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<br />APPLICATION FOR PAYMENT <br />PAYMENT NO.4 <br /> <br />Project: <br /> <br />CSAH 96 Landscape and Irrigation Improvement Project <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 />12/4/2007 <br />12/4/2007 <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 1/2 12.54% 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 />$173,428.50 <br /> <br />$0.00 <br />$173,428.50 <br />$10,873.97 <br />$162,554,53 <br />$151,680.57 <br />$10,873,96 <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 />Date: /.;l- ':;--0 '7 <br /> <br />By: <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 />URS Corporation <br /> <br />By: <br /> <br /> <br />g <br /> <br />v <br /> <br />Date: <br /> <br />/ ;?/pS-~ 7 <br />I / <br /> <br />APPROVED FOR PAYMENT <br /> <br />Owner: City of Arden Hills <br /> <br />By: Date: <br /> <br />Page 1 of 5 <br />