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<br />APPLICATION FOR PAYMENT <br />PAYMENT NO.1 <br /> <br />Project: <br /> <br />CSAH 96 Landscape and Irrigation Improvement Project <br /> <br />. <br /> <br />Owner: <br />Owner No,: <br />Contractor: <br />URS Job No,: <br />Application Date: <br />For Period Ending: <br /> <br />City of Arden Hills <br /> <br />Margolis Company <br />31809929,00201 <br />611/2006 <br />513112006 <br /> <br />URS Copy <br />City Copy <br />'f Contractor Copy <br />Inspector Copy <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 13,67% Retainage: <br />Amount Due To Date: <br />Less Previous Payments: <br />Total Due This Application: <br /> <br />$176,732,50 <br />$0,00 <br />$176,732,50 <br />$159,287,75 <br /> <br />$0,00 <br />$159.287.75 <br />$21,774,64 <br />$137,513,11 <br />$0,00 <br />$137,513.11 <br /> <br />I hereby certify that all items and amounts shown are correct for the work completed <br />to date, <br /> <br />Contractor: <br /> <br /> <br />. <br /> <br />Date:/- ~-O{ <br /> <br />The work shown on this project and the application for payment have been reviewed <br />and the amount shown is recommended for payment. <br /> <br />By: <br /> <br /> <br />Date: t ~-/J(, <br /> <br />APPROVED FOR PAYMENT <br /> <br />Owner: City of Arden Hills <br /> <br />By: Date: <br /> <br />. <br /> <br />Page 1 of 5 <br />