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<br />" <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />, <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.4 <br /> <br />Project <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />2003 Pavement Management Program <br />City of Arden Hills <br /> <br />BRW Job No.: <br /> <br />ARNT CONSTRUCTION <br />COMPANY, INC. <br />37951-023-0101 <br /> <br />Application Date: <br />For Period Ending: <br /> <br />10/21/03 <br />10/15/03 <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 Due To-Date: <br />Less Previous Payments: <br />Total Due This Application: <br /> <br />$1,903,526.10 <br />$0.00 <br />$1,903,526.10 <br />$1,754,694.49 <br /> <br />$0.00 <br /> <br />$1,754,694.49 <br />$87,734.73 <br />$1,666,959.76 <br />$1,281,696.93 <br /> <br />$385,262.83 <br /> <br />ltRS Copy <br />;< C~y Copy <br />Contractor Copy <br />Inspector Copy <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: Date: <br /> <br />The work on this project and the application for payment 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: /tla;?~.", <br /> <br />Dale: <br /> <br />Page 1 of 9 <br />