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•� V reDocument G70Zm —'1��2 City of Elk River Public Works Director Date
<br />Application and Certificate for Payment Code: 420-4-8540-4520
<br />TO OWNER: City of Elk River PROJECT: Elk River Multi Purpose Facility and
<br />APPLICATION N0: 006- 9520003306 Distribution to:
<br />Attu: Justin Femrite Lion John Weicht Park PERIOD TO: OUVNER: ❑
<br />13065 Orono Parkway 1000 School StreetNW
<br />Elk River, MN 55330
<br />FROM RJM Construction
<br />CONTRACTOR: 830 Boone Avenue North
<br />Golden Valley, MN 55427
<br />Elk River, MN 55330
<br />VIA 292 Design Group, Inc
<br />ARCHITECT: 3533 East Lake Street
<br />CONTRACTOR'S APPLICATION FOR PAYMENT
<br />Minneapolis, MN 55406
<br />Application is made for payment, as shown below, in connection with the Contract.
<br />Continuation Sheet, AIA Docmnent G703, is attached.
<br />1.ORIGINAL CONTRACT SUN
<br />2. NET CHANGE BY CHANGE ORDERS
<br />3. CONTRACT SUM TO DATE (Line 112)
<br />4. TOTAL COMPLETED & STORED TO DATE (Column G on G703)
<br />5. RETAINAGE
<br />4.50 % of Completed Work
<br />(Cohmm D +E on G703)
<br />0 % of stored Material
<br />(Column F on G703)
<br />$25,771_,257.00
<br />CONTRACT FOR: General Construction CONTRACTOR ❑
<br />CONTRACT DATE:
<br />PROJECT NOS: / RJM Construction, RELD: ❑
<br />LLC I OTHER: ❑
<br />The undersigned Contractor certifies that to the best of tho Contractoes 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 T- mived from the Owner, .and that current• payment'shown herein is now due.
<br />S398.559.40 CONTRACTOR-
<br />S26.170.816.40 By:
<br />S9.952.261.99 StateoF/�,r-,r��
<br />S447.815.78
<br />$0.00
<br />Total Retainage (Lines 5a + 5b or Total in Column I of G7M) ____ S447,815.78
<br />6. TOTAL EARNED LESS RETANAGE »_ ..._. ».»._,,..,..» W504.44621
<br />(Line 4 Less Line 5 Total)
<br />7. LESS PREVIOUS CERTIFICATES FOR PAYMENT-_-- S6.667.329:35
<br />(Lime 6 from prior certificate)
<br />8. CURRENT PAYMENT DUE .»......»»,»,.»,,.».,.•.,•»,,,,,,,,,,,,,,_.,,.»._ I S2.837.116.86
<br />9. BALANCE TO FINISH, INCLUDING RETAINAGE
<br />(Line 3 less Lute 6)
<br />this
<br />months
<br />TOTALS
<br />S16.666.370.19
<br />ADDITIONS DEDUCTIONS
<br />S410.520. S845.11
<br />S0. $11,115.95
<br />S41Q,520.44 S11.961.06
<br />County of D..M,r
<br />del/2/20
<br />Subscribed and sworn to before 4J%AAPJV%AAAAAAAAAAAAAAAAAAAAAAA"
<br />me this 14 day°f ^r, JUSTIN M. KING
<br />• Notary Publio-Mfmnesota
<br />Notary Public: "'r` 1 My Cammissian Envies lac 31.2022
<br />My Commission expires: 114411.L
<br />ARCHITECTS CERTIFICATE FOR PAYMENT
<br />Ia 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 />AMOUNTCERTIFIED_._..»»»».S2,837.116.86
<br />(Attach explanation if amow certified duos from the amount appUed Initial all figures on this
<br />Application and on the Continuation Sheet that are changed to conform with the amount certifreii)
<br />ARC CT:
<br />By: Date
<br />This Cettiticate is not negotiable. The AMOUNT CERTIFIED is Payable only to the Contractor
<br />named herein. lssoance, payment and acceptance ofpayment are without prejudice to any rights of
<br />the Owner,or Contractor under this Contract.
<br />AIA ao-mw t G7D:i--199L Copyright01953.1963,196S;1971.1978.1983-and 1992 by Thu American Irrs60de of Amh ects. An r19t is rnswvad. WARNING: Thb AW Doeummn Is proleeled by US.
<br />C00Hgfi1 Law and Mterrraliomt Treaths. UmunfaHxsQ raprodustloni or:d nlri iftn of Imi Aw, beer rmitsk or any Portion of 1f. may MSdt*ft-% m dull and erhith PWWOes. aAd v►in be prosecute¢
<br />101ha-ford rime 4401 i Possible uttderlhe Ian This doarmentwas Produced by_AIA saff are at 13:1125 ET on 0IM20M under Order No. 689672WS whkh ezp&es on 08JOMM0, w d is not for resale.
<br />User Notes:
<br />(389ADASn
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