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<br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.3 <br /> <br />Project: <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />2003 Pavement Management Program <br />City of Arden Hills <br /> <br />ARNT CONSTRUCTION <br />COMPANY, INC. <br />37951-023-0101 <br /> <br />SRW Job No.: <br /> <br />Application Date: <br />For Period Ending: <br /> <br />9/12/03 <br />9/15/03 <br /> <br />( <br /> <br />Original Contract Amount: <br /> <br />Contract Amendments: <br />Contract Amount To Date: <br /> <br />Total Amount of Work Complete To Date: <br />Material Suitably Stored On-Site but not <br />Incorporated into Work: . <br /> <br />Gross Amount Due To-Date: <br />Less 5.00% Retainage: <br />Amount Due To-Date: <br /> <br />Less Previous Payments: <br /> <br />Total Due This Application: <br /> <br />URS Cop, <br />1/ cay Copy <br />Oall.-.b Copy <br />Insp....loo Copy <br /> <br />$1,903,526.10 <br />$2,600.00 <br />$1,906,126.10 <br />$1,349,154.66 <br /> <br />$0.00 <br />$1,349,154.66 <br />$67,457.73 <br />$1,281,696.93 <br />$958,373.33 <br />$323,323.60 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br /> <br />Contractor: ARNT CONSTRUCTION COMPANY, INC. <br /> <br />By: <br /> <br />Date: <br /> <br />The work on this project and the application for paymenl have been reviewed and the <br />amount shown is recommended for payment. <br /> <br /> <br />By: <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />9ay;in <br /> <br />Date: <br /> <br />Pagolof9 <br />