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APPLICATION AND CERTIFICATE FOR PAYMENT <br /> <br />Page 1 of 2 <br /> <br />r,-) <br /> <br />TO (OWNER): <br /> <br />City of Elk River - Pat Klaers <br /> <br />PROJECT: Elk River Public City Hall <br /> <br />APPLICATION #: <br /> <br /> 13 <br /> <br />8/1/O3 <br />8/31/O3 <br /> <br />CONSTRUCTION <br />MANAGER: <br /> <br />Kraus-Anderson Construction <br />ZOO Grand Avenue <br />Saint Paul, MN 55102 <br /> <br />ARCHITECT: <br /> Tushie Montgomery <br /> <br /> .~ECTION CONTRACTOR/SUPPLIER CURRENT PAYMENT DUE <br /> 1 George F. Cook ConstructiOn Co. 42,683.45 <br /> 2 Dryden Excavating, Inc. Z,375.00 <br /> 9 Regal Contractors Inc. 14,250.00 <br /> 10 George F. Cook Construction Co. 15,917.8Z <br /> 13 Roof Tech, Inc. 94,035.75 <br /> 18 Empirehouse, Inc. 3,059.95 <br />. 34 Albers Mechanical Services, Inc. 36,993.95 <br /> 36 Weidner's Plumbing b Heating 7,239.00 <br /> 37 Direct Digital Controls, Inc. 5,112.00 <br /> 38 Reliance Electric 15,818.00 <br /> .. Kraus-Anderson 36,135.00 I <br /> ¢ <br /> t <br /> II <br /> tl <br /> e <br /> A <br /> TOTAL: Z73,619.92 <br /> <br />PERIOD FROM: <br />PERIOD TO: <br /> <br />CONTRACTOR'S PROJECT #775 <br /> <br />CONTRACT DATE <br /> <br />=CT'S CERTIFICATE FOR PAYMENT <br />accordance with the Contract Documents, based on <br />on-site observations and the data comprising the <br />above situation, the Architect certifies to the Owner <br />that to the best of the Architect's knowledge, <br />information and belief the Work is in accordance with <br />the Contract Documenls, and the Contractors are <br />entitled to payment of the AMOUNT INDICATED. <br /> <br />Amount Certified <br /> <br /> _Date: <br /> <br />Tushie Montgomery And Associates <br /> <br /> <br />