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,OrAIA Document G702'M -1992
<br />Cir:y of Elk River
<br />,Pul;e Works Director Date
<br />Lo'
<br />Application and Certificate for Payment
<br />$25.772'257.00
<br />Code: 607-4-9310-4409
<br />$0,00
<br />TO OWNER: City of Elk River PROJECT:
<br />Elk River Multi -Purpose Facility and
<br />APPLICATION NO: 002 - 9520003302
<br />DistribuUmn to:
<br />Attn: Justin Femrite
<br />Lion John Weicht Park
<br />PERIOD T0: August 31, 2019
<br />OWNER:
<br />13065 Orono Parkway
<br />1000 Schools Street NW
<br />$0.00
<br />(Column F on G703)
<br />Elk River, MN 55330
<br />Elk River, MN 55330
<br />CONTRACT FOR: General Construction
<br />ARCHITECT: ❑
<br />FROM RIM Construction VIA
<br />CONTRACT DATE:
<br />CONTRACTOR: ❑
<br />CONTRACTOR: 830 Boone Avenue North ARCHITECT:
<br />292 Design Group, Inc.
<br />PROJECT NOS: / 1
<br />Golden Vallcy, MN 55427
<br />3533 East Lake Street
<br />FIELD: ❑
<br />Minneapolis, MN 55406
<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 />$25.772'257.00
<br />2 NET CHANGE BY CHANGE ORDERS .„.»,.„.„..„»„.„„.....„„„,„ ................ ,,,„„.
<br />$0,00
<br />3. CONTRACT SUM TO DATE (Line 1 + 2) ..„ ........................................»„....„»,.. $25,772,257.00
<br />C TOTAL COMPLETED & STORED TO DATE (Column G on G703) ...»»....„..
<br />$1,398,353.07
<br />& RETAINAGE:
<br />$0.00
<br />a. 3.14 % of Completed Work
<br />$0.
<br />(Column D + E on G703)
<br />$43,972.42
<br />b. 0 % of Stored Material
<br />$0.00
<br />(Column F on G703)
<br />$0.00
<br />Total Retainage (Lines 5a + 5b or Total in Column i of G703) ...».....».„».
<br />$43,972.42
<br />6. TOTAL EARNED LESS RETAINAGE „,„,„„,,,.,,,„..„...„..„,,.,. ...... .... „.... $1,354,380.65
<br />(Linc 4 Less Line 5 Total)
<br />T. LESS PREVIOUS CERTIFICATES FOR PAYMENT .... ........... „................ .......„„
<br />$429,916.41
<br />(Line 6 from prior Certificate)
<br />8. CURRENT PAYMENT DUE........................................................................ $924,464.24
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Line 6)
<br />524,417,876.35
<br />CHANGE ORDER SUMMARY
<br />ADDITIONS
<br />DEDUCTIONS
<br />Total changes approved in previous months by Owner
<br />$0.
<br />50.00
<br />Total approved this Month
<br />$0.0
<br />$0.00
<br />TOTALS
<br />$0.
<br />NET CHANGES by Change Order
<br />$0.00
<br />OTHER: ❑
<br />The undersigned Contractor certifies that to the best of the Contractor's knowledge,
<br />information and belief the Work covered by this Application for Payment has been
<br />completed in accordance with the Contract Documents, that all amounts have been paid
<br />by the Contractor for Work for which previous Certificates for Payment were issued and
<br />payments received a Owner, and that current payment shown herein is now due.
<br />CONTRACTOR:
<br />By: Date: .19
<br />State of. Minneso
<br />County of 4Q?�In
<br />Subscribed aq4sworn to
<br />methis -day of fS_�-�. 9D I J ERIN M, CROCKER
<br />Notary Public: Notary PtibThsMInnescia
<br />ARCHITECT'S CERTIFICATE FOR PAYMENT
<br />In accordance with the Contract Documents, based on on-site observations and the data
<br />comprising this application, the Architect certifies to the Owner that to the best of the
<br />Architect's knowledge, information and belief the Work has progressed as indicated, the
<br />quality of the Work is in accordance with the Contract Documents, and the Contractor is
<br />entitled to payment of the AMOUNT CERTIFIED.
<br />AMOUNT CERTIFIED ...»..».„... »„».„»..„.......».»„„.„„»„„„„ „„„..„....„.. „ $924.464.24
<br />(Attach explanation if amount certified d Pers from the amount applied. Initial all figures on this
<br />Application and on the Continuation Sheet that are changed to conform with the amount certified.)
<br />ARCHITECT:
<br />By:. it, I Y M�
<br />Date:
<br />This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
<br />named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
<br />the Owner or Contractor under this Contract.
<br />AIA Document 6702*” —1992. Copyright ®1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document Is protected by U.S.
<br />Copyright Law and Intemational Treaties. Unauthorized reproduction or distribution of this AIAe Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted
<br />to the maximum extent possible under the law. This document was produced by AIA software at 09:16.47 ET on 08/30/2019 under Order No. 6898725545 which expires on 0810812020, and is not for resale.
<br />User Notes:
<br />(MADAM)
<br />
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