE AlA DOCUMENr G702)
<br />
<br />TO !OWNER): City of Arden Hills
<br />4354 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 56112
<br />
<br />FROM (CONTRACTORl: Rochon Corporation
<br />3650 Annapolis lane North, Suite 101
<br />Plymouth, MN 55447
<br />
<br />PAGE ONE OF 2 PAGES
<br />
<br />APPLICATION NO:
<br />
<br />15
<br />
<br />PERIOD TO:
<br />
<br />3D-Nov-Ol
<br />
<br />VIA lARCHITECT): Architectural Allial\cQ
<br />400 Clifton Avenue S.
<br />Minneapolis, MN 55403
<br />
<br />ARCHITECT'S
<br />PAOJECT NO:
<br />
<br />CONTAACT 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 139,528.93
<br />Approved this Month
<br />Number Date Approved
<br />TOTALS 0.00
<br />Net charlge by Change Orders 139,528.93
<br />
<br />e
<br />
<br />The undersigned Contractor certifies that to the best of the Contr~ctor's
<br />knowledge, information ~nd 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 for Payment were issued and payments received
<br />
<br />1rom the Owner, and that current payment shown herein is now due.
<br />
<br />By:
<br />
<br />
<br />Date: December 1, 2001
<br />
<br />~JVV'./'''''N-J--''^^"~.
<br />· . . _" - "cc'-'ARDT ~
<br />~, (P" c"' .
<br />~O, - -', 1[' ~SOrA
<br />
<br />S 0:f:j .' ccc...., ," "J~n 01.2005\
<br />~' ~Ii\
<br />.~.t'IV-.iV'o'",,,vv-.~
<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. OR[GINALCONTRACT SUM....
<br />
<br />2,942,000.00
<br />129,528.93
<br />3,081,528.93
<br />3,0513,530.138
<br />
<br />2. Net Change by Change Orders...
<br />3. CONTRACT SUM TO DATE (Line 1 +/.21..
<br />4. TOTAL COMPLETED & STORED TO DATE..
<br />
<br />(Column G on G703)
<br />
<br />5. RETAINAGE;
<br />
<br />_ % of Complete(! Work
<br />(Column D+E on G703J
<br />
<br />b. % of Stored Material
<br />(Column F on G7031
<br />Total Retainage ILine 5a+5b or
<br />Total in Column I of G7031.. .
<br />6. TOTAL EARNED LESS RETAINAGE... .
<br />
<br />152,826.53
<br />2,903,704.15
<br />
<br />ILine 4 less Line 5 TOlall
<br />
<br />7. LESS PREVIOUS CERTIFICATES FOR
<br />
<br />PAYMENT IUne 6 from prior Certificate)...
<br />8. CURRENT PAYMENT DUE... .
<br />9. BALANCE TO FINISH, PLUS RETAINAGE..
<br />(Line 3 less Line 61
<br />
<br />2,661,198.Q7
<br />42,506.08
<br />177,824.78
<br />
<br />State of: Minnesota
<br />
<br />County of: Hennepin
<br />
<br />Subscdbed and sworn to belore me this 1st day of December, 2001
<br />
<br />Notary Public:
<br />
<br />/-" /J Ii).,
<br />.;;! d2 "<-;?viAC1'l .
<br />
<br />My Commission expires: January 31, 2005
<br />
<br />JI
<br />/ ~:JVc G.e
<br />
<br />ARCHITECT'S CERTIFJCATE FOR PAYMENT
<br />
<br />In accordance with the Contract Documents, based on on.site observations
<br />and the data comprising the above applic~tion, the Architect certifies to the
<br />Owner thaI to the best of the Architect's knowledge, information and belief the
<br />Work has progressed ~sindicated,thequalityoflheWorkisinaccordance
<br />wilh the Contr~ct DocumentS, and the Contr~ctor is entitled to payment
<br />
<br />e
<br />
<br />of the AMOUNT CERTIFIED.
<br />
<br />AMOUNT CERTIFIED,..."....... ........,,,......5 1-ZiC3Dfo.Og
<br />{
<br />IAttach explanation if amount certified differs from the amount applied for.!
<br />
<br />ARCHITECT:
<br />,.fft'
<br />By:vfltc
<br />
<br />! ". J
<br />vUJ~i!lL./ L
<br />
<br />(
<br />! /1 /()?.--
<br />
<br />This certilicate is not negotiable. The AMOUJr CE~T[FIED is payable
<br />
<br />onlv to the Contractor named herein. Issuance, payment ~nd acceptance
<br />of payment are without prejudice to any rIghts of the Owner or Contr~ctor
<br />underthisComraCt
<br />
|