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<br />~ <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />OCT-09-2002 13:43 <br /> <br />BRW <br /> <br />6123736526 P.l1/14 <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />PrOject: <br />Owner; <br /> <br />Owner No.: <br /> <br />Contractor: <br /> <br />2002 Sanitary Sewer and Water Main Rehabilitation Project <br />City of Arden Hills <br /> <br />VISU-SEWER CLEAN & <br />SEAL, INC. <br />37951-022-0101 <br /> <br />SRW Job No.: <br /> <br />Application Date: <br />For Period Ending: <br /> <br />10115/02 <br />9/30/02 <br /> <br />Original Contract Amount: <br />Contract Amendments: <br />Contract Amount To Date: <br />Total Amount of Work Complete To Date: <br />Material Suitably Stored On-Site but not <br />Incorporated into Work: <br />Gross Amount Due To-Date: <br />Less 5,00% Retainage: <br />Amount Du"" To-Date: <br />Less Previous Payments; <br />Total Due This Apptication; <br /> <br />$246,435.50 <br />$0.00 <br />$246,435.50 <br />$69,076.50 <br /> <br />$0.00 <br />$69,076.50 <br />$:3,453.9:3 <br />$65,624.57 <br />$0,00 <br /> <br />$65,624.57 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br /> <br />Conlractor: VISU-SEWER CLEAN & SEAL, INC, <br /> <br />By: <br /> <br />Date: <br /> <br />The work on Ihis projecl and the application for payment have been reviewed and the <br />amount shown is recommended for payment. <br /> <br /> <br />Date: <br /> <br />/on~;l. <br /> <br />By. <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page lotS <br />