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CCP 12-08-2003
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CCP 12-08-2003
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5/8/2007 1:18:51 PM
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<br />. <br /> <br />. <br /> <br />. <br /> <br />DEC-03-2003 11:49 <br /> <br />612 373 6522 <br /> <br />P.02 <br /> <br />BRW 4W <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.5 <br /> <br />Project: <br />Owner: <br />Owner No.: <br />Conlractor: <br /> <br />2003 Pavement Management Program <br />City of Arden Hills <br /> <br />SRW Job No.: <br /> <br />ARNT CONSTRUCTION <br />COMPANY, INC. <br />37951-023-0101 <br /> <br />URS Copy <br />.....etty Copy <br />Cootractor Copy <br />Inspec10r Copy <br /> <br />Application Date: <br />For Period Ending: <br /> <br />11/19/03 <br />11/15/03 <br /> <br />Original Contract Amount: <br />Contract Amendments; <br />Contract Amount To Date: <br />TOlal 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 />Tolal Due This Application: <br /> <br />$1,903.526.10 <br />$0.00 <br />$1,903,526.10 <br />$1.865.992.87 <br /> <br />$0.00 <br />$1,865,992.87 <br />$93,299.64 <br />$1.772.693.23 <br />$1.666,959.76 <br />$105.733.47 <br /> <br />f 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 payment have been reviewed and the <br />amount shown Is recommended for payment. <br /> <br /> <br />Date: / () - ;l-tJ ~ <br /> <br />.'. <br /> <br />By: <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Pagel 019 <br />
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