Laserfiche WebLink
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION <br /> <br />AIA DO, AENT G702/CMa (Instructions on reverse side) <br /> <br />I'A(iE ( <br /> <br />PA(; ES <br /> <br />TO OWNER: City of Elk River PROJECT: <br /> 13065 Orono Parkway <br /> Elk River, MN 55330 <br /> <br />FROM CONTRACI'OR: <br /> <br />CONTRACT FOR: <br /> <br />Rink Systems, Inc. <br /> <br />1103 Hershey St <br /> <br />Albert Lea MN 56007 <br /> <br />Addition to Elk River Arena <br /> <br />Rink and Dasherboard System <br /> <br />VIA CONSTRUCTION MANAGEt~,: <br />VIA ARCHITECT: <br /> <br />APPI. ICATION NO.: 6 Distribution to: <br />PERIOD TO: 1131198 [] OWNER <br />PROJECI' NOS.: [] C()NSTRI !CTION <br /> MANAGER <br />CONTRACT DATE: [] A RCItlTECT <br /> 5/28196 [] (7(3NTRA(71'OR <br /> <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Application is made for payment, as shoxvn below, in connection with thc Contract. <br /> <br />Continuation Sheet, AIA Document G703, is attached. <br />1. ORIGINAL CONTRACT SUM .................. <br /> <br />2. Net Change Blt Change Orders ............... <br /> <br />3. CONTRACT SUM TO DATE (l,ine I + 2) ........ <br /> <br />q. TOTAL COMPLETED & STORED TO DATE ...... <br /> (COILH1H1 G Oil G702) <br /> <br />5. RETAINAfiE: <br /> a. __% of Completed Work <br /> (Columns D + E on G703) <br /> <br /> b. __% of Stored Material <br /> (Column F on G703) <br /> qbtal Rctainagc (Linc 5a + 5b or <br /> qbtal in Cohmm I of G703) ................. <br /> <br />6. TOTAL EARNED LESS RETAINAGE ............ <br /> (Linc 4 less Line 5 'R)tal) <br /> <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT <br /> (Line 6 from prior Certificate) ................. <br /> <br />8. CURRENT PAYMENT DUE .................. <br /> <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br /> (Linc 3 less l.inc 6) <br /> <br />394,470.00 <br />74,414.00 <br /> <br />a~n?S4 00 <br />468,884.00 <br /> <br />468,884.00 <br /> <br />444,714.00 <br />24,170.00 <br /> <br />CttANGE ORDER SUMMARY ADDITIONS DEI)IICTIONS <br />Total changes approved in <br />previous months by Owner <br />qbtal approved this Month <br />TOTALS <br />NET CftANGES by Change Order <br /> <br />Thc undersigned Contractor certifies that to thc best of thc Contractor's knowledge, infi)r <br />marion and helief thc Work covered by this Application for Payment has bccn completed <br />in accordance with the Contract Documents, that all amounts have bccn paid by thc <br />Contractor for Work fl)r which previous Certificates fl)r Payment were issued and pay- <br />merits received from thc Owner, and that current payment shown herein is nmv duc. <br /> <br />Subscribed and sworn to heft)re i 1:'~%~ ~TAEY ~1[~-~INNtmlA <br />mc this ~5~ day ()f0~oua,~ /qq$ Ik~:i ~v COMMiSSiON EXPIRES <br /> ~ JANUARY 31, 2000 <br /> <br />My Commission expires: / ~ ~j ~ 2~0~ <br /> <br /> CERTIFICATE FOR PAYMENT <br /> In accordance with the Contract Documents, based on on-sim observations :lfld the data <br /> comprising this application, thc Construction Manager and Architect certify to thc Owner <br /> ti'tat to thc best of their knowledge, infornmtion and hclicf thc Work has progressed as <br /> indicated, thc quality of thc Work is in accordance with thc Contract Documents, and <br /> the Contractor is entitled to payment ()f the AMOIINT CEP, TIFIED. <br /> <br /> AMOUNT CERTIFIED ............................... <br /> (Attach t'.x'l~lanation (/' anlount cert~fl'ed d~/fers J)'cm! lbe amounl a/~/~lied./br Dlitial <br /> all/)'gttl~ on lbt's A/;/~licati(,t and on lbo ContDntaliou Sheet that changed to cou/brln <br /> trg,~t,nl cert(fied.) ' <br /> <br /> i~ICTRI ICTION MANAGER: <br />By: Dale: <br />ARC I I 1T E C'I': <br /> <br /> By: l)atc: <br /> This Certificate is not negotiable. Thc AMOUNT CERTIFIED is payahlc only to thc C()n- <br /> tractor named herein. ]SStlaBCe, payllle~lt and acceptaBce of paylllellt arc without <br /> prejudice to any rights of thc Owner or Contractor under this Contract. <br /> <br /> AIA DOCUMENT G702/CMa · APIq. ICATION AND CER'FIJdI(L. kTE FOR PAYMENT * CONSTRI?CrlON MANAGI{RAI)\'ISt,]R EI)ITI()N <br /> 1992 EDITION · AIA® * ©1992 · "['lie AMERICAN INSTITUTE OF ARCIIITECTN, 1v.55 NEW YORK AVENI!E, NW., WASIlINGT()N, <br /> I)C 2ooo6 '5292 · WARNING: Unlicensed photocopying violates U.S. COl~#ight laws and will subject the violator to legal prosecution. <br /> <br />CAIITIOH: You shroud use an nrioinal AIA document which has this caution nrinted in red An oriainal assurer that chann*,q u,ill rqnt hp r~hcr-Hrprt ~e mn,, c ..... ,,I., * <br /> <br />G702/CMa-1992 <br /> <br /> <br />