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<br />, <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />Project: <br />Owner: <br />Owner No.: <br />Contractor: <br /> <br />Street Sign Program <br />City of Arden Hills <br /> <br />SRW Job No.: <br /> <br />NORTHERN TRAFFIC <br />SUPPLY: INC. <br />37951-005-0101 <br /> <br />Application Date: <br />For Period Ending: <br /> <br />12/13/2004 <br />12/3/2004 <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 />$51,620.00 <br />$0.00 <br />$51,620.00 <br />$47,222,00 <br /> <br />$0.00 <br /> <br />$47,222.00 <br />$2,361.10 <br />$44,860.90 <br />$0.00 <br /> <br />$44,860,90 <br /> <br />~RS Copy <br />City Copy <br />Contractor Crr,y <br />Inspectof " <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed to- <br />date. <br />Contractor: NORTHERN TRAFFIC SUPPLY, INC. <br /> <br />By: /?~ c:t'- ?--t:---. Date: / Z - 7.- 6 'y <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: / ;J - t - () 't <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page 1 of 4 <br />