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<br />APPLICATION AND CERTIFICATION FOR PAYMENT
<br />
<br />TO OWNER City of Elk River
<br />
<br /> 13065 Orono Parkway
<br /> Elk River, Minnesola 55330
<br />
<br />PROJECT: Elk River Ice Arena
<br />
<br /> Expansion
<br /> Elk River, Mirmesota
<br />
<br /> FROM CONTRACTOR: VIA ARCHITECT: RSP Archhects, Ltd.
<br /> M. A. Moncmson Company 120 First Avenue North
<br /> 700 Meadow Lane North Mirmeapotis, g. fN 55401
<br /> Golden Valley, Minnesota 5.~22
<br /> CONTRACT FOR:
<br />~ L'onstn~ion Ma.~gt'm~t
<br />
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Application is made tbr payment, a$ :xhown bek~w, in conm:cfion with the Contract.
<br /> "~ 2
<br />Continuation She, eL AIA Documen! G, 0,, is attached.
<br />
<br /> I ORIGINAL CONTRACT SI,.~I
<br /> 2. Nel change ~. Clmng¢ Orders
<br /> 3 CONIR~-~CT SUM lrO DATE (Line ! = 2)
<br /> 4. FOT..-X[ COMPLETED & STORED TO
<br /> DATE (Column G on
<br />5. REYAINAGE:
<br /> a_ _ % of Con',pieced Wink
<br /> {Coluann D - E on G703)
<br /> b. % of Stored ,:Material
<br /> (Column F on
<br /> Total Retainag¢ {L.i,~
<br /> hmal in Colunm I of G?03)
<br />6. Iai'AL EAI~'qED LESS RETAINAGE
<br /> {Line 4 Le~ Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR
<br /> PAYMENT {Line 6 f~om l~rior C¢~tilica~)
<br />8 CURREN'[ PAYMENI DUE
<br />
<br />44,$74_00
<br />
<br />AL4 DOCUMENT G702
<br />
<br /> APPLICATION NO:
<br />
<br />PERIOD TO: I Z,"3 I..'96
<br />
<br />9. BALANCE TO FINISH. INCLI.;.'DING RETAIXiAGE (Line 3 le~s Lme b)
<br />
<br />PROJECT NO: 951019
<br />
<br />PAGE ONE OF 2
<br />
<br />PAGES
<br />
<br />Dislribution to:
<br />[-'~O~¥,'NER
<br />~}ARC}I ITECT
<br />CON rlLRCTOR
<br />
<br />~ CONTRA CT DATE May, 1996
<br /> The undersigned Contracto~ certifies that to ~e ~ ol'~ C~c~s ~o~le~,
<br /> infatuation and ~lief the Wo~ ~v~d by this Aoolic~ fm Payment h~
<br /> compl~ed in ac~rd~ ~'i~ I~ Con~l Document, ~ ~1 ~mn~ have
<br /> the Ctmtr~lor fey Wo~k for which p<vi~s Ceflificales Ih{ Pm'm~! ~ iss~
<br /> ~).'menl~ ~ccived l}om ~ Ox~ner. ~d ~al c~nl ~3'm~{ s~.n h~m i~
<br />
<br />2,288,20A.00
<br /> 145,296.00
<br />2,433,5O0.00
<br />2278,811.00
<br />
<br />$ 44,874 .O0
<br />
<br />$ 2,23:1,937.1111
<br />
<br />,901,629.00
<br />19%363.00
<br />
<br />CltANGE ORDER SL,q~&M~adt y ADDITIONS DEDUCTION.R'-
<br />To~al changes approved
<br />in previous m~mths b? Owner $118.744.(}(i
<br />Total approved thL~ Month $26,552.00
<br />TOIALS $1.45,296.00
<br />NET CI'L-~NGES by Change Orclet $145.296.00
<br />
<br />.CONTILACI-OR: M.A. Morlenson
<br />
<br />S~ate of.' Minnesota Count,.- of: Ilennepin
<br />Subscribed and :--',~orn to before mc this I 0t,h da,,' of Janua. rx.
<br />Notary Public: '
<br />My Commission expires: .lanuao, 3 I. 2000
<br />
<br />January( I0. 1997
<br /> 1997
<br />
<br /> ARCHITECT'S CERTIFICAiI:: FOR PAYMENT
<br />In accordance with th~ Contract Documents. ba.~d on on-silo observalions and the 'data
<br />comprising {he applicafio~ the Architect certifies to the Owner thai ~o Ihe best of the
<br />Archimct's knowled~e, intbrmafion and belief the Work h~ pn.~..ressed as indicated,
<br />the qoal~' of the Work is in accordance with the Cataract Documem& and the
<br />is entirtted to p~'menl of the AMOUNT CERTLF[ED_
<br />
<br />AMOLqqT CERTIFIED ..........
<br />
<br />/..{Itt,ch extd.,z~ation If amount cert~£ted differs #om the amtranl apphed. In&iai all flg,~re$ oe IhL~
<br />.41~plication and on~¢ Contiratcuion gheet thai are charged to conform '~'it3; the
<br />Al' CHiTECT:
<br />
<br /> Dine:
<br />This Cerlificate ia not negotiable_ The AMOUNT CERTIFIED is payable only Io the
<br />C'ontractor named hereto. ~ssm~nce, paymeot and acceptance al pa)Tnenl are
<br />prejudice to any rights of the O~x'na or Contracto{ under this CoIItra~l.
<br />
<br />t'~'~DOC'JM'~NIr'q~"~ ~'F~-IC'AFIG~iA'%CCE-RTIFICA7/O~ F'--~ PAYME-hi~' I~E~ITIC~-AiA
<br /> · ~ff' AM£R~'...AN IteCal~TLrlE~ Osc ARCHffEC TS. I ~ NE'frs' YORK A',/E.. N
<br />Usem may obtain validation of thL~ documem by requesting a completed AJA Document D401 - Certitrmation of Ooeumenrs Authen~city from Um Licensee.
<br />
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