3.9. SR 05-19-1997 - Laserfiche WebLink

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APPLICATION AND CERTIFICATION FOR PAYMENT .al,4 DOCUMENTG702 P^GEO. EO~ 2 TO OWlqER City of Elk River 13065 Orono Parkway Elk River, Minnesota 553.10 PROJECT: Elk River lee Arena Expansion Elk River, Minne.~ta FROM CONTRACTOR: VIA ARCHITECT: RSP Architects, Ltd. M. A. Mortenson Company 120 First Avenue North 700 Meadow Lane North Minneapolis, MN 55401 · Golden Valley, Minnesota 55422 CONTRACT FOR: Construction Management APPLICATION NO: I 1 PERIOD TO: 4/30/97 PROJECT NO: 951019 CONTRACT DATE May, 1996 Distribution to: [~i"-IOWNER F~ARCHITEC/ ~ CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT Application is made' for pa)anent, as shown below, in c,)nnection with the Conlract. C0nti#uation Sheet. AIA Document G703, is attached. I. ORIGINAL CONTRACT SUM 2. Net change by Change O~ders 3. CONTRACT SUM TO DATE (Line I ~: 2) 4. TOTAL COMPLETED & STORED TO DATE (Colunm G on G703) 5. RETAINAGE: a. % of Complel~l Wo~ (Column D 4- Eoa G703) b. % of Stored Material (Column F on G703) Total Relainage (Lines 5a + 5b or Tolal in Colunm I of GT03) 6. TOIAL EARNED LESS RETAINAGE (Line 4 L~ss Linc 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $ 2,288,20'1.00 $ 181.063.00 $ 2,469,267.~ $ 2,453,772.00 3 t ,212.00 $ 31,212.00 $ 2,422, 560.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE $ (Line 3 less Line 6) $ 2,399,285.00 46,707.60 CHANGE ORDER SUMMAR'¥. ADDITIONS DEDUCllONS Total changeS apl~r°ved in pren4ous months by Ovmer SI64,827.00 Tolal approved this Month $16,236.00 TOTALS $181,063.00 $0.00 NET CHANGES by Change Order S I 81,06.1.00 AIADOCU~,ENTGTO2-APPLK',AT1ONAhlDCERIIFICAIlONFORPAYMENT 1992£DIIIO.q-A~ .OtG~a2 Thc undersigned Conlractor oertifies Ihal to thc best of the Contractor's knowledge, information and belief the Work oovcred by this Application for Paymcni has been completed in accordanoe with thc Cont~acl Documents, that all amounts have been paid by thc Conlracqor for Work tbr which previous Certificates tb~ Paymcnl we[c i~ucd and paymcnLs received from lhe Owner, and that curr~nl payment shown herein is now due. CONTRACTOR: M.A. Mortcnson Company State of: Minnesota Counl~: enncm - ' Subscfi~ ~d ~,,~m to.bSrom m~this 14,~ My Co~ission e~i~s: Jan~ 3 l, 2000 AR~HITEGT'S ~ERTIFIGATE FOR PAYMEN~ .... In a~M~ce ~ the ~n~ Documen~ b~d nn on-ait~ ob~tions ~d ~e data ~mpfising I~ applieMion, ~e Archite~ At~il~t'$ ~owledge, ~nlb~alion ~d belief thc Work h~ p~ ~ indicatM, the quali~' ofih~ Work ia in a~or~n~ wi~ ~he Con.ct D~en~, ~d ~¢ ConO~4or ia ¢ntifl~ to pa~enl of ~e ~ODNT CERTIH ED. AMOUNT CERTIFIED ........... $ (A/tach explanalion i.[ amount certified differs from the amount appliecl Initial all figure.* on dpplication and onlhe Continuation Sheet ti, ntt are changed ~o coRform n'it3 the amount certified..) ARClllTECT: By: Date: This Cerliflcate is nol negotiable. The AMOIJNT CERTIFIED is payable only to the Con~raetor named herein. Is$]mnee, iya)'mcnl and acceptance ot payment are prejudice Io any fights oflhe Owee~ or ContracL~r under this ConlracL IHE AMERICAN II'~Sl'lrUIrE OF ARCHIIECT~. tt-a~ NEW YOR~( AVE.. r4 W.. WA6HINOION~. O~ 2tX'~e~a292 Usem may obtain validation of this document by requesting a completed AIA Document 1:)401. Certification of Document's AuthenUcity from the Licensee.