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<br />. <br /> <br />e <br /> <br />e <br /> <br />APPLICATION FOR PAYMENT <br />PAYMENT NO.5 <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 /> <br />Owner No.: <br /> <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 />1/18/2005 <br />1/7/2005 <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 Slored On.Site but not <br />Incorporated into Work: <br /> <br />Gross Amount Due To-Date: <br /> <br />Less 3.00% 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 />$34,170.00 <br />$1,093,359.76 <br />$1,075,202.51 <br /> <br />$0.00 <br />$1,075,202.51 <br />$32,256.07 <br />$1,042,946.44 <br />$961,138.09 <br /> <br />$81 ,808.35 <br /> <br />hRS Copy <br />City Copy <br />Contractor Copy <br />Inspector ecl"" <br /> <br />I hereby certify that all . ems and amounts shown are correct for the work completed to- <br />date. <br /> <br />Contr <br /> <br />By: <br /> <br /> <br />Date: <br /> <br />/ - .J-G, ~o~ <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: ) ~ ;<6-05 <br /> <br />APPROVED FOR PAYMENT <br />Owner: City of Arden Hills <br /> <br />By: <br /> <br />Date: <br /> <br />Page 1 of 9 <br />