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<br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.6 <br /> <br />Project: <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />2003 Pavement Management Program <br />City 01 Arden Hills <br /> <br />ARNT CONSTRUCTION <br />COMPANY. INC. <br />37951-023-0101 <br /> <br />BRW Job No.: <br /> <br />Application Dale: <br />For Period Ending: <br /> <br />8/9/04 <br />7/30/04 <br /> <br />Original Contract Amount: <br />Contract Amendments: <br />Contract Amount To Date: <br />Total Amount of Work Complete To Date: <br />Material Suitabfy Stored On-Site but not <br />Incorporated into Work: <br />Gross Amount Due To-Date: <br />Less 0.50% Retainage: <br />Amount Due To-Date: <br />Less Previous Payments: <br /> <br />Totaf 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 /> <br />$1,865,992.87 <br />$9,329.96 <br />$1,856,662.91 <br />$1,772,693.23 <br /> <br />$83,969.68 <br /> <br />/ URS Copy <br />City 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 /> <br />By: <br /> <br />Date: <br /> <br />g -3 -.oy <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 />?-03 -or--- <br /> <br />Date: <br /> <br />Page 1 of 9 <br />