4.3. SR 09-16-2019 - Laserfiche WebLink

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TWIN CITY ACOUSTICS, INC. Application and Certificate for Payment 7CFA 9449 Science Center Drive, Ste 100 p N New Hope, MN 55428 Phone: 763-535-6697 Fax: 763-535-5309 JEL�wD�LNEN. Contractor: RJM Construction Job : Elk River Ice Arena & Lion John Weicht Park Application: 1 830 Boone Avenue North Golden Valley MN 55427 Billing Cycle: 7/01/2019 to 7/31/2019 Application For Payment On Contract Original Contract ...................................... Net Change by Change Orders ................ Contract Sum to Date ............................... Total Complete to Date ............................ Total Retained .......................................... Total Earned Less Retained .................... Less Previous Billings .............................. 149,410.00 0.00 149, 410.00 2,250.00 112.50 2,137.50 0.00 Current Payment Due ............................. 1 2,137.50 Balance on Contract ................................. 147,272.50 Terms: Invoices are due and payable 30 days from the date of the invoice. Please make checks payable to: Twin City Acoustics, Inc. Invoice Date: 07/16/2019 The undersigned Contractor certifies to the best of the Contractor's knowledge, information and believe 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 -,Twin City Acoustics, Inc. `mow By; - _ p2t+r .?116/19 Dave Brin -Pa' ent State of: Minnesota~ County of: Anoka Subscribed and Sworn to before a this 16th "y of Ju JULIE LYNN HAOPERT Notary PublilPyment /; �/'�—j�_- Notary Public " Minnesota My commisss: 011311 022 My Commission Expires Certificate foJan 31 2022 i J 1. In accordance with the Contract Documents, based on on-site observations and the data comprising this application, the Construction Manager and Architect certify to the Owner that to the best of their knowledge, information and belief the Work has progr?ssed 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 for. Initial all figures on the Application and on the Continuation Sheet that changes to conform to the amount certified.) Construction Manager: Architect: BY, Date: This certificate is not negotiable, The AMOUNT CERTIFIED is payable only to the contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner of Contractor underthis Contract.