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<br />J <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />Project: <br /> <br />Arden Hills Park Department <br />Perry Park Ballfield Improvements <br />City of Arden Hills <br /> <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />THOMAS & SONS <br />CONSTRUCTION <br />37951-005-8001 <br /> <br />BRW Job No.: <br /> <br />Application Date: <br />For Period Ending: <br /> <br />1/7/04 <br />1/2/04 <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 />$42,698.75 <br />$0.00 <br />$42,698.75 <br />$37,098.50 <br /> <br />$0.00 <br />$37,098.50 <br />$1,854.93 <br />$35,243.57 <br />$0.00 <br /> <br />$35,243.57 <br /> <br />VUPS Ceop;, <br />Citv Co::;v <br />Ccntrac()' <br /> <br />!ift..0f)CtO' <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br /> <br />Contractor: THOMAS & SONS CONSTRUCTION <br /> <br />By: <br /> <br />Date: <br /> <br />The work on this project and 1he application for payment have been reviewed and the <br />amount shown is recommended for p~yment. <br /> <br /> <br />Date: <br /> <br />J/;/cy <br /> <br />By: <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page 1 of4 <br />