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<br />.APPLlCATlON AND CERTIFICATE FDR PAYMENT (SUBSTITUTE AlA DOCUMENT G702J <br />TO (OWNER]; City 01 Arden Hills PROJECT: Arden Hills City Hall <br /> <br />4364 West Round lak.e Rd <br /> <br />1245 West Highway 96 <br />Arden Hills, MN 55112 <br /> <br />Arden Hills, MN 55112-5794 <br /> <br />fROM lCONTRACTORl: Rochon Corporation <br />3650 Annapolis lane North, Suite 101 <br />Plymouth, MN 55447 <br /> <br />APPLICATION NO: <br /> <br />PERIOD TO: <br /> <br />VIA lARCHJTECTl: Architectural Alliance <br />400 Clifton Avenue S <br />Minneapolis, MN 55403 <br /> <br />ARCHlTEcrs <br />PROJECT NO: <br /> <br />CONTRACT FOR: General Constfuction <br /> <br />CONTRACT DATE: <br /> <br />"'AGE ONE OF 2 PAGES <br /> <br />17 iREVISEDl <br /> <br />30-Apr.02 <br /> <br />CONTRACTOR.S APPLICATION FOR PAYMENT <br /> <br />8/15/00 <br /> <br />CHANGE ORDER SUMMARY <br />Change Orders apprO\led in ADDITIONS DEDUCTIONS <br />previous months by Owner <br />TOTAL 139,528.93 <br />Approved this Month <br />Number Dale ApprO\led <br />TOTALS 0.00 <br />Net change by Change Drdets 139.528.93 <br /> <br />. <br /> <br />The undersigned Contractor certifies that to the best of the Con\facto,'s <br />knowledge. information and belief the Work COl/ered by this Application <br />for Payment h.;l$ Deen completed in accordance with the CDntract <br />Documents. that all amounts have been paid by the Contractor 1m Work lor <br /> <br />which previous Certific<ues for Payment were issued and payments received <br /> <br />from the Owner, and that current payment shown herein is now due. <br /> <br />By: <br /> <br /> <br />May 1.2002 <br /> <br />~Date <br /> <br />J <br /> <br />ice President <br /> <br />Application is made for Payment. as shown below, in connection <br />with the Contract, Cominuation Sheet, Substitute AlA Document <br />G703 is attached. <br /> <br />L ORIGINAL CONTRACT SUM ............................. $ <br /> <br />2. Net Change by Change Orders.. <br />3. CONTRACT SUM TO DATE IUne 1 +/-2).. <br />4. TOTAL COMPLETED & STORED TO DATE.. <br />(Column G on G7031 <br /> <br />5. RET AINAGE: <br /> <br />% 01 Completed Work <br />!Column D +E on G703) <br /> <br />b. % at Stored Material <br /> <br />IColumn F on G703) <br /> <br />Total Retainage (Line 5a+5b or <br />Total in Column I of G7031.. <br /> <br />6 TOTAL EARN[O LESS HETAINAGE__ <br /> <br />~Line 4 less Line 5 T Nan <br /> <br />7. LESS PREVIOUS CERTIFICATES FOR <br /> <br />PAYMENT Jline 6 from priOl Certificate!. . S <br /> <br />8. CURRENT PAYMENT DUE.... ........................ S <br />9. BALANCE TO FINISH, PLUS RETAINAGE_._.__. <br /> <br />JUne 3 less Line 6) <br /> <br />State of: Minnesota <br /> <br />Coulltyof: Hennepin <br /> <br />2.942,000.00 <br />139,528.93 <br />3,081,528.93 <br />3.071,116.08 <br /> <br />153.605.81 <br /> <br />2.918.510_27 <br /> <br />2,911,029.0] <br />7,481.24 <br />163,018.60 <br /> <br />ARCHITEcrs CERTIFICATE FOR PAYMENT <br /> <br />$; l ((-1,1,21- <br /> <br />In accordance with the Contract Documents, based Oil on-site observatiolls <br />and the data comprising the above application, the Architect certifies to the <br />Owner that 10 the best of tile Architect's knowledge, information and belie! the <br />Work has progressed as indicated, the quality (II Ihe Work is in accordance <br />with the Contract Documents. and the Contractor is entitled to payment <br /> <br />of the AMOUNT CERTIFIED. <br /> <br />. <br /> <br />Subscribed and sworn to before me this 1st day of May, 2002 <br /> <br />Notary Public: <br /> <br />My Commission expires: January 31, 2005 <br /> <br />AMOUNT CERTIFIED. <br /> <br />.......$ <br /> <br />(Attach explanation if amount certified differs from the amOlmt applied for.I <br /> <br />ARCHITECT, ~ <br /> <br />Bl~ 0", <br /> <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 tights of the Owner or Contractor <br /> <br />under this Contract. <br />