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<br />~ <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.3 <br /> <br />Project: <br /> <br />Booster Station Rehabilitation Project <br />Addendum No, 1 <br />City of Arden Hills <br /> <br />Owner: <br />Owner No,: <br />Contractor: <br />BRW Job No,: <br /> <br />ENCOMM MIDWEST, INC, <br />37951-026-0201 <br /> <br />Application Date: <br />For Period Ending: <br /> <br />4/5/04 <br />4/3/04 <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-Dale: <br />Less 5,00% Retainage: <br />Amount Due To-Date: <br />Less Previous Payments: <br />Total Due This Application: <br /> <br />OOSCopy <br />I'CiIy Copy <br />Contractor Copy <br />Inspector Copy <br /> <br />$175,420,00 <br />$0,00 <br />$175,420,00 <br />$123,869,00 <br /> <br />$0,00 <br /> <br />$123,869.00 <br />$6,193.45 <br />$117,675.55 <br />$13,585,00 <br />$104,090,55 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date, <br /> <br />Contractor: ENCOMM MIDWEST, INC. <br /> <br />By: d-~~ p~ <br />I <br /> <br />Date: <br /> <br />s~ S"-c>'f <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: <br /> <br />;; - f--o '7 <br /> <br />Date: <br /> <br />Page 1 of 4 <br />