3.8. SR 07-21-1997 - Laserfiche WebLink

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APPLICATION AND CERTIFICATION FOR PAYMENT TO OWNER Ciiy of Elk Rivcr 13065 Orono Parkway Elk River, Minnesota 55330 PROJECT: Elk River Ice Arena Expansion Elk River, Minnesota FROM CONTRACTOR: VIA ARCHITECT: RSP Archilects, Ltd. M. A. Mortenson Company 120 Firsl Avemte Norlh 700 Meadow Lane North Minneapolis, MN 55401 Golden Valley, Minnesota 55422 CONTRACT FOR: C~nslmc6on Managemen! CONTRACTOR'S APPLICATION FOR PAYMENT Application is made lbr p~ymen~ as shown below, in eenneclion with the Conlract. Continuation Sheel, AIA Document G703, is eltachcd. ,4M DOCUMENT G702 APPLICATION NO: 12 PERIOD TO: 6/30/97 PAGE OI~E o~: 2 PAGES PROJECT NO: 951019 Distribution to: F-~OWNER F~ARCFIITECT FT~ CON T RA CTOR CONTRACT DATE May, 1996 The undersigned Conlraetor certifies IbM to the best of the Contractor's knowledge, information and belief the Work coveied by this Application for Paymen! has been completed in accordance with the Contracl Documents, that ali arno!mis have been paid by the Contractor tbr Work for which previous Certifi~tes for Pa!Then! ~r~ i.~nmd and paymenL~ received from ~e Owncr~ and thai cunent paymen! shoo, tn herein is now due. I. ORIGIIqAL CONTRACT SUM 2. Net change by Ch~ge O~dess 3. CONTRACT SUM TO DATE 0Ane 1 a- 2) 4. TOTAL COMPLETED & STORED TO DATE - (Column G on G703) 5. RETAINAGE: a. % of C0mpleted Work (Column D -~ E on G?03) I~. % of Stood MMerial (Column F on G703) ' Total Retainage (Line. s 5a ~- ab or Total in Coloron I of G?l)3) 6. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from pdo~ Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Lin~ 3 less Line 6) $ 2,288~04.00 $ 190,4~2.U0 $ 2,478,606.00 $ 2,467,517.00 26,035.00 $ 26,035.00 $ 2,441,482.00 $ 2,422,560.013 $ 37,124.00 CON TRACTOR: M. A. Mt~enson Company Bt': Date: Jul)' 10, 1997 Slate of: Minnesota Counly of: Hennepin Subscribed and sworn ~o b~lbre me ~is 10th .da}, of . July 1997 Notary Public: My Commission expires: Janumy 31, 2000 . ARCHITECT"S CI=RTIFIGATI:'FOR PAYMI::NI In accordance with the Contract Documents, based on c~-sie: observations and the dnla comprising the application,, the A~c. hitcet certifies to !~ Owner thal !o thc best of e&e Anrhitect's knowlcdge~ information and belief the Work has progrezsvd as indic, a~ed, the qnali~y oflhe Work is in accordance wilh ~he Contra~ Docamen~s, and the Con~ractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ........... $ ' CHANGE ORDER SUMM~RY ADDITIONS DEDUCTIONS Tolal Changes approved in previous months by O,wncr $181,063.1)~} Total approved this Month $9,339.00 TOTALS $190,402.00 $0.00 NET CHANGES by Chaag~ Order $190,402.00 A~ OOCIJ~ENT O'i~ - APPLICA'f ION AI~D CERllFlCAlION FC~ PAYMENT - t.092 E~n't(~l · AIR · ~1~2 IHE AMERICAI9 INS ! II UTE O~: ~C~ i ~:~i:a 17~5 NEW YORK A'qE., N.W.. WASHINGTON. DC 2(IOC~-5292 Users may obtain validation of this document-by requesting a completed AIA Document D401 - Certification of DocumenfsAuthenttcity from tho Licensee. (~4ttach explanation if amount certified differs from the amount applied Initial all figures on this Application and an!he Continuation Sheet thai are changed lo conform wilh the amount certified) ARCHITECT: By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is pa)able only to L:ontra~or named harem. Issuance, payment and aoceptance ot payment afc w~thout prejudice to an)' rigbls of the Owner or Contractor under this Contract.