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PROTECT APPLICATION AND PROTECT,CERTIFICATE FOR PAYMENT <br />AIA DOCUMENT G722/CMa (Instructions on reverse side) <br /> <br />PAGE ONE OF PAGES <br /> <br />TO <br /> OWNER~ity of Elk Ri~;er <br /> 13065 Orono Parkway <br /> Elk River, MN <br /> Lori Johnson <br />ATTENTION: <br /> <br />PROJECT: <br /> <br />Northbound Liquors <br />19348 Evans Sweet NW <br />Elk River, MN 55330 <br /> <br />APPLICATION NO.: Distribution to: <br />PERIOD TO: 05 1-1 OWNER <br />PROJECT NOS.: 08/31/97 [] CONSTRUCTION <br /> MANAGER <br /> 3460 <br /> [] ARCHITECT <br /> <br />PROJECT APPLICATION FOR PAYMENT <br /> <br />Application is made for Payment, as shown below, in connection with the Project. Project <br />Application Summary, AIA Document G723/CMa, is attached. <br />I. TOTAL CONTRACT suMs (Item A Totals) $ 940.433 <br />2. Total net changes by Change Orders $ 46,401 <br />(Item B Totals) 986,834 <br />5. TOTAL CONTRACT SUM TO DATE (Item C Totals)$ <br /> <br />PROJECT CERTIFICATE FOR PAYMENT <br /> <br />In accordance with the Contract Documents, based on on-site observations and the data <br />'compriSing this Application, the Construction Manager and Architect certify' to thc Owner <br />that [o the best of their knowledge, information and belief the Work has progressed as <br />indicated, the quality of the Work is in accordance with the Contract Documents, and <br />the Contractors are entitled to payment of the AMOUNTS CERTIFIED. <br /> <br />4. TOTAL COMPLETED & STORED TO DATE <br /> (Item F Totals) <br />.5. RETAINAGE (Item H To~als) <br /> <br />6. LESS PREVIOUS TOTAL PAYM~:NTS <br /> (Item I Totals) <br />7. CURRENT PAYMENT DUE (Item J Totals) <br /> <br />747,776 <br /> <br />367161 <br />445,209 <br /> <br />266,406 <br /> <br />Thc undersigned Construction Manager certifies that to the best of the Construction <br />Manager's knowledge, information and belief this Project Application for Payment is an <br />accurate compilation of the Contractors' Applications for Payment, attached hereto. <br /> Greystone Construction Company <br />CONSTRUCTION M~~~. <br /> 9/2/97 <br />By: Date: <br /> <br />State of: MN <br />County of: Scott <br />Subscribed and sworn to before <br /> · 2 _ ~eptember 1997 -_ ' <br />me mis aay or '~ ~ <br /> <br />266,406 <br /> <br />TOTAL OF AMOUNTS cERTIFIED ................ <br /> Greystone Construction Company <br />CONSTRUCTION MANAGER: <br /> <br />T~ ' <br />ARCHITECT: ~ <br />By: ~ ~., <br /> <br />This Certificate is not <br />Contractors named in Ail <br />tance of payment 2re without preiudice to any rights of the Owner or thc Contractors <br />under their Contracts. <br /> <br />%~.~. AIA'IX)CUMENT ~ ' PROJECT APPLICATION AND PROJECT CERTIFICATE FOR PAYMEhrr · 1992 EDITION * AIAe <br /> ~)1992 · THE AMERICAN INS'rlTUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N?~., WASHINGTON, D.C. 20006-$292 <br /> <br /> 9/2/97 <br /> <br /> Date: <br /> <br /> Ssociates, Inc. <br /> <br />.'gotiable. Thc AMOUNTS CERTIFIED are payable only to the <br />Document G723/CMa, attached. Issuance, payment and accep- <br /> <br />G722/CMa-1992 <br /> <br /> <br />