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<br />; <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />Project: <br /> <br />2004 Pavement Management Program <br />Edgewatcr Avenue Neighborhood <br />ADDENDUM NO.1 <br /> <br />City ot Arden Hills <br /> <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />ARNT CONSTRUCTION <br />COMPANY, INC. <br />31809367.00101 <br /> <br />BRW Job No.: <br /> <br />Application Date: <br />For Period Ending: <br /> <br />8/3/04 <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 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 /> <br />Total Due This Application: <br /> <br /> <br />~Sc~y <br />Contractor Copy <br />Inspector Copy <br /> <br />$1,059,189.76 <br />$0.00 <br />$1,059,189.76 <br />$239,902.10 <br /> <br />$0.00 <br /> <br />$239,902.10 <br />$11,995.11 <br />$227,906.99 <br />$0.00 <br /> <br />$227,906.99 <br /> <br />I hereby certify that al ems and amounts shown are correct for the work completed to- <br />date. <br /> <br />PANY, INC. <br /> <br />By: <br /> <br />Date: <br /> <br />e - 3. -0 '--/ <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 />8"-0'5-0 't <br /> <br />Date: <br /> <br />Page 1 of 9 <br />