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<br />. <br /> <br />e <br /> <br />e <br /> <br />e <br /> <br />APPLICATION AND CERTIFICATE FOR PAYMENT (SUBSTITUTE AlA DOCUMENT G7021 <br /> <br />PAGE ONE OF 2 PAGES <br /> <br />TO (OWNER]: City of Arden Hills <br />4364 West Round Lake Ad <br /> <br />Arden Hills, MN 55112-5794 <br /> <br />PROJECT: Arden Hills City Hall <br />1245 West Highway 96 <br />Arden Hills. MN 551 12 <br /> <br />FROM ICONTRACTOR): Rochon Corporation <br /> <br />APPLICATION NO: <br /> <br />16 <br /> <br />PERIOD TO: <br /> <br />31.Dec-Ol <br /> <br />VIA IARCHITECTI: Architectural Alliance <br />400 Clifton Avenue S. <br />Minneapolis, MN 55403 <br /> <br />ARCHITECT'S <br />PROJECT NO: <br /> <br />3650 Annapolis Lane North. Suite 101 <br />Plymouth, MN 55447 <br /> <br />CONTRACT FOR: General Construction <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENr <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 change by Change Orders 139,528.93 <br /> <br />The undersigned Contractor certities 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 p<lid by the Contractor lor Work jar <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 />B <br /> <br /> <br />Date: January 1, 2002 <br /> <br />CONTRACT DATE: BIl 5tOO <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.. ..$ 2,942,000.00 <br />2. Net Change by Change Orders.. 139,528.93 <br />3. CONTRACT SUM TO DATE (Une 1 +t-2).. 3,081,528.93 <br />4. TOTAL COMPLETED 1\1 STORED TO DATE.. $ 3,064,241.08 <br /> IColumn G on G703J <br /> <br />5. RETAINAGE: <br />% of Completed Work <br />(Column D + Eon G703) <br />b. % 01 Stored Material <br />(Column F onG703) <br />Total Retainage (Une 5a+5b or <br />Total in Column I of G703)., <br />6. TOTAL EARNED lESS RETAINAGE <br /> <br />153,212.05 <br />2,911,029.03 <br /> <br />(line 4 less Line 5 Total) <br /> <br />7. lESS PREVIOUS CERTIFICATES FOR <br />PAYMENT {Line 6 from prior Certificate)... $ <br />8. CURRENT PAYMENT DUE......................... ....... $ <br />9. BALANCE TO FINISH, PLUS RETAINAGE.... <br /> <br />2.903,704.15 <br />7,324.88 <br />170,499.90 <br /> <br />lLine 3 less Line 6) <br />State of: Minnesota County 01: Hennepin <br />Subscribed and sworn to before me this 1st day of January, 2002 <br /> <br />Notary Public: <br /> <br />My Commission expires: January 31, 2005 <br /> <br />ARCHITECT'S CERTIFICATE FOR PAYMENT <br /> <br />AMOUNT CERTIFIED.......... <br /> <br />.........$ <br /> <br />',321-; ff <br /> <br />In accordance with the Contract Documents, based on on.siteobservations <br /> <br />and lhedata 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 ac cordance <br />with the Contract Documents. and the Contractor is entitled to payment <br /> <br />of the AMOUNT CERTIFIED. <br /> <br />(Attach explanation if amount certified differs Irom the amount a ppliedfor.J <br /> <br />ARCHO;~T: III/'" / n. , <br />By ~{(Jte <br /> <br />This certificate is not negotiable. The AMOU <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 /> <br />I <br /> <br /> <br />under this Contract. <br />