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PROJECT APPLICATION AND PROJECT,CERTIFICATE FOR PAYMENT <br /> <br />AIA DOCUMENT G722/CMa (Instructions on reverse side) <br /> <br />PAGE ()NE (')F PAGES <br /> <br />TO <br /> OWNE~(~iIy-- of Elk River <br /> 13065 Orono Parkway <br /> Elk River, MN <br /> Loft Johnson <br />ATTENTION: <br /> <br />PROJECT: <br /> <br />Northbound Liquors <br />19348 Evans Street NW <br />Elk River, MN 55330 <br /> <br />APPLICATION NO.: Distribution to: <br />PERIOD TO: 06 r"l OWNER <br />PROJECT NOS,: 09/30/97 [] CONSTRUCTION <br /> MANAGER <br /> 3460 <br /> [] ARCHITECT <br /> <br />PROJECT APPLICATION FOR PAYMENT <br />Application is made for Payment, as shown below, in connection with the Project. Project <br />Application Sumrnary, AIA Document G723/CMa, is attached. <br />1. TOTAL CONTRACT suMs (Item A Totals) $ 956,394 <br />2. Total net changes by Changa Orders $ 48,989 <br />(Item B Totals) 1,005,383 <br />3. TOTAL CONTRACT SUM TO DATE (Item ~ Totals) $- <br /> <br />4, TOTAL COMPLETED & STORED TO DATE <br /> (Item F Totals) <br />5. RETAINAGE (Item H Totals) <br /> <br />6. LESS PREVIOUS TOTAL PAYMENTS <br /> (Item I Totals) <br />7. CURRENT PAYMENT DUE (Item J Totals) <br /> <br />914-817 <br /> <br />44,510 <br />711,615 <br /> <br />158,692 <br /> <br />The undersigned Construction Manager certifies that to the best of the Construction <br />Manager's know edge, information and belief this Project Application for Payment is an <br />accurate compilation of the Contractors' Applications for Payment, attached hereto. <br /> <br />CONSTRUCTION M Greystone Construction Company <br />  10/1/97 <br />B y: Date: <br /> <br />State of: <br />County of: Scott <br /> <br />Subscribed and sworn to before <br />me this 1 /%day o~ct°ber 1997 .................... <br /> <br />~~ ~. · ~OIAKY ~BLIC MINNE~TI ) <br /> <br />PROJECT CERTIFICATE FOR PAYMENT <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 the Owner <br />that to 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 />158,692 <br /> <br />TOTAL OF AMOUNTS CERTIFIED ................ $ <br /> Greystone Construction Company <br />CONSTRUCTION MAN~ 10/1/97 <br /> <br />By: ' ~'~{,,~ -~ Date: <br /> <br /> Tushie-Mon'tgomery & Associates, Inc. <br />ARCHITECT: ~'~~c..1t <br />By: Date: <br /> <br />This Certificate is not negotiable. The AMOUNTS CERTIFIED are payable only to the <br />Contractors named in AIA Document G723/CMa, attached. Issuance, payment and accep- <br />tance of payment are without prejudice to any rights of the Owner or the Contractors <br />under their Contracts. <br /> <br />AIA DOCUMENT G722./CMI · PROJECT APPLICATION AND PROJECT CERTIFICATE FOR PAYMENT · 1992 EDITION "AIA® <br />L~1992" THE AMERICAN INSTITUTE OF ARCHITECTS, {735 NEW YORK AVENUE, N.W:, WASHINGTON, D.C. 20006-5292 <br />WARNING: Unllcen~ photocopying vlolat# U.S. oopyflght law~ and will ~ubj~-t the ~olator t~ legal p~ution. <br /> <br />G722/CMa-1992 <br /> <br /> <br />