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<br />APPLICATION AND CERTIFICATION FOR PAYMENT <br /> <br />PROJECT: <br /> <br />Pheasant Marsh 3rd <br /> <br />CONTRACTOR: <br /> <br />C.W. Houle, Inc. <br />1300 W Co Rd I <br />Shoreview, MN 55126 <br /> <br />OWNER: <br /> <br />Ground Development CONTRACT FOR: Utility and Street <br />7575 Golden Valley Road, Suite 250 Construction <br />Golden Valley, MN 55427 <br /> <br />VOUCHER NO.: 1 <br /> <br />VOUCHER DATE: July21,2006 <br /> <br />PERIOD ENDING: July 2~6 <br />tP1(O)~~ <br /> <br />The present status of the account for this Contract is as follows: <br /> <br />ORIGINAL CONTRACT SUM .............. ............................ ................................. <br /> <br />$ <br /> <br />597,711.85 <br /> <br />Net change by Change Orders .......... ............................ ................................. <br /> <br />$7,457.36 <br /> <br />CONTRACT SUM TO DATE... ............. ............................ ................................. <br /> <br />$ <br /> <br />605,169.21 <br /> <br />VALUE OF WORK COMPLETED TO DATE .......... .......... ................................. <br /> <br />$ <br /> <br />259,869.06 <br /> <br />LESS CHARGES AND DEDUCTIONS .......................... ................................. <br /> <br />LESS RETAINAGE <br /> <br />5% <br /> <br />$ <br /> <br />12,993.45 <br /> <br />LESS PREVIOUS VOUCHERS............. ............................ ....""......................... $ <br /> <br />CURRENT PAYMENT DUE.................. ............................ ............................".. <br /> <br />$ <br /> <br />246,875.61 <br /> <br />The undersigned Contractor certifies that the Work covered by this Application for Payment has <br />been completed in accordance with the Contract documents, that all amounts have been paid by <br />them for Work for which previous Certificates for Payments were issued and payments <br />received from the Owner, and that the current payment shown herein is now due. <br /> <br />Contractor: <br /> <br />c. W. Houle, Inc. <br /> <br /> <br />w)~~ <br /> <br />Date: <br /> <br /> <br />In accordance with the Contract and this Application for Payment the Contractor is entitled to <br />payment in the amount shown above. <br /> <br />Engineer: JAMES R. HILL, INC. <br />1523 94th Lane NE, Suite B <br />BLAINE, MN 55449 <br /> <br />BY: -;:? 04 <br />l :?,c~.. .' -::.... ~:~". ~'~_J <br />r1l",O .' ,.' <br />, " ',. ,.:., ". " ,,",~...J <br />['I.'Ct: ,..~:tl.:'Ok, <br />I ':~ <br /> <br />DATE: 7/u.~" <br /> <br />34 <br />