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<br />" <br /> <br />'. <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.3 <br /> <br />Project: <br /> <br />2004 Pavement Management Program <br />Edgewater Avenue Neighborhood <br />ADDENDUM NO, 1 <br />City of Arden Hills <br /> <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />ARNT CONSTRUCTION <br />COMPANY, INC. <br />31809367,00101 <br /> <br />SRW Job No,: <br /> <br />Application Date: <br />For Period Ending: <br /> <br />1 0/6/2004 <br />1 0/2/2004 <br /> <br />Original Contract Amount: <br /> <br />Contract Amendments: <br /> <br />Contract Amount To Date: <br /> <br />Total Amount of Work Complete To Date: <br />Material Suitably Stored On-Site but not <br />Incorporated into Work: <br /> <br />Gross Amount Due To-Date: <br /> <br />Less 5,00% Retainage: <br /> <br />Amount Due To-Date: <br /> <br />Less Previous Payments: <br /> <br />Total Due This Application: <br /> <br />$1,059,189,76 <br />$0,00 <br />$1,059,189,76 <br />$963,594,36 <br /> <br />$0,00 <br /> <br />$963,594,36 <br />$48,179,72 <br />$915,414.64 <br />$723,503,24 <br /> <br />$191.911.40 <br /> <br />lJAS Copy <br />City Copy <br />Contractor Copy <br />II1Spector Cop-i <br /> <br />I hereby certify that all' ms and amounts shown e correct for the work completed to- <br />date. <br /> <br />Contract <br /> <br />By: <br /> <br /> <br />Date: /0- G, _d~ <br />, <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 />Date: /tJ -6 "oy <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page 1 of 9 <br />