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<br />
<br />PROJECT:
<br />
<br />1III!llt:~.,", ,
<br />
<br />'APPlICA TIOH AND CERT/FICA T/OH FOR PAYMENT
<br />
<br />Pheasant Marsh 3rd Addition
<br />
<br />CONTRACTOR: SOi/-COn, Inc.
<br />PO Box 217
<br />East Bethel, MN 55011
<br />
<br />OWNER:
<br />
<br />G"""", Development. Inc. CONTRACT FoR: Site Grading & Ems,,,,, Control
<br />7575 Golden Valley Road, SUite 250
<br />Golden Valley, MN 55427
<br />
<br />VOUCHER NO.:
<br />
<br />1
<br />
<br />Pra~, Tf~
<br />U~~ ~ U
<br />PERIOD ENDiNG: May 25, 2006
<br />
<br />~
<br />
<br />VOUCHER DATE: May 26, 2006
<br />
<br />The present status or !he OCcount for !his Contract Is as 'oI1OWs:
<br />
<br />ORIGINAL CONTRACT SUM ............ ............. .............. .......... .....................
<br />
<br />Net change by Change On:lers .,..... ........................... .... ................... ........
<br />CONTRACT SUM TO DATE ............. ................. .......... .::............. ...............
<br />
<br />..1 119.495.0~
<br />$ 119,495,O~
<br />=-
<br />..! 61, 141.5~
<br />..1
<br />$ 3,057.0~
<br />-
<br />J
<br />-L 58,084.4~
<br />
<br />VALUE OF WORK ~O TO OATE ................ ...............................
<br />lESS CHARGES AND DEDlJCT;QNS ............. .......... ..... .......... ................
<br />
<br />LESS RETAINAGE
<br />
<br />5%
<br />
<br />LEss PREvtOUS VOUCHERS.......... .................. ......... ..... ....... .......... .........
<br />CURRENT PAYMENT DuE............... .......................... ............................... .
<br />
<br />........................... ...............................
<br />
<br />n.. unde"'on.. Con_ ""lifieo the! !he Wo~ cove..., by this ApP","Uon for P"Yment has
<br />been compfet.. In a'CO",anre With the Conbact documents. tha' a" amoun~ ha.. basn pal. by
<br />tham for Won. fa, Which P-us ""'""oatas for Pay.,en~ ...", 'SSUed and _n~
<br />"'- Imm th. Ow,,,,,, -lhet tha ........ ""_nt s'- he,.., is now dUe.
<br />
<br />
<br />In a'CO",,,,,,,,, With tha Conbact and this App"relion to, Payment the "-acto,. .ollUed fa
<br />payment in the amount shown above.
<br />
<br />Date: S ..... 30 ....404- 4
<br />
<br />Engineer. JAMES R. Hill, INC.
<br />1523 94th Lane NE, Suite B
<br />Blaine, MN 55449
<br />
<br />BY:_ ;Jfi:?--t:::P' _ -----...:. DATE:~
<br />
<br />1\, PPt:;(",',lf-:O
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<br />,JA 'I'i/li:; r'\L.:;VI;.....~.~'-
<br />DATE~,~-6t.
<br />INITIALS');w/
<br />
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<br />..'-.,.,.c...._____
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