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<br />, <br /> <br />. <br /> <br />. <br /> <br />. <br /> <br />Project: <br />Owner: <br />Owner No,: <br />Contractor: <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.6 <br />2003 Pavement Management Program <br />City of Arden Hills <br /> <br />ARNT CONSTRUCTION <br />COMPANY, INC, <br />BRW Job No,: 37951-023.0101 <br /> <br />Application Date: 12/14/04 <br />For Period Ending: 12/11/04 <br /> <br />Original Contract Amount: <br />Contract Amendments (CO #1): <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 0.50% Retainage: <br />Amount Due To.Date: <br />Less Previous Pavments: <br /> <br />Total Due This Application: <br /> <br />$1,903,526,10 <br />$126,487,94 <br />$2,030,014,04 <br />$2,029,044,99 <br /> <br />$0.00 <br />$2,029,044.99 <br />$10,145,22 <br />$2,018,899,77 <br />$1 ,772.693.23 <br />$246,206.54 <br /> <br />vGRS Copy <br />C~y Copy <br />Contractor Copy <br />Inspector Co:)y <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed <br />to-date. <br /> <br /> <br />By: <br /> <br />Date: I d - ,)./- 0,/ <br /> <br />The work on this project and the application for payment have been reviewed and <br />the amount shown is recommended for payment. <br /> <br /> <br />Date: /~-;l3 -t?'f <br /> <br />APPROVED FOR PAYMENT <br /> <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page 1 of 9 <br />