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<br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.5 <br /> <br />j URS Copy <br />City Copy <br />Contractor COpy <br />I nspector Cop, <br /> <br />Project: <br />Owner: <br />Owner No.: <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 />3/10/03 <br />2/28/03 <br /> <br />Original Contract Amount: <br /> <br />Contract Amendments: <br />Contract Amount To Date: <br /> <br />Total Amount of Work Complete To Date: <br /> <br />Material Suitably Stored On-Site but not <br />Incorporated into Work: <br /> <br />Gross Amount Due To-Date: <br /> <br />Less 5.00% Retainage: <br />Amount Due To-Date: <br /> <br />Less Previous Payments: <br /> <br />Total Due This Application: <br /> <br />$246,435.50 <br />$0.00 <br />$246,435.50 <br />$231,366.17 <br /> <br />$0.00 <br /> <br />$231,366.17 <br />$11,568.31 <br />$219,797.86 <br />$193,882.89 <br /> <br />$25,914.97 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br />Contractor: VISU-SEWER CLEAN & SEAL, INC. <br />By: Date: <br />The work on this project and the application for payment have been reviewed and the <br />amount shown is recommended for payment. <br />URS Corporation <br />By: Date: <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br />By: Date: <br /> <br />Page 1 of 5 <br />