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<br /> URS Copy <br /> )'\. Ci~y Copy <br /> APPLICATION FOR PAYMENT Contractor Copy . <br /> PAYMENT NO.3 Inspector CC9Y <br /> Project. CSAH 96 Landscape and Irrigation Improvement Project . <br /> Owner: City of Arden Hills <br /> Owner No.: <br /> Contractor: Margolis Company <br /> URS Job No.: 31809929.00201 <br /> Application Date: 10/24/2006 <br /> For Period Ending: 10/31/2006 <br /> Original Contract Amount: $176,732.50 <br /> Contract Amendments: $0,00 <br /> Contract Amount To Date: $176,732.50 <br /> Total Amount of Work Complete To Date: $173,428.50 <br /> Material Suitably Stored On-Site but not <br /> Incorporated Into Work: $0.00 <br /> Gross Amount Due To Date: $173,428.50 <br /> Less 12.54% Retainage: $21,747.93 <br /> Amount Due To Date: $151,680,57 <br /> Less Previous Payments: $150,088,64 <br /> Total Due This Application: $1,591.93 <br /> I hereby certify that all items and amounts shown are correct for the work completed <br /> to date. <br /> Contractor: . <br /> By: -<\: Date: /J Itt!br;; <br /> , - ___._._M_ / I ' <br /> I <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 /> Date: 1/- 6 -t/6 <br /> APPROVED FOR PAYMENT <br /> Owner: City of Arden Hills <br /> By: Date: <br /> . <br /> Page 1 of 5 <br />