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APPLICATION AND CERTIFICATE FOR PAYMENT <br />CONSTRUCTION MANAGER -ADVISER EDITION <br />AIA DOCUMENT G702/CMA <br />PAGE ONE OF PAGES <br />TO RIM Construction PROJECT: Elk River Ice Arena <br />OWNER: Attn: Demolition <br />830 Boone Ave N <br />APPLICATION NO_: 19066.01 <br />PERIOD TO: 8131/2019 <br />Distribution to: <br />OWNER <br />CONSTRUCTION MANAGER <br />Golden Valley, MN 55427 <br />FROM Rachel Contracting, Inc <br />CONTRACTOR: 4125 Napier Court NE <br />CONTRACT DATE: 7/10/2019 <br />ARCHITECT <br />CONTRACTOR <br />St Michael, MN 55376 <br />CONTRACTOR'S APPLICATION FOR PAYMENT <br />Application is made for payment, as shown below, in connection with the Contract. <br />Continuation Sheet, AIA Document G703, is attached. <br />1. ORIGINAL CONTRACT SUM ...................................... <br />2. Net change by Change Orders .................................. <br />The undersigned Contractor certifes that to the best of the Contractor's knowledge, <br />information and belief the Work covered by this Application for Paymenthas been <br />completed in accordance with the Contract Documents, that all amounts have been <br />paid by the Contractor for Work for which previous Cerificates for payment were issued <br />$ 178,890.00 and payments received from Owner, and that current payment shown herein is now due. <br />3. CONTRACT SUM TO DATE (bine 1+-2) ................ $ 178,890,00 <br />4, TOTAL COMPLETED & STORED TO DATE ................... $154,890.00 <br />(Column G on G703) <br />S. RETAINAGE: <br />a. 5 % of Completed Work <br />(Columns D a E on 6703) <br />b. % of Stored Material <br />(Columns F on G703) <br />Total Retainage (line 5a + 5b or <br />Total in Column I of G703)...... <br />S 7,744.50 <br />.••••.•.•• $ 7,744.50 <br />6. TOTAL EARNED LESS RETAINAGE ............................ $ 147,145.50 <br />(bine 4 less Line 5 'rotaq <br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ - <br />(Line 6 from prior Certificate) ................._....._. ,.. ;;.... ....... <br />8. CURRENT PAYMENT DUE ......................................... I $ 147,145.50 <br />9. BALANCE TO FINISH, INCLUDING RETAINAGE <br />(Line 3 less Line 6) .... .._...... <br />$ 31,744.50 <br />CHANGE ORDER SUMMARY <br />ADDITIONS DEDUCTIONS <br />TOTAL CHANGEs APPROVED IN <br />PREVIOUS MON'T'HS HY OWNER <br />'T'OTALAPPROVED THIS MONTH <br />TOTALS <br />$ 0 <br />NEI' CFIANGES BY CHANGE' ORDER <br />1 $ <br />CONTRA R. . acI el Contracting, Inc <br />BY:Zf <br />Date: 08/23/2019 <br />State of: MN <br />County of: Wright <br />Described and sworn to before <br />the this 23rd day of August, 2019 <br />JENNIFER LEIGH AMENRUO <br />Notary Public NOTARY PUBLIC <br />MINNESOTA <br />My Commission Expires: 1/31/20'l4 r my Comtnisslon EVims Jan, 31, 2024 <br />CERTIFICATE FOR PAYMENT <br />In accordance with the Contract Document, based on on-site observation and the data <br />comprising the application, the Architect certifies to the Owner that to the best of the <br />Architect's Knowledge, information and belief the Work has progresses as indicated, <br />the quality of the Work is in accordance with the Contract Documents, and the Contractor <br />is entitled to payment of the AMOUNT CERIFI ED. <br />AMOUNT CERTIFIED $ <br />CONSTRUCTION MANAGER: <br />By: Date: <br />Amirri C'ti <br />By: Date: _ <br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the <br />Contractor named herein. Issuance, payment and acceptance of payment are without <br />prejudice to any rights of the Owner or Contractor under this Contract. <br />