3.5. SR 10-20-1997 - Laserfiche WebLink

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APPLICATION AND CERTIFICATION FOR PAYMENT .4I, t DOCUMENTG702 PAGEONEOF 2 PAGES TO OWNER City of Elk River 13065 Orono Parkway Elk River, Minnesota 55330 PROJECT: Elk River Ice Arena Expansion Elk River, Minnesota 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: 13 PERIOD TO: 9/30/97 PROJECT NO: 951019 CONTRACT DATE May, 1996 Distribution to: ~]OWNER [~-]ARCHITECT [-'1'~ CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line I :t: 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. % of Completed Work (Column D + E on G703) b. % of Stored Material (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) 6. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE $ $ $ 2,288,204.00 $ 190,402.00 $ 2,478,606.00 $ 2,470,350.00 23,281.00 $ 23,281.00 $ 2,447,069.00 $ 2,441,482.00 $ 5;587!00 9. BALANCE TO FINISH, INCLUDING RETAINAGE $ 31,537.00 (Line 3 less Line 6) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $181,063.00 Total approved this Month $9,339.00 TOTALS $190,402.00 $0.00 NET CHANGES by Change Order $190,402.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. CONTRACTOR: M. A. Mortenson Company By: Date: October 10, 1997 State off Minnesota Subscribed and sworn to before me this 10th Notary Public: My Commission expires: January 31, 2000 County off Hennepin day of October 1997 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising the application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED ........... $ (Attach explanation if amount certified differs from the amount applied. Initial all figures on this ,4pplication and onthe Continuation Sheet that are changed to conform with the amount certified.) ARCHITECT: By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the 12ontraetor named here~n. Issuance, payment and acceptance ot payment are w~thout prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702- APPLICATION AND CERTIFICATION FOR PAYMENT. 1992 EDITION. AIA · 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE.. N.W., WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 - Certification of Document's Authenticity from the Licensee.